TIME health

This Is Where Ebola First Struck in 1976 and What Happened

Ebola Virus
An electron micrograph photo of the Ebola Virus. May 11, 1995. AP Photo

Investigators identified a cotton factory as the source of the infection

History News Network

This post is in partnership with the History News Network, the website that puts the news into historical perspective. The article below was originally published at HNN.

It began in Nzara, a town inhabited by 20,000 people living in thatch-roofed houses within the dense woods in southern Sudan. Roughly five percent of the population worked in a large cotton factory that was owned by an even larger agricultural company. The factory kept detailed records of its employees’ work hours, perhaps to keep close tabs on absenteeism. Fortunately, it also helped investigators track the pattern of a deadly virus transmission.

On June 27, 1976, one employee would not make it to his work as a storekeeper in the factory. The person, later designated by the initials YG, became very ill, experiencing severe fever, headaches, and chest pains. His brother initially nursed him at home, located 10 kilometers from the factory in a remote and rural area south of Nzara. Three days later, with his condition worsening, he was brought to the Nzara hospital – a small and ill-equipped facility that typically did not admit a lot of patients. By the fifth day he was bleeding from the mouth and nose. He began to suffer from bloody diarrhea. Nine days after his illness began, YG died. His brother became ill a week later but survived.

One of YG’s co-workers, BZ, who was also a storekeeper, was admitted to the same hospital on July 12, six days after YG died. This second storekeeper died on July 14. On July 19, the second storekeeper’s wife also died from the same illness. A third factory employee, PG, worked in the cloth room next to the store.

In contrast to YG and BZ, who usually stayed close to home and had few friends, PG was an outgoing bachelor who lived at the center of town and was quite well known in the area. PG and his two brothers, Samir and Sallah, lived with a merchant, MA. The brothers were active in their community and organized social events such as dances. When PG fell ill in late July, many of his friends naturally came to visit. Two women in particular, HW and CB, were kind enough to nurse him during the first days of his illness. His condition apparently deteriorated rapidly as he succumbed to infection three days later. Samir became ill a day before PG died, and together with Sallah, they travelled 128 kilometers east to Maridi where Samir was admitted to the Maridi hospital. Sallah assisted in caring for his brother who died on August 17. A day later, Samir himself became sick and died not too long after. By this time, the two women who cared for PG, as well as another factory worker and a nurse in Nzara hospital had died from the same disease. Investigators later determined that 48 cases and 27 deaths could be traced to exposure to PG – the ebullient, outgoing bachelor of Nzara.

During this first Ebola outbreak in southern Sudan that started in June 1976, 248 cases were identified. Fifty-three percent of the victims died. Investigators identified the cotton factory in Nzara as the source of the infection. Most of the victims, however, were actually infected in Maridi, which ironically had a more active and larger hospital where transmission of the virus was amplified. By the end of the year, the epidemic also hit the Democratic Republic of Congo (DRC), infecting more than 300 people and killing almost 90% of the victims.

In late October of 2014, the World Health Organization reported nearly 10,000 Ebola Virus Disease cases from the 2014 outbreak. Nearly all the cases were in Liberia, Sierra Leone, and Guinea. The fatality rate was nearly 50%. Thirty-five years after the initial Ebola outbreak, it is chilling to see the similar pattern of risk of transmission, particularly to the individuals who care for the Ebola victims, being mirrored even within 21st century hospitals.

Rod Tanchanco is a physician specializing in Internal Medicine. He writes about events and people in the history of Medicine. His personal blog is at talesinmedicine.com.
TIME Research

Google Is Working on a Pill That Can Catch Diseases Earlier

A pill that can detect the signs of diseases, including cancer

Google has plans to design an ingestible pill that detects the presence of malignant cells and other signs of disease, the company said Tuesday.

The pill would contain tiny magnetic particles that would travel through a patient’s bloodstream and register the presence of chemicals or cells associated with diseases like cancer on a little device, the Associated Press reports. The goal would be to allow patients to monitor their health in real-time to catch a potential illness before it’s even diagnosable.

The project, announced at a tech conference organized by the Wall Street Journal, is the latest life sciences innovation from the Google X facility. The secret research center, home of Google Glass, previously revealed a partnership with pharmaceutical company Novartis to create smart contact lenses that monitor diabetics’ blood sugar levels.

[AP]

TIME medicine

The Right—and Right Time—to Die: How Doctors Should Help

Jauhar is a cardiologist and the author of Doctored: The Disillusionment of an American Physician.

