Pain and suffering are hallmarks of disease, and while philosophers and poets can wax eloquent about their benefits to the spirit, both physicians and their patients are united in wanting to eliminate them from the body. All forms of suffering are not created equal, however, and Darwinian medicine helps us understand the consequences of assuming that they are. Pain itself is a useful signal, of course. The few individuals born without the ability to feel pain lead very complicated and controlled lives and generally die at an early age. It is easy to understand why; we rely on pain to tell us when to move our hand from a hot stove or how far to bend a joint. But what about disease symptoms that range from annoying, like the itch of a mosquito bite, to debilitating, like the cough of pneumonia? What about the general malaise, the mopiness and lethargy that accompany a wide range of illnesses? Could they, too, serve a useful purpose?
In particular, what about fever, the ubiquitous partner of illnesses ranging from colds to malaria? Fever is the most common reason for parents to bring their children to the hospital emergency room, and millions upon millions of dollars are spent each year on fever-reducing drugs like acetaminophen, ibuprofen, and aspirin. Most parents believe that high fevers, those above 104° F (40° C), are dangerous, and can cause brain damage if left untreated.
But Hippocrates was a strong advocate for the beneficial effects of fever, believing that it burned off excesses of the humors or essences of the body, and many cultures around the world used to induce fever to treat disease; in at least one Native American tribe, a sufferer was placed inside the carcass of a freshly slaughtered horse to absorb the heat lingering in the body cavity. In 1927, the Nobel Prize for medicine went to Julius Wagner-Jauregg, an Austrian physician who had tried many cures for the fatal paralysis caused by late-stage syphilis. His breakthrough came when he deliberately infected syphilitic patients with malaria to induce high fevers; most of them showed striking disease remission, whereupon he cured the malaria with quinine. Wagner-Jauregg was not completely certain why his treatment worked, pointing out in his Nobel acceptance speech that the high temperature alone was not the sole mechanism behind recovery. He speculated that the fever activated some other component of the body's natural disease resistance, but had little information to support this suggestion, since the workings of the immune system were only beginning to be understood. More recently, malaria therapy has been suggested for the treatment of Lyme disease, some forms of cancer, and even AIDS, but it is viewed with considerable skepticism by the medical establishment.
Worse Than The Disease?
So what about that widespread use of drugs to lower fever in children? Practices are changing, albeit slowly. Some medical practitioners now warn against “fever phobia, " the needless panic felt by many parents and health care providers when a child's temperature rises. A paper published in the Bulletin of the World Health Organization surveyed numerous studies on the use of fever-reducing drugs in children and came to the rather startling conclusion that they made no difference in the outcome of the disease, the duration of the symptoms, or even the comfort level of the children themselves. In one of the studies, parents were not told whether they were giving their children a potent drug or an inactive placebo (they agreed to this in advance). When asked which they thought the child had received after the sickness was over, the parents guessed right about half the time, exactly what you would expect by chance. A slightly higher degree of activity and alertness was noted in the children receiving the medication, but this was minor. The authors acknowledge that this is not the final word on the subject, but it does give food for thought. Medical researchers have also debunked two commonly held misconceptions about high fever in children: that it can result in dangerous seizures, and that fevers from infection must be controlled before they reach a certain point, often 41°C (I06°F), to prevent seizures and brain damage.
Febrile seizures, as they are called, are certainly frightening to watch, but they tend to occur early in the fever process, rather than after fevers have mounted, and a small percentage of children simply seem to be prone to them; administering fever-reducing medicine does not stave off their recurrence. They also do not have permanent ill effects, and although parents are advised to notify the doctor if their child has one, they are not necessarily a cause for alarm. And while it is true that fevers over I06°F are potentially damaging, such high temperatures are virtually always the result of heatstroke or brain injury, not infection, and so fears of a cold - or flu - caused fever rising to this level are groundless. Michael S. Kramer and Harry Campbell, two child-health experts writing in a document for the World Health Organization, say, “One is left to conclude that the principal rationale for antipyretic [fever-reducing] therapy is to soothe worried parents and health care workers and to give them the sense that they are controlling the child's illness, rather than it controlling them. "
This is ironic, since it is not so simple as us versus them. Fever, as a mechanism that activates the immune system to cure us of the pathogen, is a defense, a tool on our side, and the best way to control an illness is to leave the fever alone, at least some and perhaps most of the time. Certainly we can choose to suppress fever if we have a task to do that requires a more alert mind, but we need to be mindful of the price that exacts.
From the book Riddled With Life by Marlene Zuk Published by Harcourt, Inc. ; April 2007; $25.00US; 978-0-15-101225-1
MARLENE ZUK is a professor of biology at the University of California, Riverside, where she studies parasites and behavior in a variety of animals. She is the author of *** Selections: What We Can and Can’t Learn about Sex from Animals. She lives in Riverside, California.