An envious fever of pale and bloodless emulation...

Fever is a fascinating phenomenon. The biochemistry and physiology of it is fairly well understood (sort of), but historically and presently, it is endowed with great teleologic power. The nearly magical ability of the body to heat up dramatically was noted by the earliest physicians. In the Hippocratean school, fever was often viewed within the humoral framework as an excess of yellow bile and was seen to be beneficial, although it was also recognized that some fevers were a grave sign. Later in the history of medicine, fever was equated with infection as was thought to be "a bad thing" and fought with whatever means were available.

In modern medicine, fever is not seen as a good or bad thing, but as a sign of "a commotion in the blood". The same careful observations that the ancients made were made again in the context of science, and the physiology of fever was teased out. Certain substances (such as endotoxin) were found to reliably reproduce fever, and observations such as this helped us understand what fever is.

Fever as a therapy in and of itself was explored by Dr. Wiliiam Coley in the early 20th century when he noticed that cancer patients who contracted and survived erysipelas infections sometimes had regression of tumor. He developed an early form of immunotherapy whereby he gave people a dose of "toxins" inducing a sepsis-like response. In modern times, interleukin-2 is used to treat some cancers and makes people appear similarly septic.

Throughout much of the last century, though, fever has generally been seen as a "bad thing" because of it's association with illness. Fevers are often associated with discomfort, and medications that lower fever make people feel better. This may be because of the lowering of the fever, or it may be because the medication reduces the production of substances that cause both the fever and the discomfort.

It has long been suspected, and some animal models have borne it out, that fever can be beneficial in helping improve some parameters of infection. No good studies, however, have shown any significant benefit in humans to allowing a fever to "run its course", and in children, fevers can cause seizures. In the hospital we often hold off on treating fevers in order to observe the course of a disease, but more often then not, we treat fevers to make people feel better.

But if you're a doctor-wannabe, you may look at this long history, ignore all of modern immunology, and take a child-like view of fever.

Immunology is endlessly fascinating. The general and specific responses we have evolved to protect ourselves from disease are incredibly complex. But some people have the ability to take that complexity and gum it down into a useless pablum. Dana Ullman ("Hahnemann's cognitively-impaired bulldog") thinks that because fever may be a beneficial adaptation, it is the key to fighting disease. In his mind, lowering a fever is akin to encouraging the disease.

CNN's Dr. Sanjay Gupta had a recent case of swine flu, and this is what Ullman had to say:

It is therefore no wonder that he became the sickest he has ever become. Taking drugs that suppress fever disables the body's own defenses in fighting infection. It is akin to unscrewing the warning oil pressure light in your car as a way to get rid of that irritating red signal. Such "treatment" is not curative, and in fact, it can lead to much more serious problems.

What an idiot. Gupta knows that ibuprofen won't treat the flu---just as he knows that ibuprofen is unlikely to delay his getting better.

Look, Dana, medicine is hard. You can't just decide some day to be an "expert"---that actually requires studying the hard-won scientific knowledge of those who came before you, not elaborating foolishly on any bubbe meise you hear about. And I'm not even touching his lauding of Royal Copeland, the homeopath who helped stand in the way of real infection control during the pandemic of 1918. If he is one of your heroes, you are reading the wrong books.

Look. Not everyone has the cognitive capacity or intellectual honesty to be a doctor---and that's OK. There's a lot of careers out there. It's OK to admit that there are people more qualified than you in a particular field. I'm not going to pretend to practice surgery, and Dana Ullman shouldn't pretend to understand human biology. It really is that simple.