I've tried to fight a patient's inevitable death, but I know that's not always the best care—and America needs to talk about what is

As doctors, we are expected to prolong human life, and we do—but often regardless of the costs. Brittany Maynard, the 28-year-old Oregon woman with an inoperable brain tumor, puts a human face on this tragedy. Maynard has decided that she does not want to suffer through a painful, protracted death and is planning to end her life with doctor-prescribed pills, obtained through Oregon’s Death With Dignity Act; she may have died by the time you read this. In Oregon, more than 1,100 people have obtained life-ending prescriptions since the law’s passage in 1997, and about 750 have used them safely and appropriately. By numerous accounts, the law has been a success. And yet many doctors, not to mention laymen, continue to regard its goals with suspicion. I have been one of those doctors.

I once cared for an 88-year-old patient with a severely leaky heart valve. When she was hospitalized with worsening kidney and heart failure, a critical-care specialist decided to forgo aggressive treatment. But unwilling to give up, and against my better judgment, I transferred her to the cardiac intensive-care unit. Her stay there was a disaster. She was unable to be weaned from a respirator. Her liver failed. Even as it became clear to me that she was going to die and that my interventions had been for no good purpose, I became very reluctant to change course. We checked blood tests several times per day. I inserted a pressure catheter in her pulmonary artery to monitor her hemodynamics. I started her on dialysis. The breathing tube remained in her throat till the end. Eventually she succumbed to multi-system organ failure and sepsis, nearly a week after I’d moved her to the ICU.

At their core, my actions were a kind of deception—convincing myself, despite the evidence, that I could save my patient and stay the inexorable course of her disease. Perhaps I was embarrassed by my impotence or afraid to see a beloved patient pass. I don’t know. But it was the kind of deception that many in my profession practice.

Of course, it isn’t only doctors who medicalize the terminal phase of life. Patients and their families do too. I once took care of a middle-aged man in the ICU who’d had a cardiac arrest and ended up with significant brain damage because he had been out so long. His wife would not accept the terminal nature of his condition. “He is going to pull out of this,” she told me adamantly. When I asked if her husband had ever expressed any preferences about being on life support, she told me what I expected: they had never discussed it.

That conversation is often the crux of the problem. Most people never have it, thus families and doctors are left to substitute their own judgments and prejudices for those of the patient. What does a dying patient want? What is the minimum quality of life that is acceptable to him or her? As Maynard has so poignantly shown us, these are questions we need to ask before it is too late. And it’s not just families who need to have the tough talk. As a nation, we need to rethink our approach to dying and death. Our reluctance to confront mortality is the cause of too much suffering.

Most Americans die in a hospital or a nursing home. Almost one-third of the $554 billion we spent on Medicare in 2011 was used to treat people in the last six months of their lives. Nearly every colleague I’ve talked to recognizes that this wastes precious resources and prolongs suffering. But they—I—have not been taught a different way.

Hospice is one alternative. The modern hospice movement started in 1967, when Dame Cicely Saunders, a nurse, opened St. Christopher’s Hospice in London. Saunders formulated three principles for easing the process of dying: relief of physical pain, preservation of dignity, and respect for the psychological and spiritual aspects of death. Though it’s been slow, progress has been made. The number of American hospitals offering palliative care has nearly doubled since 2000, growing to nearly 1,500 programs—the majority of hospitals. Yet even as reflective an observer as Atul Gawande admits in his new book, speaking no doubt for the majority of physicians, “The picture I had of hospice was a morphine drip.”

Doctors witness death and dying nearly every day. Disease may win in the end, but we must strive to never lose sight of the patient at the center of it all, and we must empower our patients to make their own decisions in the terminal phase of their lives. Maynard’s terrible tale reminds me of what an elderly woman with terminal heart disease once told me: “My husband said the hardest thing to do is to die; I always thought it would be easy.”

 

Jauhar is a cardiologist and the author of two books, Intern: A Doctor’s Initiation and the recently published Doctored: The Disillusionment of an American Physician

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Healthcare

Need Your Flu Shot? Just Call an Uber

Uber Taxi App In Madrid
Pablo Blazquez Dominguez—Getty Images

The one-day program is available in three U.S. cities

Uber on Thursday launched a one-day pilot program to deliver free flu shots and flu prevention packs in three major U.S. cities.

