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A feverish debate.


There seems to be disagreement among doctors as to when a person should be treated for running a fever. One side seems to believe that treatment should begin immediately, at least for the sake of the patient's comfort, while another side argues that a fever can effectively act to destroy certain viruses while protecting against infection. Thus, treatment should in some cases at least be delayed despite the possibility of generalized discomfort, irritability, or occasionally confusion.

Dr. Paul J. Mankus, assistant professor of family medicine at the Medical College of Wisconsin in Milwaukee, argues for immediate treatment. "Our calling is not only to cure patients," he admonishes, "but to care for them." Patients with fever, he adds, need to feel as though someone cares about their condition. Parents of children with fever-related seizures (not to mention the children themselves) don't care whether a doctor believes that such seizures are harmless; Mankus writes they want to see relief, and they want to see it NOW. Besides, Mankus writes, "there's no good evidence that letting a fever run its course will shorten an illness's duration, so we should at least make the patient comfortable."

On the other hand, Dr. Jerry Kruse, assistant professor of family practice at Southern Illinois University and assistant director of the Quincy Family Practice Program in Quincy, Ill., thinks that "in specific diseases, fever may have protective action." Kruse writes that studies show fever can boost the body's protective mechanisms, such as white blood cell counts and interferon production. Also, he writes, "the risks of side effects from fever-reducing medications outweigh benefits in patients with fevers below 103 degrees F. Kruse points to the example of children with chicken pox and influenza who were given aspirin and then developed Reye's syndrome. Also, he says, the side effects of medications such as Tylenol can change as infectious diseases change, despite being given in correct dosages. Kruse concludes that "it's probably the muscle-pain relieving, and not the fever-reducing, effect of medication that makes patients feel better."

Kruse allows that no studies thus far prove the protective effects of fever (although he believes that the basic research he mentions indicates a theoretical basis for such a hypothesis). Likewise, Mankus admits there may be evidence that fever can kill certain heat-sensitive and iron-dependent microbes (although he believes that "elevated temperatures probably don't play a major role in fighting infections"). What neither doctor seems to want to address, however, is the question of what rights the patient has in all of this. Does the patient, in fact, have a say-so in regard to his or her treatment and whether he or she should receive it? The answer, it seems, depends on the individual in question--again, something neither doctor seems to want to address.
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Title Annotation:when should a fever be treated
Publication:Medical Update
Date:Apr 1, 1989
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