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Ever wonder if every medical test or treatment you've taken was truly necessary? Or are you inclined to get every bit of health care you can? Maybe you feel good about getting the most out of your health insurance. Perhaps a neighborhood imaging center is advertising discounted screening tests, your employer offers health screens as a perk, or you're intrigued by ads touting supplements for a seemingly endless number of conditions.

But keep in mind: just because you could get a particular test or treatment or take a supplement doesn't mean you should. One study suggests that as much as 20% of all health care in the US is unneeded. In short: when it comes to health care, more is not always better.

Isn't it better to be proactive about your health?

We're all taught that knowledge is power. So it might seem reasonable to want to know as much as possible about how your body is working. And isn't it better to take action before there's a problem rather than waiting for one to develop? What's the harm of erring on the side of more rather than less?

The truth is that knowledge is not always power: if the information is irrelevant to your specific situation, redundant, or inaccurate, the knowledge gained through unnecessary health care can be unhelpful or even harmful. Unnecessary tests, treatments, and supplements come with risks, even when they seem harmless. And, of course, unnecessary care is not free — even if you're not paying a cent out of pocket, it drives up costs across health systems.

Screening tests, wellness strategies, and treatments to reconsider

Recommended screening tests, treatments, and supplements can be essential to good health. But when risks of harm outweigh benefits — or if proof of any benefit is lacking — think twice. Save your time, money, and effort for health care that is focused on the most important health threats and backed by evidence.

Cancer screening: When to stop?

Screening tests for some cancers are routinely recommended and can be lifesaving. But there's a reason they come with a recommended stop age. For instance, guidelines recommend that a person at average risk of colorectal cancer with previously normal colonoscopies stop having them once they turn 75. Similar limits apply to Pap smears (age 65) and mammograms (age 75). Studies suggest that beyond those ages, there is little benefit to continuing these screens.

Watch out for wellness marketing

Dietary supplements are a multibillion-dollar industry. And a whopping 70% or more of US adults take at least one, such as vitamin D, fish oil, or a multivitamin. People often consider them as insurance in case vital elements are missing from their diet, or they believe supplements can prevent dementia, heart disease, or another condition.

Yet little evidence supports a benefit of routine supplement use for everyone. While recent studies suggest a daily multivitamin might slow cognitive decline in older adults, there's no medical consensus that everyone should be taking a multivitamin. Fish oil (omega-3) supplements haven't proven to be as healthful as simply eating servings of fatty fish and other seafood low in toxic chemicals like mercury and PCBs. And the benefits of routinely taking vitamin D supplements remain unproven as well.

It's worth emphasizing that dietary supplements clearly provide significant benefit for some people, and may be recommended by your doctor accordingly. For example, if you have a vitamin or mineral deficiency or a condition like age-related macular degeneration, good evidence supports taking specific supplements.

Reconsider daily aspirin

Who should be taking low-dose aspirin regularly? Recommendations have changed in recent years, so this is worth revisiting with your health care team.

• Older recommendations favored daily low-dose aspirin to help prevent cardiovascular disease, including first instances of heart attack and stroke.
• New recommendations favor low-dose aspirin for people who've already experienced a heart attack, stroke, or other cardiovascular disease. Adults ages 40 to 59 who are at a high risk for these conditions and low risk for bleeding also may consider it.

Yet according to a recent study, nearly one-third of adults 60 and older without past cardiovascular disease take aspirin, despite evidence that it provides little benefit for those at average or low risk. Aspirin can cause stomach bleeding and raise risk for a certain type of stroke.

Weigh in on prostate cancer screening

Men hear about prostate cancer often. It's common, and the second leading cause of cancer deaths among men. But PSA blood tests and rectal exams to identify evidence of cancer in the prostate are no longer routinely recommended for men ages 55 to 69 by the United States Preventative Services Task Force.

The reason? Studies suggest that performing these tests does not reliably reduce suffering or prolong life. Nor do possible benefits offset downsides like false positives (test results that are abnormal despite the absence of cancer). That can lead to additional testing, some of which is invasive.

Current guidelines suggest making a shared decision with your doctor about whether to have PSA testing after reviewing the pros and cons. For men over age 70, no screening is recommended. Despite this, millions of men have PSA tests and rectal examinations routinely.

Not everyone needs heart tests

There are now more ways than ever to evaluate the health of your heart. But none are routinely recommended if you're at low risk and have no signs or symptoms of cardiovascular disease. That's right: in the absence of symptoms or a high risk of cardiovascular disease, it's generally safe to skip EKGs, stress tests, and other cardiac tests.

Yet many people have these tests as part of their routine care. Why is this a problem? Having these tests without a compelling reason comes with risks, especially false positive results that can lead to invasive testing and unneeded treatment.