The UberHEALTH service will be available only Thursday in Boston, New York and Washington, D.C., between 10 a.m. and 3 p.m. ET, according to Uber’s blog. The service can be requested while ordering a ride on the Uber app, after which a registered nurse will administer flu shots and distribute materials for up to 10 people at no additional cost.

The free flu shot service, which is a partner project with Vaccine Finder, is only the latest of Uber’s limited time specials. Uber has previously rolled out delivery services for air conditioners and diapers, and even its own Optimus Prime.

 

TIME Research

6 Medical Breakthroughs That Matter

Medical research
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Including an alternative cancer treatment

It’s not every day that you catch wind of a true health game changer. That’s because research is more often than not a long, slow process of trial and error, and for every bright idea there are a bunch that don’t pan out. Luckily, this year brought plenty of major steps forward, including a new cure for a deadly disease and innovative gadgets that zap your migraines. Here are the developments making a difference right now.

New tech for migraine pain

Technology is opening up a new route to much-needed headache helpers. “Current drugs just don’t do the trick for many people,” says John Delfino, MD, a headache specialist at NYU Langone Medical Center. But the FDA recently approved two gadgets for migraines: Cefaly, a band that’s worn across your forehead for 20 minutes daily, and SpringTMS, a device you hold to the back of your head at the onset of pain. Both work by stimulating certain nerves deep in the head, using electrical signals (in the case of Cefaly) or magnetic energy (for the SpringTMS). There’s also new hope for debilitating cluster headaches in the form of an electrode that’s implanted behind the jaw and controlled by a remote. In the initial trial, 68% reported relief when they turned on the electrode during a headache, and of that group, over 80% had fewer episodes.

HEALTH.COM: 18 Signs You’re Having a Migraine

A watch that tracks your health

Say good-bye to your current fit tracker: The Apple Watch, when used with your iPhone, can log your steps and even your heart rate, giving you more feedback in one gizmo than ever. (Oh, and you can ask Siri for directions during your runs.) Available early next year, the watch will sync with the Health iPhone app, which you can get now. You can use Health to import your calorie, sleep, and fitness data from apps you already use, like Nike+.

An alternative cancer treatment

Everyone knows the storied side effects of chemotherapy: hair loss, diarrhea and more. That’s because chemo drugs destroy cells that multiply quickly, whether they’re cancerous or healthy. But scientists are finally finding success with a more selective approach: immunotherapy. These treatments harness your body’s natural defenses to beat cancer back. “What we’ve discovered is that cancer cells evade your immune system by putting it into overdrive, causing it to tire out and give up. The new drugs interrupt the cycle so your body can fight,” explains J. Leonard Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society. The results so far have been staggering: “It’s not an overstatement to say this is a turning point in cancer research, especially for patients with melanoma,” Dr. Lichtenfeld says. Treatments for cancers of the kidney, lung and pancreas could be up next.

HEALTH.COM: 15 Worst Things to Say to a Cancer Patient

A real cure for Hep C

Usually symptomless, hepatitis C kills 15,000 Americans a year. Until now, treatment helped a mere 30 to 40% of people with the virus, which is passed via infected blood and can lead to liver failure and liver cancer. But in December 2013, the FDA approved Sovaldi (sofosbuvir), a pill that cures up to 90% of hep C patients when used with another new drug, simeprevir. “Before, it was like fighting a war with flyswatters, but now the big guns have arrived,” says Douglas Dieterich, MD, professor of medicine in the division of liver disease at Mount Sinai Hospital in New York City, who also was involved in clinical trials of Sovaldi. More help is expected to be FDA-approved soon: ledipasvir, combined with sofosbuvir, for one form of hep C known as genotype 1, as well as a three-drug cocktail that has cured 90% of people treated with it.

HEALTH.COM: 8 Things You Didn’t Know About Hepatitis

A smarter pregnancy test

An upgraded pee stick from Clearblue not only tells you if you’re pregnant but also gives you an idea of how far along you might be, via an extra strip that measures the concentration (not just the presence) of human chorionic gonadotropin in your urine. “It doesn’t beat the tests your doctor will run. But it could help women with irregular periods (caused by, say, breast-feeding or polycystic ovary syndrome) begin prenatal care on time,” says Pamela Berens, MD, professor of ob-gyn at the University of Texas Health Science Center.

