So I first started thinking about this one day when a nurse called me for an order for Tylenol for a patient with a fever of 101. I had received calls identical to this hundreds of times before but this time I stopped. I asked if the patient had any symptoms and she told me he did not. But that was just what she was used to. Patient has a fever give them Tylenol. Let me explain for those that do not work in the medical field. This situation is not unique. At almost all hospitals across the country, and certainly in every one I have worked in, if a patient gets a fever they will be given Tylenol. and if they do not have an order for Tylenol the nurse will call for one. And one must assume we do this for good reason. We are preventing brain damage, seizures, something right? Actually no. There is no evidence we are doing any good whatsoever.
The day I received this call I went to the literature to see what I should be doing. I found this wonderful article by Michael Ryan and Mitchell Levy from the journal Critical Care 2003. I suggest everyone read the article.
The case they lay out is compelling and shocking. Fever has been evolving for millions of years. Even reptiles when they have an infection seek out warmer areas to raise their temperature. And pretty much every warm-blooded animal gets fevers with infections. So why would animals do something that is energy wise so costly when they need all that energy to fight infection? Because the fever is fighting the infection. Fever helps release cytokines and other immune modulating chemicals that help the body to fight infection. It also causes the body to release what are called heat shock proteins that help protect the body during times of stress, inflammation or infection.
In this article and in a review of the literature there are no good human studies but there are many animals studies and they all show that fever is good and increases the survival from infection. And more over, multiple studies show that suppressing fever with medications such as acetaminophen (Tylenol) actually increase the risk of death from infection. Not one study has ever been done to show any benefit of suppressing fever on mortality or morbidity.
The only real concerning side effect of fevers is febrile seizures that really only happen in children and even then only 2 to 4% of children at that. And even with this as a rationale makes no sense because studies have been done and not one showed that suppressing the fever with medication decreased the risk for febrile seizure.
Brain damage from a fever does not happen until temperatures as high as 107 degrees. This rarely happens and I personally have never seen it, even without medication for the fever.
So we have a wide-spread use of a medication to suppress the bodies natural and very effective response to infection. We have been doing this for decades without any research to see if this has been beneficial or harmful. It is time we finally do that study. The body has spent millions of years to develop this effective response to infection. I think it is about time we get out of its way