SHOULD WE TREAT FEVER [in children]? Thread based on a quick literature search for personal interest's sake.
I'm either missing major pieces of evidence, or the #1 Finnish authority for health information gives strange advice. /1
I'm either missing major pieces of evidence, or the #1 Finnish authority for health information gives strange advice. /1
Some background: The aforementioned organisation, @DuodecimFi, disseminates information to doctors and the general public. Their article [terveyskirjasto.fi/terveyskirjast…] is v. positive towards fever reduction and says there are no adverse effects. /2 
According to Duodecim, you should use antipyretics (paracetamol, ibuprofen etc.) for fever higher than 38.7°C/101.7°F. In Helsinki, we also have consultation service which tells you that for 2-year-olds, you need to medically lower fever if ear measure reaches 37.8°C. /3
This strikes me as odd, because in my dissertation I'm studying these things called complex systems. They're characterised by shittons of interacting parts, and have mechanisms, function of which are often not immediately clear on the outset. /4
As if the amount of parts isn't enough, the outputs are not proportional to the inputs (screen cap from my pre-preprint)... /5
To get an idea about this, just google the functions of vermiform appendix, which my primary school teaching said was a useless remnant of evolutionary history.
Also, systems like this tend to self-repair. /6
Also, systems like this tend to self-repair. /6
What does the literature say? I don't have access to @DuodecimFi's reference #2, but the first one doesn't seem to support the info in the article much. /7
(nb. the fever treatment article also unconditionally recommends giving sugary drinks to counter dehydration, but that's a whole different conversation regarding the functions of appetite suppression during illness) /8
The American Academy of Pediatrics' article Fever and Antipyretic Use in Children (2011, reaffirmed 2016) [pediatrics.aappublications.org/content/127/3/…] describes fever as being likely beneficial, and underlines corresponding temp from heat exhaustion is a very different ordeal. /9
Widespread misunderstandings are discussed in an article called "Fever Literacy and Fever Phobia" [journals.sagepub.com/doi/full/10.11…] /10
A 2010 piece [onlinelibrary.wiley.com/doi/full/10.11… "Literature review: should antipyretic therapies routinely be administered to patient fever?" states this /11
Somewhere in the 2000's I started hearing that fever is useless, and this view was promoted forcefully in a first aid training I took in 2016. What do biologists think? What I thought was abandoned folk wisdom, still seemed to rule [journals.uchicago.edu/doi/full/10.10…] /12
But these are biologists, what do they know about clinical medicine? Same spirit is recounted in "Fever and hypothermia in systemic inflammation", Handbook of Clinical Neurology (2018) [sci-hub.tw/10.1016/B978-0…].
Nb. all these articles are available from sci-hub.tw!
Nb. all these articles are available from sci-hub.tw!
So, obviously I'm no MD and this was just a quick dig I took out of personal interest. But I'm ofc a bit agitated about the contradiction between what health professionals (incl. @DuodecimFi) tell me and what I found in the literature.
Is this an evidence of absence vs. absence of evidence thing? Did I miss major pieces of the puzzle? Have I misunderstood the whole cabal with this sleep deprived brain?!
If you're an MD in Finland (or could kindly tag one), help clear away my confusions!
If you're an MD in Finland (or could kindly tag one), help clear away my confusions!
I'm also curious about how fever is portrayed in other countries, especially in the case of children. Good? Bad? Ugly?
(ping @FredHasselman @dingding_peng @tkaiser_science)
(ping @FredHasselman @dingding_peng @tkaiser_science)
