What do you do when you have a fever? If you are like most people, you reach for acetaminophen (Tylenol), ibuprofen (Advil or Motrin IB), naproxen (Aleve) or old-fashioned aspirin. But is that a good idea?
It is easy to understand why people could perceive a fever as the problem rather than part of the body’s reaction to infection. Fever is obvious, and people with fevers usually feel bad. But that isn’t the only way to interpret elevated body temperature.
The ancient Greeks, especially Hippocrates, thought that fever could be beneficial. Many different cultures have adopted ritual use of inducing a fever-like state. Steam baths, saunas and sweat lodges all raise body temperature.
When pharmaceutical firms developed medications that could lower fever, doctors embraced the concept.
Aspirin was the first popular drug to do this. The Bayer company developed it in 1897 and began distributing it without prescription in 1915. But the company lost its patent during the First World War, and drug manufacturers in other countries began making it.
An advertising campaign in August 1918 promoting aspirin was very successful. The drug was widely used that fall during the influenza pandemic. A spike in deaths that occurred in October has been attributed to the overuse of aspirin.
That may have been a consequence of the high doses that were used. Too much aspirin can lead to rapid breathing and fluid accumulation in the lungs.
Aspirin may also have interfered with the immune response. An elevated temperature is the body’s way of mobilizing the immune system. Researchers have observed: “Fever is a cardinal response to infection that has been conserved in warm-blooded and cold-blooded vertebrates for over 600 million years of evolution” (Nature Reviews. Immunology, June 2015). When body temperature is high, both the innate and adaptive branches of the immune system are more effective against infection. That means the white blood cells that serve as the surveillance system are activated. In addition to attacking the invaders, they also alert B cells to produce antibodies that will tag the pathogen for destruction.
If a fever serves a protective function, does lowering it put people at risk? There are some data to support that concept. The French minister of health stirred up a hornet’s nest recently when he said that people with COVID-19 should not take ibuprofen.
Many health professionals discounted his advice on the grounds that there is no clinical evidence to support such a prohibition. More to the point, though, is whether fever reducers in general might be counterproductive when people have a viral infection. Some scientists have found that reducing fevers can increase the transmission of infectious diseases (Proceedings of the Royal Society B: Biological Sciences, March 7, 2014).
Of course, a very high fever can be dangerous. In addition, people with septic shock are at greater risk of dying if their fever rages out of control.
As in all things, moderation and common sense should be followed. A mild to moderate fever may be helpful. Lowering it with over-the-counter medicines could be counterproductive.
King Features Syndicate