Just a pill – no mush here

Its the time of the year when all kinds of flu and cold ‘remedies’ have a prominent place on the TV ad slots. It doesnt seem to end really – take this for sniffles, this for fever, this for coughs and if you feel crap as a whole, this will do you wonders. There are multitude of amazing pills that can fix you and bring you to your shiny sunny self before you can say sss..s..sick! And yet, people still walk around with runny noses, miserable looks and colds that last forever. Something aint right, something doesnt add up. Its simple, those things just dont work. No pill will fix the pesky cold or flu. It may drug you enough, so you believe you are better, but your body still needs to actually fight off the infection.

Being sick sucks. It feels horrid and it is definitely no fun, there is no arguing about it. And it should feel like that. Our whole body is at war, all the defenses and army is up and fighting with the invader, using all the possible ammunition. The desire to escape the situation is quite understandable. Early physicians knew that and used it for their benefit. They kept on experimenting with new ‘discoveries’ in order to make an impression on the patients and to keep on justifying their profession – ‘harmful drugs made the presence of the physician a dubious advantage in much medical care. Wellington state in 1870 that “over medication has been the besetting sin of the  medical profession”‘ [1. American Physicians in the Nineteenth Century ]. This is 1870, long before the bloom of pharmacology and Big Pharma.

One of the enemies back then and now is fever. They were determined to bring it down “at all hazzards” and used variety of ways to do so – blood letting and aconite amongst them. Today antipyretics (fever reducers)  are some of the most used drugs out there – who hasnt popped a Panadol/Paracetamol/Motrin/Tylenol/Aspirin etc. etc. recently? Its almost a given to do so at the first sign of the raise in temperature. Is the fear of fevers actually justified or is it an irrational one?

Fevers are not specific to us humans. Just about every vertebrates and invertebrates respond with it when faced with toxins or dangers to the creature. This ability has been kept and developed throughout evolution, despite the expense it costs us in regards to energy use. Its not easy to raise our temperature and its not cheap. We use ten percent more energy for every 1 degree raise we achieve. This would not have continued to be so if there was no benefit to be gained. The creatures that did this for no good reason would have simply not survived and after a few thousand or millions of years, the feature would have been lost. [2. Is Fever Beneficial?]

And yet here we are each of us running a fever when needed without a fail. So what is the benefit?  It enhances the immune response.  It helps the mobility and activity of white cells. In patients with sepsis, fever has been shown to reduce mortality [3. Fever control in septic shock : Beneficial or harmful?]. Higher temperature is thought to make the person less hospitable for the growth of bacteria [4. Myth vs. Reality – Should you treat fever? ] and a few more complicated beneficial effects.

“Although treatment of fever may improve patient comfort and reduce metabolic demand, fever is a normal adaptive response to infection and its suppression is potentially harmful.” [5. Fever in the critically ill medical patient ]

And we come back to the comfort. Yeah, fever may be helpful, but if we can save ourselves the unpleasant feelings, why not do it? No particular reason other than saving our livers and system from unnecessary drugs. There are none of them that dont come along with a price. Paracetamol (Tylenol, Panadol, Efferalgan) for example, is derived from coal  and toxicity from it is the biggest cause of liver failure and drug overdoses in the Western World [6. Paracetamol – Wikipedia ] . Popping a pill to supress the work of our bodies may seem like an easy way out, but in effect it makes more work for the already taxed system, now it needs to clean up the chemicals on top of dealing with the infection. The Australian Prescriber in short advises that:

“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. Paracetamol may prolong infection and reduce the antibody response in mild disease, and increase morbidity and mortality in severe infection.

The fever is not the enemy. The issue still needs to be dealt with and the issue is not the fever, contrary to the numerous ads that make it seem so. The fever is not an ugly monster that is attacking our child and by drugging it we are not heros.

Here are some more fever myths and facts from the Motts Children’s Hospital . Really, the evidence against antipyretic use is quite plentiful, but in the end I think this quote from the Bulletin of the World Health Organization summarises well the reality:

“Fever represents a universal, ancient, and usually beneficial response to infection, and its suppression under most circumstances has few, if any, demonstrable benefits. On the other hand, some harmful effects have been shown to occur as a result of suppressing fever: in most individuals, these are slight, but when translated to millions of people, they may result in an increase in morbidity and perhaps the occurrence of occasional mortality. It is clear, therefore, that widespread use of antipyretics should not be encouraged either in developing countries or in industrial societies. Unfortunately though, just as fever represents an ancient biological response, an emotional effect is embedded deeply. Through the ages, parents have seen that when fever begins to diminish and disappears, the child feels better and recovers from the illness — whatever it was. Thus, the fever has become synonymous with the illness. This flaw in logic has persisted in parents’ and physicians’ minds, and they are seduced by the thought that if they “make the fever go away, the patient will be well.” No amount of scientific discourse will change this attitude, and antipyresis will continue to be used in children with low-grade fevers, or even no fevers, in the home as well as the hospital.”

…no amount of evidence will change attitudes. How true, not just in this particular case.

Its not just a pill. And now you know.