[back] Fever

Fever: When Will They Ever Learn?

by Hilary Butler

Chapter 46 From One Prick to Another

[pdf version]

This appeared in VRAN Newsletter Fall 2008

“Fever is generally considered harmful by physicians and is treated with antipyretics as it may lead to febrile seizures, stupor, dehydration, increased breathing, discomfort and tachycardia. It is a common practice to treat even low-grade fevers of 101° to 102°F with antipyretics. Home use of antipyretics upon the first signs of fever is also common. These behaviors have lead to the ubiquitous use of aspirin, acetaminophen, nimesulide, and ibuprofen which control temperature by inhibiting prostaglandin synthesis in the hypothalamus.”¹

Paracetamol (or, acetaminophen, or Tylenol to Americans) was first used in medicine in 1893, but only became a commonly used drug in 1949.² Until 1971, no one had a clue how it worked, but that didn’t matter. Doctors didn’t seem to think that was important. Fever was “dangerous” so you stamped it out at all costs. Since 1972, scientists have been gradually starting to unravel some of the ways paracetamol suppresses various pathways in the brain and in the body, but as of 2008, their knowledge is incomplete, and part of the reason for that is that these same researchers still don’t understand all the gears the body goes through to produce a fever, or why each gear is important, or the reason for the body getting into immune-system cruise as a result of fever. Most of these researchers just don’t understand that fever is there as a beneficial adaptive response. When you don’t know something as basic as that, but are intent on simply suppressing it because it can be done, you can be sure you are asking for trouble somewhere down the line.

Come my turn, I said that I had some grave concerns about the accuracy of some of the “opinions” expressed by the previous speaker. The word opinion was used since I saw no references or “facts” put up on the whiteboard. This person was purely talking off the top of their head. Without sparing anyone’s feelings or reputation, I launched into a literary review of the FACTS indicating that FEVER has a crucial role in fi ghting infections, and then into another literary review, showing paracetamol to be dangerous when suppressing a temperature. The article I started with was a 1995 medical article,3 the conclusion of which says:

There is little evidence to support the use of paracetamol to treat fever in patients without heart or lung disease, or to prevent febrile convulsions.  Indeed, paracetamol may decrease the antibody response to infection, and increase morbidity and mortality in severe infection. It should be explained to parents that fever is usually a helpful response to infection, and that paracetamol should be used to reduce discomfort, but not to treat fever.

Immunity: Too many parents and health workers think that infection is bad, infection causes fever, and that therefore fever is bad. In fact, fever is often a benefi cial host response to infection, and moderate fever improves immunity.

Therefore, it may not be a good idea to give drugs that reduce temperature to patients with severe infection. This evidence suggests that aspirin and paracetamol increase mortality in severe infection, and that they may prolong the infection and reduce the antibody response in mild disease.

By the time I’d finished, the board was covered with medical references, but as I looked around the room, it seemed as if the audience had shut off, in some mindnumbing, glazed-eyes “default” mode, which presumably said, “Listen to the teacher, not to some numbskull mother.” So I quickly asked for questions. The first one was, “What medical school did you go to?” My reply was instant. “Which medical articles on fever and infection have you read?”

In the child’s post-mortem, neither the role of paracetamol, nor of MMR was considered relevant to the cause of death, which was specified as “chickenpox”. I believe the role of both paracetamol and the MMR were very relevant as factors in this child’s death, and that such a post mortem reveals the ignorance and contempt that many doctors have to this day, to the immunosuppressive role of fever reducers, or to any suggestion that a sick child should never be vaccinated.

When I settled down to read a 2007 article in Pediatrics,⁴ these two parts of sentences leapt off the page:

“Understanding the role of fever, if any …” and later, “… the functional significance of fever remains uncertain.”

In 2007, no one in the department of Neurology and Developmental Medicine in Maryland, or any of the people in the Department of Epidemiology and Biostatistics, Pennsylvania, had a clue about the role of fever in infection? Why is that? Okay, they were looking at it in the context of autistic children. This study was undertaken because, “In the past few decades, parents and clinicians have reported that behaviors of children with ASD5s tend to improve, sometimes dramatically, during febrile episodes.”  The children’s improvement subsided afterwards, but the question remains to be answered, “WHY?”

Here again, we have a wonderful example of what “proof” is. Proof is whatever the doctor says it is, until they are proven incorrect. When a parent says, “My autistic child improved dramatically during fever”, it is anecdote. Even when clinicians agree, that knowledge is still “anecdote”, and it takes decades before a study of individuals is done, to confirm what parents have known for a very long time.

