Month: April 2023

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

• Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
• Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
• Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
• Wash clothing and bathe or shower after being outdoors to remove pollen.
• Close windows during peak allergy season or on windy days.
• Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
• If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
• Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

About the Author

Peter Grinspoon, MD, Contributor

Dr. Peter Grinspoon is a primary care physician, educator, and cannabis specialist at Massachusetts General Hospital; an instructor at Harvard Medical School; and a certified health and wellness coach. He is the author of the forthcoming book Seeing … See Full Bio View all posts by Peter Grinspoon, MD

Scientific advances have brought us scores of new drugs in recent years. In the US, one major agency — the FDA — is responsible for making sure that the drugs they approve are safe and effective. Yet there were more than 14,000 drug recalls in the last 10 years, according to FDA statistics. That averages out to nearly four drug recalls a day!

Why are drug recalls so common, and how can you maximize safety when taking the medicines you need?

Why do so many drug recalls occur?

The FDA approves prescription drugs if research shows a medicine is safe and effective. Usually the risks are well known by the time approval is granted. For over-the-counter drugs, the bar is lower: proof that they work is not required, but the FDA still maintains oversight for safety.

Drug recalls are common because:

• Rare side effects may be missed in clinical trials. Studies leading to drug approval might have hundreds or thousands of study subjects. But a rare problem may not be detected until tens of thousands of people have taken a drug.
• Study subjects tend to be healthier than the general population. When you’re trying to figure out if a drug works, the chances of success are higher and reliability of results is greater if study subjects are healthy. Once a drug is approved, people taking it may be older, less healthy, or taking multiple drugs for health issues.
• Problems during or after manufacturing can make a safe drug harmful. Examples include bacterial contamination, incorrect labeling, and improper storage.
• Bad behavior by drug makers may affect drug safety. For example, multiple over-the-counter supplements marketed for male sexual performance were recalled in recent years because they were laced with prescription drugs for erectile dysfunction.

Are most drug recalls high-risk?

Fewer than one in 10 poses a serious health risk. The FDA grades risk severity for recalls as follows:

• Class I is dangerous and poses a serious health risk (a hand sanitizer contaminated with methanol)
• Class II might cause a temporary or slight risk of serious harm (a diabetes medicine stored at the wrong temperature)
• Class III is unlikely to cause any harm to health, but there is a violation of FDA requirements (an ointment for dermatitis in damaged tubes).

Between 80% and 90% of drug recalls are Class II.

In 2022, 6% of recalls were Class 1, 86% were Class II, and 7% were Class III.

How do drug recalls happen?

The FDA inspects drug manufacturing facilities every two to three years. The agency also tests thousands of drugs each year.

Problems spotted during inspections, concerns identified by drug makers, or problems reported by patients or health care professionals can prompt a recall. The FDA then assigns a risk classification, supervises actions taken by the drug maker to remedy the problem, and monitors the product to make sure the problem is eliminated.

Drug recalls in the US are almost always voluntary. That means the drug maker acknowledges the problem and takes corrective action rather than waiting for a possible mandate from the FDA.

How can you stay informed about medicines you use?

Here are some practical measures to take:

• Sign up to receive texts or emails about recalls, market withdrawals, and safety alerts from the FDA.
• When filling prescriptions, take a good look at your medicine. Pills should not be discolored or crumbling, or have an unusual odor. If your prescription hasn’t changed, a refill should look similar to what you’ve taken in the past. If you suspect a problem, contact your pharmacist or the health care professional who prescribed it. And if you do confirm a problem, you can report it to the FDA.
• If you learn of a recall for a drug you take, check the lot number on the package to see if your medication is affected. If the risk is classified as high (Class I), contact your doctor right away for advice. For many recalled drugs, there are safe and effective alternatives.
• A recall notice will tell you if the medicine can be replaced or if you can be reimbursed. If you are instructed to dispose of medication, do so safely.

Another way to limit your potential exposure to recalled drugs is to take fewer drugs. Review your medication list with your doctor regularly and take only what you truly need.

The bottom line

News on drug recalls may not inspire confidence. It might make you wonder if the drugs you take are safe. In general, yes: the vast majority of medicines on the market have an excellent safety profile. But with more than 1,000 drug recalls every year, there’s plenty of room for improvement by drug makers and good reason to encourage better regulation of the industry.

Follow me on Twitter @RobShmerling

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Climate change is an escalating threat to the health of people everywhere. As emergency medicine physicians practicing in Australia and the United States, we — and our colleagues around the world — already see the impacts of climate change on those we treat.