A new way to fight breast cancer

Women with ductal carcinoma in situ (DCIS), an abnormality that can become invasive breast cancer, or a strong family history of the disease are often prescribed tamoxifen to prevent it. “But many women won’t even start taking it, because they’ve heard of side effects like hot flashes and blood clots,” says Seema Khan, MD, of Northwestern Memorial Hospital in Chicago. To see if there might be a better way, Dr. Khan prescribed tamoxifen in the form of either a pill or a gel applied to the breast to 26 women awaiting surgery for DCIS. Women who used the gel showed the same decrease in abnormal cell growth as the pill group—and they had no increase in blood markers linked to clots and other symptoms. The availability of the gel is still a few years away, but Dr. Khan says a topical gel might work for other drugs as well, suggesting that this is one discovery that could lead to many more.

HEALTH.COM: 12 Things That (Probably) DON’T Cause Breast Cancer

This article originally appeared on Health.com.

TIME medicine

10 Biggest Myths About the Flu

Flu shots here
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Don't get us wrong, we're all for washing your hands with soap and water. But it's not enough to stop the flu

Every flu season—which starts in October and peaks in January and February in the U.S.—as many as 20% of Americans get sick with a virus that can cause serious, even lethal complications (not to mention the general awfulness of a fever, chills, congestion, and body aches). So how come there are still so many myths and rumors about the flu? While officials aren’t predicting whether this year’s influenza will be better or worse than in years past, it’s smart to make sure you know the truth about this dreaded virus and what you can do to reduce your risk of catching it.

HEALTH.COM: 10 Ways to Soothe a Sore Throat

You can catch the flu from the flu shot

No, you can’t. Really. This longstanding rumor just won’t die no matter how often experts debunk it. “The flu vaccine is made with dead viral particles, and since the virus is not living, it can’t infect you,” explains Holly Phillips, M.D., a New York City internist and WCBS News medical contributor. The nasal-spray version of the vaccine, called the FluMist, (which is FDA-approved for kids and adults between ages two and 49 who are healthy and not pregnant) does contain a crippled version of live flu virus. However, it still can’t make you sick, says Dr. Phillips. This misconception may stem from the fact that it takes 2 weeks for your body to form antibodies to the vaccine and fully protect you. So if you pick up a cold or the flu before or just after rolling up your sleeve, don’t blame your runny nose and sore throat on the shot.

Young, healthy people don’t need to worry about the flu

“While it’s true that influenza is most threatening to the very young, the elderly, and people with underlying illnesses, it can still cause severe symptoms in otherwise healthy people,” says Dr. Phillips. That’s why the CDC recommends that everyone get the shot, preferably early in flu season. Even if you’re not in a high-risk group, getting the shot can stop you from transmitting the virus to more vulnerable people. “The more people who get the shot, the more we cut down on the amount of influenza circulating in the population, which can protect your grandmother or child,” says Dr. Phillips. Even if you don’t regularly interact with kids or seniors, take a few minutes and get the shot—at your doctor’s office, local pharmacy, or community health center. You can’t pass on a virus you never got in the first place.

HEALTH.COM: 10 Ways You Put Yourself at Risk for the Flu (Without Realizing It)

The flu includes gastrointestinal symptoms

As miserable as symptoms of the flu are, digestive distress is rarely one of them. What’s politely called the “stomach flu” is a colloquial term that refers to a group of viruses that primarily cause vomiting and diarrhea, says Dr. Phillips. “These viruses are not influenza,” she says. That’s not to say that the flu doesn’t occasionally lead to some gastrointestinal issues; some sufferers do experience nausea and even vomiting. But if you develop these symptoms without any of the classic flu tip-offs, you’re probably dealing with an entirely different germ.

Pregnant women can’t get a flu shot

On the contrary, all pregnant women should get the jab as soon as possible. “The flu shot is very safe for pregnant women, and getting it can even protect the baby for the first few months of life, when he or she is not old enough to get the flu shot yet but is very vulnerable to illness,” says Dr. Phillips. (Babies at least six months old are eligible for the vaccine.) Antibodies that form in response to the shot will not only protect you from the flu, they will protect your baby after birth and be delivered via breast milk, according to the CDC. Pregnancy causes immune, heart, and lung changes that can increase your risk for a bad case of flu, which can affect your pregnancy. “High fevers and severe infections can lead to serious pregnancy complications and even premature labor,” says Dr. Phillips.