Four more reasons to avoid unnecessary care

Besides the concerns mentioned already, there are other reasons to avoid unnecessary care, including:

• The discomfort or complications of testing. If you're needle-phobic, getting a blood test is a big deal. And while complications of noninvasive testing are rare (such as a skin infection from a blood test), they can occur.
• The anxiety associated with waiting to find out test results
• False reassurance that comes with false negatives (results that are normal or nearly so, suggesting no disease when disease is actually present)
• All treatments have side effects. Even minor reactions — like occasional nausea or constipation — seem unacceptable if there's no reason to expect benefit from treatment.

The bottom line

You may believe your doctor wants you to continue with your current schedule of tests and treatments, while they might think this is your preference! It's worth discussing if you haven't already, especially if you suspect you may be taking pills or getting tests you don't truly need.

If your doctor says you can safely skip certain tests, treatments, and supplements, it doesn't mean that he or she is neglecting your health or that you don't deserve great health care! It's likely that the balance of risks and benefits simply doesn't support doing these things.

Less unnecessary care could free up resources for those who need it most. And it could save you time, money, and unnecessary risks or side effects, thus improving your health. It's a good example of how less can truly be more.

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

Ever ridden an e-scooter or e-bike? The convenience, affordability, and flat-out fun of these “micromobility” modes of transportation are undeniable. But did it also seem a bit dangerous?

In fact, the rate of accidents involving e-bikes and e-scooters is climbing. Maybe that shouldn’t be surprising given their dramatic jump in popularity. And then there’s the way riders often use them: at high speed, near cars and pedestrians, and on roads and sidewalks that weren’t designed for them.

Disruptive innovations, such as e-bikes and e-scooters, inevitably come with downsides. So, how can we minimize risks for accidents?

E-bikes, e-scooters, and injuries

Between 2018 and 2022, sales of e-bikes rose from around 250,000 per year to more than a million. E-bike and e-scooter rentals have also increased dramatically. As their popularity grows, emergency rooms are seeing many more people injured while riding e-bikes and e-scooters.

A 2024 study in JAMA Network Open highlights this. Researchers drew data from the National Electronic Injury Surveillance System, which is run by the US Consumer Product Safety Commission. They analyzed ER care between 2017 and 2022 for people injured while riding an e-bike or e-scooter, compared with people injured while riding conventional bikes and scooters.

What did the study find?

During the six-year study period, roughly three million people riding e-bikes, e-scooters, or their conventional counterparts sought care in the ER, including about 45,500 e-bike riders and 190,000 e-scooter riders, and about 2.5 million conventional bike riders and 305,000 conventional scooter riders.

Certain themes emerged around e-micromobility:

ER care spiked upward

• E-bike injuries more than doubled every year, going from 751 in 2017 to 23,493 in 2022.
• E-scooter injuries increased by more than 45% every year, going from 8,566 in 2017 to 56,847 in 2022.

More risky behavior

• 43% of e-bike and e-scooter riders wore helmets versus 52% for conventional micromobility riders
• 7% of e-bike riders and 9% of e-scooter riders were drinking before their accidents versus 4% of conventional bike riders and 3% of conventional scooter riders.

More accidents occurred in urban areas compared with rural settings:

• 83% of e-bike and e-scooter accidents
• 71% of conventional bike and scooter accidents.

All riders experienced similar types of injuries: scrapes, bruises, broken bones, and head and neck injuries were most common.

What are the limitations of this study?

This study only included people evaluated in an ER, so it excluded people with less severe injuries — and even those with significant injuries who didn’t go to an ER. Some may have sought no care at all, or gone to a primary care practice or walk-in clinic to avoid costly ER care or for other reasons.

Nor did the study count injuries suffered by pedestrians injured by e-bike or e-scooter riders. Property damage, such as damage to a car, wasn’t calculated.

And ultimately the study cannot compare the safety of e-bikes and e-scooters with conventional options. That’s because no data were collected on the number of miles traveled using a particular mode of transportation, or over how much time.

How can you avoid e-bike or e-scooter injuries?