Will we be seeing you one day soon? Hopefully not. Yet an ever-growing number of us will face climate-related emergencies, such as flooding, fires, and extreme weather. And all of us can actively prepare to protect health when the need arises. Here’s what to know and do.

How is climate change affecting health?

As the planet warms, people are seeking emergency medical care for a range of climate-related health problems, such as heat exhaustion and heat stroke, asthma due to air pollution, and infectious diseases related to flooding and shifting biomes that prompt ticks, mosquitoes, and other pests to relocate. News headlines frequently spotlight physical and emotional trauma stemming from hurricanes, wildfires, tornadoes, and floods.

We care for people displaced from their homes and their communities by extreme weather events. Many suddenly lack access to their usual medical team members and pharmacies, sometimes for significant periods of time. The toll of extreme weather often lands hardest on people who are homeless, those with complex medical conditions, children, the elderly, people with disabilities, minoritized groups, and those who live in poorer communities.

On a recent 110º Fahrenheit day, for example, a woman came to an emergency department in Adelaide, Australia complaining of a headache, fatigue, and nausea, all symptoms of heat exhaustion. She told medical staff that she had just walked for two hours in the sun to obtain groceries, as she had no car or access to public transportation. While health advisories in the media that day had advised her to stay inside in air conditioning, walking outside was only the only option she had to feed her family. For this woman and many others, well-intended public health warnings do little to reduce the risk of illness during extreme weather. Achieving safe, equitable health outcomes will require addressing access to shelter, access to transportation, and other societal factors that put people at risk of bad health outcomes.

Extreme weather contributes to large-scale health and safety issues

Increasingly, climate-related extreme weather is leading to interrupted access to medical care, contributing to later illness and death. Extreme weather can damage key infrastructure like the electrical grid, so that those relying on home medical equipment cannot use it. It may shut down health care facilities like a dialysis center or emergency room, or slow care in facilities that stay open.

People fleeing a fire or hurricane can be displaced into settings where they may have difficulty getting medical care or obtaining much-needed medicine, such as insulin, dialysis, high blood pressure treatments, and heart medicines. Such factors can worsen chronic conditions and may even cause death, particularly in people with existing medical conditions like heart failure, lung disease, and kidney disease.

How can you be ready to protect your health?

We all have a part to play in keeping ourselves and our communities well in the face of increasing dangers from climate change. Taking these steps will help.

If you or a loved one has health issues:

• Keep a printed summary handy listing all medical conditions, medications and dosages, and phone numbers for your health providers.
• If you have to leave your home, try to bring all medications with you — even bringing empty pill bottles will help a doctor trying to restart your medications.
• Store medicines in a waterproof bag in a place where you can easily find them. This will help if you need to evacuate quickly.

Think about what to do if you need to leave home quickly. Now is the time to figure out your basic emergency plan:

• Where will you go if you need to evacuate?
• How will you get there?
• How could you communicate with others if there is no electricity or phone service?
• Do you have written contact info for a few family members and friends, in case you lose your phone or the battery dies?

Finally, we all need to look out for others in our community. Check in on elderly neighbors and those around you who may be socially disconnected, and make sure that they are safe where they live and are able to access the medical care they may need when the weather turns hot, cold, smoky, fiery, snowy, wet, or windy.

Climate change is here. It is already having tangible and significant impacts on our communities and the health of people around the world. Moreover, the increased risk of climate-related extreme weather is here to stay for the foreseeable future, and we must prepare for the threats it poses to our health, both now and in decades to come. We all have a part to play — health professionals, communities, and individuals — in keeping ourselves and each other healthy and safe.

About the Authors

Kimberly Humphrey, MD, MPH, Contributor

Dr. Kimberly Humphrey is an emergency physician, a current Fellow in Climate Change and Human Health at Harvard C-CHANGE at Harvard's T.H. Chan School of Public Health, and a visiting scholar at the Harvard FXB Center. Her research focuses on the … See Full Bio View all posts by Kimberly Humphrey, MD, MPH

Caleb Dresser, MD, MPH, Contributor

Dr. Caleb Dresser is an emergency physician and assistant director of the Climate and Human Health Fellowship, cohosted by Beth Israel Deaconess Medical Center, the Harvard FXB Center, and Harvard C-CHANGE. His research focuses on understanding the health implications of climate-related … See Full Bio View all posts by Caleb Dresser, MD, MPH