HEALTH.COM: 10 Diet Changes All Pregnant Women Must Make

You can stop the flu by washing your hands a lot

Don’t get us wrong, we’re all for washing your hands with soap and water. But it’s not enough to stop the flu. Influenza is spread through the air via droplets of saliva from a person who is contagious (which starts a day before symptoms show and up to seven days after). The droplets can land on you and get into your nose, mouth, and eyes. You can also pick up the flu by touching contaminated surfaces (the flu can live up to eight hours on surfaces, according to the CDC), then touching your hand to your face. So wash your hands with soap and water and avoid touching your eyes, nose, or mouth. This slashes your risk somewhat, Dr. Leavey says. It’s also important to stand at least six feet from anyone with the flu; the airborne droplets can’t travel farther than that. Disinfect common areas in your home or workplace if someone with the flu spent time there. And above all, get vaccinated.

If you get the flu, the shot didn’t work

The flu vaccine isn’t like vaccines that protect you against measles or polio, which offer 100% protection. Usually, the flu shot is only about 60 to 90% effective. That’s because multiple strains circulate every year, and it’s difficult for scientists to predict perfectly which strains will be dominant. “If you do get the flu after going for the shot, it just means that you contracted a different strain that wasn’t included in the vaccine,” says Dr. Phillips. If this happens, there is an upside: your symptoms will likely be less severe, since the shot will probably be at least somewhat effective against the strain you have, she adds. And keep in mind that to the CDC, a flu shot is a success if it prevents hospitalizations and deaths, not if you sail through the season without a sniffle.

Antibiotics can fight the flu

There’s no point in bugging your doctor—antibiotics don’t work on viruses. That said, there are Rx antiviral meds that might help. Tamiflu is the best known; this drug has been shown to cut the course of the disease by 1-2 days, if you take it within 48 hours of the first sign of flu symptoms. These are generally recommended only for those at high risk of complications. “The effects are relatively modest,” says Dr. Phillips. “Once you have the flu, you’re going to be miserable regardless. Prevention with the flu shot is a better approach.” Other meds that can offer some relief include over-the-counter fever reducers such as ibuprofen and acetaminophen, as well as congestion fighters. Best bet? Stay home, get some rest, drink lots of fluids, and wait it out (but be on your guard for serious complications).

Bell’s palsy is a side effect of the flu shot

Bell’s palsy is a condition that causes weakness or paralysis on one side of the face. It’s usually temporary, clearing up after several weeks, and it’s typically thought to be triggered by a viral infection, such as herpes simplex (the virus responsible for cold sores) or Epstein-Barr, which leads to mononucleosis. How did the flu get into the mix? Decades ago, a few isolated cases of people developing Bell’s palsy after getting a flu vaccine were reported. Yet no link was ever established showing that one caused the other, says Dr. Phillips. The overwhelming consensus is that the two have nothing to do with each other, adds Dr. Leavey.

HEALTH.COM: Unexpected Ways to Prevent the Flu

Flu shots can cause Alzheimer’s

The flu shot doesn’t cause any illness or condition, and that includes Alzheimer’s disease, says Dr. Leavey. Alzheimer’s is a type of dementia that leads to memory loss and other cognitive changes. Why some people develop Alzheimer’s is not fully understood, and that opens the door to lots of speculation—which seems to be how the rumor linking the flu jab to Alzheimer’s got its start. “The connection also has to do with the fact that senior citizens are strongly advised to get a flu shot every year, so people associate old age with flu shots, the way they associate old age with Alzheimer’s,” he says. “Or an elderly person who had a flu shot begins showing signs of memory loss months later. The two are unrelated, yet people conclude that the vaccine had something to do with it.”

This article originally appeared on Health.com.

TIME medicine

Child Medication Errors Occur Every 8 Minutes, Study Says

pills
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According to a study in the journal Pediatrics

Every eight minutes, a child experiences a medication error like taking the wrong drug or consuming too much, according to a new study published on Monday.

Researchers looked at out-of-hospital medication errors in the National Poison Database System from 2002 to 2012 and found that more 200,000 mishaps are reported to U.S. poison control centers every year, noted the study in the journal Pediatrics. In about 30% of those cases, the child is under age 6.

Nearly 82% of medication errors were from liquid medicine, followed by tablets and capsules at 14.9%, the researchers said. They added that errors increased as kids’ ages decreased, and that 27% of the mistakes occurred when a child was accidentally given the same medication too soon.

Twenty-five of the children died as a result of the errors during the 11-year study period, but overall the vast majority of the cases did not require treatment.

The study authors argue that medication errors are a significant public-health problem that needs more attention. One way to cut down, they suggest, is by making drug packaging and their labels more clear when it comes to directions and dosing.