The only useful response from this study was that, “more research is needed to prove conclusively fever-specific effects and elucidate their underlying biological mechanisms …”

The premise of another autism study,⁶ conducted in 2003, was that: “The blockage of fever with antipyretics interferes with normal immunological development in the brain, leading to neurodevelopment disorders such as autism in certain genetically and immunologically disposed individuals.”

The article then goes on to say that “The effects may occur in utero or at a very young age when the immune system is rapidly developing.” Antipyretics might lead to neurodevelopment disorders if given when the immune system is rapidly developing? What about vaccines?

There is another interesting point in the discussion, and that’s the fact that for once, someone has taken “anecdote” seriously, albeit just about a generation after the anecdotes were first told. Let me tell you some “anecdotes” from the days when parents were not paranoid about measles, and when some young wives and mothers knew how to dose measles with vitamin A, vitamin C and other treatments which doctors said didn’t exist. We knew that contrary to vaccination-spin pamphlets, complications and deaths were very unlikely in healthy children treated correctly.

Like-minded parents used to get together and comment how, after measles, or even moderate fevers from other infections, children would make developmental milestone leaps, and it was not trickery of the imagination. This happened twice in our house. I have a habit of writing everything down, during and after infections, because I know it won’t be remembered in days or years to come. Also, I liked Plunket nurses⁷ and doctors to know what I’d written before they filled in the next gap, even if they did sigh and roll their eyes before writing in their own words of wisdom!

Looking through clear fi les full of medical articles on (ab)use of paracetamol for infectious fever, I am amazed to see the number of times, and in such a broad variety of clinical situations,⁸ that this phrase comes up:

“Routine antipyretic therapy in children with infectious diseases has long been the source of controversy.”

Controversy? Where? I know of no mother who frequents a doctor’s surgery who realizes there is any controversy around the use of paracetamol for infection. For decades now, a few medical people have had doubts, and made rumbling noises, but does their discontent achieve anything in reality? Is anyone researching what fever does in the body, not just in terms of infection outcome, but in the context of the overall health of children?

The answer lies in some of the advertisements we have seen, and still see. Forinstance, the McNell Motrin advertisement used in American Newsweek in 2000,⁹ told us that Motrin “never surrenders” and is “For Moms who don’t fool around with fever.”

A recent advertisement¹⁰ in New Zealand for paracetamol is a lot more subtle and takes the “intellectual pride” route. It says:

“I wouldn’t put just anything in my body. That’s why I always think twice about what I do. Some decisions are hard to make. But in the end, you’ve got to do what’s right for you. Panadol. It’s my choice.”

Which tells you nothing about Panadol®, but is pitched to make you think that if clever people who think twice, make the “choice” to take Panadol®, that would be the right thing for you to do as well. It’s the old ‘go with the (alleged) crowd’ trick. Do readers think about the fact that they aren’t told what those supposedly clever people even thought about in the fi rst place?

Studies conducted overseas¹¹ and in New Zealand12 have shown that children who were given paracetamol early in life have a 25% higher risk¹³, of having asthma symptoms. Antibiotic use in infancy has been found to have the same association.

No doubt until then, I will continue to be sent stories like this one from an overseas blogger who had finished reading Chapter 39 in our first book,¹⁴ Just a

Little Prick, and felt compelled to tell their story. He gave permission for me to publish their experience with fever.

One morning when Savannah was barely one, while playing around with us in bed, she suddenly went slack and inert. Controlled panic ensued.  I drove, in pyjamas and stockinged feet, at breakneck speed to get her to the hospital, about 8 minutes away. Several white-clad professionals immediately went to work on her. She was given some kind of fever reducing injection (I probably don’t want to know what it was). I think her fever had spiked to 105 ^oF or so. When I asked if this might cause brain damage, I was told that only an EEG could tell. So we subjected Savannah to the machine, with wires stuck to her scalp. She “turned out” to be just fine, for which “intelligence” we had to fork out aplenty. We were advised to bathe Savannah in water as cold as she could stand. We did. Next day, we took her to a pediatrician someone recommended.

He diagnosed Roseola.

He became visibly angry when we told him what we had been sprung for the EEG. Then he told us the truth. “Children are capable of withstanding temperature spikes like that with no damage. My hardest job is to convince parents to DO NOTHING when their children develop high fevers. They can handle it.”

14 Just a Little Prick. “The Fever-Pitch Bandwagon,” p. 259.