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A Fever All Through The Night

Published: August 17, 2010

A medical story from our pals at the New Scientist Magazine tackles the subject of fever. In the July 31st edition, an article by Robert Mathews dishes out the facts on some new concerns arising from recent studies.

Fever is something we are all familiar with. You wake up one morning feeling groggy and tired, so you consult your thermometer, which confirms what you’ve feared – your temperature is elevated. In our modern era, the normal response to this is to gulp down a couple of pills, antipyretics, like aspirin, acetaminophen, ibuprofen, etc. In this article, Robert Mathews states that “It has long been acknowledged that such drugs could, in theory, be counterproductive. They do, after all, interfere with the body’s natural response to infection. But these qualms have been set aside for a variety of reasons: the need to relieve discomfort, fears about brain damage, time honored practice, and the urge to be doing something rather than nothing.” The article also notes “The upshot of this is that antipyretics are routinely used for any feverish illness, from the sickest of patients in intensive care, to the people using over the counter medicines at home.” Standard advice to people with the flu is to dose up with acetaminophen. It is true that parents with young children are well aware of the perils of inaction, as young children might sometimes get febrile convulsions associated with a fever. “But,” says the article “There is now growing concern that these time-honored approaches are at best misguided, and at worst potentially life threatening.” New findings are starting to support a much older view of fever – that it is a key component of the body’s disease fighting strategy. The article also notes “The idea that antipyretics can prevent fits in children is increasingly shaky.”

Now I must say, I’ve grappled with the concept of treating a fever since my earliest days in medical school. It seems clear that the body mounts this defense for a reason, yet what do we do in modern medicine? Try and reverse it! The idea that a fever can be beneficial dates back to the Greek physician Hippocrates, 2400 years ago. In the 1860’s, the French physician Claude Bernard developed the idea of homeostasis – the idea that the body is trying to return to a certain given state. By that time, the thermometer was invented and physicians were able to accurately gauge just how hot a person was. Not surprisingly, doctors seized upon new antipyretics like acetaminophen and aspirin to rapidly control rising temperatures. Of course physiologists have long suspected that fever is an evolutionarily ancient disease fighting system, existing not only in mammals and birds, but also in fish, amphibians and reptiles. A sick lizard will climb out on a hot rock in order to get better. Perhaps it is just as well that no lizard physicians are giving him Tylenol.

People have been studying how fever works, and it seems that many disease fighting mechanisms work better in hot conditions. Studies show that a fever enhances the ability of T-lymphocytes to home in on the site of an infection. It has also long been known that fevers are bad news for many microbes. Incidentally, this is one reason why we get colds in the winter time. The viruses that cause them hang out in the coldest part of your body during the coldest part of the year.

Anyway, there are clearly reasons why you should use antipyretics. There is good evidence to suggest that a raised temperature can be extremely harmful to the body after a head injury or stroke, and of course, if some one is incredibly uncomfortable due to a fever, it makes sense to knock it down. Still, I believe that a re-think in this area has been long overdue.