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We
are pleased to present the following
excerpt from the book
Riddled with
Life: Friendly Worms, Ladybug Sex, and the
Parasites That Make Us Who We
Are
by Marlene Zuk
Harcourt - April
2007
Grasshoppers,
Aspirin, and The Best
Defense
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.
Copyright
2007 by Marlene Zuk. Published with
permission.
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
Sexual Selections: What We Can and
Can't Learn about Sex from Animals.
She lives in Riverside,
California.
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