TIME medicine

6 Common Prescription Mistakes You Might Be Making

Pill bottles
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In honor of Talk About Your Medicines Month

It’s hard to imagine a time when there wasn’t a pill—sometimes dozens of different ones—to treat so many health conditions. Today, 70% of Americans take at least one prescription drug and more than half take two, according to the Mayo Clinic.

While the healing powers of modern medicine are pretty awesome, you still need to be cautious when it comes to any drug. The Food and Drug Administration (FDA) reports that medication errors cause at least one death every day and injure 1.3 million people annually.

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In honor of Talk About Your Medicines Month, read up on common mistakes to avoid with your prescriptions.

You get the brand name over generic

Yes, they’re cheaper, but generic drugs are just as effective as the brand name. To be approved by the FDA, a generic drug must have the same active ingredients as the original. The only difference is the inactive ingredients, like dye or preservatives, which don’t affect the action of the drug. “Small variations in the generic are permissible,” says Kim Russo, PharmD, chief clinical officer at VUCA Health, a medication video service available at certain pharmacies nationwide. “Most of the time we don’t even medically notice it.” If you don’t tolerate one of the inactive ingredients well, then you might need the brand name. Otherwise, save yourself the money and go with the generic.

You mix your meds with the wrong foods (or drinks)

Always check what foods or drinks could interact with your medicine. One to watch out for: grapefruit and grapefruit juice. “As many as 50 drugs on the market can be affected,” Russo says. Depending on the drug, grapefruit juice can reduce or increase absorption­—the latter could lead to overdose. Then there are certain drugs that shouldn’t be taken with calcium-rich foods because they interfere with your body’s absorption of the medication, Russo says. Plus, there are medications that cause you to lose or retain potassium, so you’ll want to talk to your doctor or pharmacist about whether you need to start (or stop) eating certain foods. And you should ask your doctor if it’s OK to drink alcohol while taking your prescription. “Alcohol can turn possible mild side effects into dangerous ones,” Russo says. The FDA has more info on bad food-drug combos.

HEALTH.COM: 16 Worst Birth Control Mistakes

You don’t check your Rx label at the pharmacy

To save yourself the stress of a medication error, make sure you have the right prescription before you leave the pharmacy. If your pharmacist only asks for your name at the counter, provide another identifier, like a birth date or address. That way you’ll know the drug is filled under the correct person, Russo says. Another good idea: open your bag. “I would read the label and open the prescription to see if you recognize it,” Russo says. A different color or shape may just mean the drug is coming from a new generic manufacturer, but it never hurts to be safe.

You don’t talk to your pharmacist

Most pharmacists will ask if you have questions about your medication. But when’s the last time you actually voiced one? It’s never a good idea to rush through picking up a new prescription. That’s the time to find out what the medicine is for as well as the benefits and possible side effects or drug interactions, Russo says. If you’ve been on the medication a while and have noticed unexplained changes lately, say a rash or constant headache, that’s also a good time to speak up. On three or more medications? “It’s a great idea once a year to make an appointment with your pharmacist to review them,” Russo suggests.

HEALTH.COM: 15 Tips for Saving Money on Prescription Drugs

You store your meds in the wrong spots

The number one worst place you could keep your medication is the bathroom. That’s because moisture can degrade medicine, Russo says. Medications also need to be protected from light. “That’s why prescription vials are the amber color, to block UV light,” Russo says. Still, you should keep medication in a dark place, especially if you have a pill organizer that’s clear and light can get through. Certain drugs shouldn’t be taken out of the vial at all. Some medications, like insulin, might need to be refrigerated initially, but can be taken out to warm up before injecting and then stored at room temperature for a set number of days. Just keep in mind some drugs are meant to be kept in the fridge and they can lose their effectiveness if left at room temperature for even a few hours, Russo says. Check with your pharmacist to know how long is too long.

You don’t dispose of old meds properly

Most pills remain effective up to two years after the expiration date, Russo says. When it’s time to get rid of them, though, don’t count on the toilet as your go-to disposal method. “Flushing certain cardiac, seizure, or hormone medications can be very harmful to the environment,” Russo says. Only a few medications, including ones for pain, are recommended by the FDA for disposal by flushing. The rest you should throw in a plastic bag with kitty litter or used coffee grounds so kids or pets won’t be tempted to eat them. Then, the bag’s ready for the trash. You could also ask your pharmacist about upcoming medicine take-back programs.

HEALTH.COM: 27 Mistakes Healthy People Make

This article originally appeared on Health.com

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