Ten common-sense precautions can help you avoid injuries and ER visits:

• Wear a helmet. If you’re renting an e-bike or e-scooter, you may need to bring your own since many rental systems do not provide helmets.
• Practice. E-bikes are much heavier than conventional bicycles and may handle differently. And many adults have not ridden a scooter since elementary school! So if you aren’t familiar with riding an e-bike or e-scooter, practice in a safe location where there’s no traffic or pedestrians.
• Follow road rules. Ride on available bike lanes and avoid sidewalks. On an e-bike, use arm signals to alert those nearby of your intentions to turn or change lanes. (On an e-scooter, it’s best to keep both hands on the handle bars at all times.).
• Slow down. Some e-bikes approach speeds of 30 miles per hour. The faster you go, the less time you have to react to unexpected potholes or veering vehicles, and the more serious an injury is likely to be if you have an accident.
• Lower risks. Don’t ride while under the influence of alcohol or drugs, or use your phone while moving.
• Go it alone. Don’t add riders. Most e-bikes and e-scooters are built for one rider at a time.
• Ride defensively. Watch out for potholes or opening car doors.
• Reflect. Wear reflective clothing or attach a light if riding at night.
• Call out. Announce your presence to others. For example, shout “on your left!” as you approach pedestrians or slower riders that you intend to pass.
• Lobby. Reach out to local politicians to create bike lanes and other infrastructure to make micromobility safer.

The bottom line

Whether it’s part of your daily commute, an occasional quick zip from point A to point B, or just a ride for the fun of it, e-bikes and e-scooters are a great way to get around. Though they do come with some risk, you can do a lot to minimize the odds of wrapping up your travels with a trip to an ER.

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

Ever heard of mpox? Wondering why it’s back in the news?

Many of us first learned about mpox (formerly called monkeypox) in 2022, when the largest known outbreak spread to nearly 100,000 people in more than 100 countries. While mpox often circulates in central and western Africa, the 2022 outbreak quickly spread from the Democratic Republic of the Congo (DRC) to places it had never been detected before. In the US alone, it caused more than 32,000 infections and 58 deaths.

Now, a new outbreak of mpox has put it back in the news. What should you know — and do — about this latest international health emergency? What are your risks? Are vaccines available? If you get mpox, how can you avoid spreading it?

What’s different about the 2024 mpox outbreak?

This time, a new strain of the virus (called Clade 1b) is spreading quickly. That’s why the World Health Organization (WHO) declared a second mpox global health emergency in August 2024.

Already, more than 15,600 cases and 500 deaths have been reported, mostly in the DRC. And mpox has been found in countries that previously hadn’t identified any cases, including Burundi, Kenya, Rwanda, and Uganda. Recent cases diagnosed in Sweden and Thailand have public health officials bracing for additional international spread, including to Asia, Europe, and the US.

6 things to know about mpox

What is mpox and how does it spread?

Mpox is a viral infection caused by the same family of viruses as smallpox. In central and western Africa it’s common in certain animals, including squirrels and rats. People can become infected after contact with infected animals. Mpox can spread from person to person through close physical contact, including sex.

What are the symptoms of mpox?

Mpox causes flulike symptoms, fever, headache, enlarged lymph nodes, and a unique rash. The rash usually begins a few days into the illness as small flat spots. The spots evolve over a week or two to become small fluid-filled bumps (vesicles) similar to chickenpox, and then larger pus-filled blisters. Over another week or two, the blisters scab over and heal. Once that happens, a person is no longer contagious.

Although the disease is usually mild, some people develop complications. Serious complications include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

What is your risk of getting mpox?

Location and activities factor into your risk for developing mpox.

Risk increases if you

• have close physical contact with an infected animal or person
• have contact with bedding, clothes, or other objects or surfaces touched by an infected person
• live in or visit a place where the mpox virus is endemic — that means present in the environment, such as in the soil or infected animals or people
• are a man who has sex with men
• have many sexual partners.

When people get mpox, risk factors for experiencing more severe disease or complications like pneumonia include:

• pregnancy
• young age (especially children younger than age 1)
• having a weakened immune system
• having eczema (because this weakens the protective skin barrier).

Why is the new mpox outbreak so worrisome?

The new outbreak of mpox is especially worrisome because the strain of the virus is deadlier than in 2022. The virus is spreading more quickly and reaching places where mpox had not previously been found.

In addition, the new outbreak has disproportionately affected kids and teens in resource-poor countries. Many are already suffering with malnutrition, or other infections such as cholera.

It’s worth noting that the strain of mpox from the 2022 outbreak (Clade 1) is still circulating at a low level in the US. Right now, fewer than 15 people a week are diagnosed with it and treatment is available.

Are there mpox vaccines and treatments?

There are two vaccines available to prevent mpox in the US:

• Jynneos is approved to prevent mpox and smallpox. It requires two doses four weeks apart.
• A vaccine called ACAM2000 is approved for preventing smallpox and is considered effective for mpox. It could be made available if needed, but its potential side effects make it a second choice.

Resource-poor countries in Africa, Asia, and elsewhere have had limited access to vaccines. Even in resource-rich countries like Europe and the US, vaccine hesitancy has been an obstacle to containing the outbreak. In one study, only half of a vulnerable population in Illinois received the initial dose of the mpox vaccine, and only a quarter received both recommended doses.

An antiviral drug called tecovirimat is approved to treat smallpox. Animal studies suggest it may be effective in treating mpox as well. Now being investigated as an mpox treatment, the drug may be available by enrolling in a study. A 2024 study found tecovirimat did not reduce the length of time adults and children with Clade 1 mpox had symptoms. However, the death rate (1.7%) was half of what was expected. But it’s unclear whether the low death rate was actually due to drug treatment.

How can someone with mpox avoid spreading it?

If you are diagnosed with mpox, it’s important to take these measures to avoid infecting others:

• Avoid close contact with others until your skin lesions have healed.
• Wear a well-fitting medical mask while near others; those visiting you should wear a mask as well.
• Stay several feet or more away from others.
• Use a separate bedroom and bathroom.
• Clean all surfaces you’ve touched.
• Don’t share eating utensils, towels, or bedding with others.
• Increase room ventilation by opening windows or using a high-efficiency particulate air (HEPA) purifier.

Some experts recommend avoiding contact with pets or other animals because they could become infected and spread the disease to new animal species in new places.

The bottom line

Will mpox be the next pandemic? That’s unlikely. The virus that causes mpox spreads mainly by direct contact — unlike the virus that causes COVID-19, which spreads through small respiratory droplets that are easily breathed in. Also, people with mpox who are contagious typically have obvious symptoms, so they can take steps to avoid spread.

Currently, the risk mpox poses to most people in the US appears to be quite low. To help make sure it stays that way and to help countries where mpox is common, US public health officials are working with their counterparts in other countries to contain the outbreak. To be successful, we’ll need a robust. well-coordinated international effort, including financial support to resource-poor countries to fund educational programs, vaccination, testing, and treatment.

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

Parents often wonder: What can we do to keep our children healthy? Are there ways to boost the immune system and ward off illnesses?

The answer is yes — but there are no magic wands or magic supplements. The best way to keep the immune system healthy is, basically, to take necessary steps to keep healthy. As boring as that sounds, it’s tried and true.

Here’s what you can do to help keep your children healthy this school year.

Give them a healthy diet

By healthy I mean a diet with lots of fruits and vegetables (five servings a day are recommended, and they should take up half of every meal plate), whole grains, and lean protein. A healthy diet also has dairy or another source of calcium, and healthy fats like vegetable oils.

The foods to avoid are processed foods, foods with added sugar, and foods with unhealthy fats, like the saturated fats found in animal products. That doesn’t mean your child can’t ever eat cookies or ice cream. But if you want to your child to be healthy, they shouldn’t eat those foods every day. (The Academy of Nutrition and Dietetics has suggestions for healthier baked goods and other ways to make your family’s diet healthier).

There are many supplements that claim to boost your immune system. While the jury is still out as to whether most of them make a real difference, none of them take the place of a healthy diet. If you have a child who refuses vegetables or otherwise has a limited diet, a multivitamin with iron may make sense; talk to your doctor about whether vitamins or supplements are a good idea for your child.

Make sure they get enough sleep

We all need sleep to refresh and recharge our bodies, and that includes children. The amount of sleep a child needs varies by age (from 12 to 16 hours a day for infants to eight to 10 hours for teens), and also from child to child (some just need more than others). You can encourage healthy sleep by limiting screens — for teens, devices really should be shut off an hour or two before bedtime, and preferably not be in the bedroom at night — and keeping to a regular schedule.

Get them active

Exercise keeps us healthy and less likely to get sick. Children should really be active for an hour a day. “Active” doesn’t have to mean playing a sport or going to the gym; it could be playing at the playground or going for a walk. More is not necessarily better; if you have a child who is a serious athlete, exercising several hours a day, make sure that the exercise isn’t eating into sleep or causing burnout, both of which could cause problems with the immune system.

Manage stress

Stress makes us less healthy and more prone to infection. Make sure that kids have downtime to play, and access to activities and people that make them happy. Spend time together as a family, and create opportunities for your children to talk about anything that might be worrying them. If you have concerns about your child’s moods or emotional health, talk to your doctor.

Make sure they are up to date on important vaccines

Immunizations protect us from all sorts of illnesses. Check with your doctor to see if your child is up to date on immunizations. The flu shot is recommended yearly for all people 6 months of age or older.

Don’t forget the simple precautions

Everyone in the family can take simple precautions to help stay healthy. Wash your hands. Cover your coughs and sneezes with your elbow. Stay away from sick people to the extent that you can. Masks can help, too, especially in crowded indoor spaces.

If your child has a health problem that could make it harder to fight off an infection, talk to your doctor about any extra or different precautions you should take.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD