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david price

Primum non nocere is the Latin phrase for "first, do no harm." But we are now at the point in our development of medicines that we are all in danger of doing harm without realizing it.

Our ability to produce new drugs and treatments is fast outstripping our understanding of the mechanisms of health and potential inadvertent consequences. Who would have thought that the simple giving of a fever reducing agent, to either one of our family members or ourselves before we go off to school or work, may inadvertently lead to the death of someone that we see that day?

A paper published in Proceedings of the Royal Society B by McMaster researchers David Earn, Paul Andrews and Benjamin Bolker has demonstrated that there is an important and surprising downside of many people taking fever reducing medication for influenza. Because lowering fever increases the amount of virus ill people give off, and because they feel better and interact more with others, they end up infecting more people. Consequently, when many of us take fever reducing medication, thousands more people end up becoming sick or dying.

Our body's ability to have a fever as a response to an infection has developed over millennia. Many of the viruses that infect us have a very narrow temperature window in which they can replicate. Make their environment too hot and they don't work as well or die. That environment, as shown by a number of researchers, is around 37 C. Our body's natural defence mechanism is to increase our temperature and thus limit the ability of these viruses to reproduce.

As a society, we have set up a perfect storm.

When we become infected with, for example, an influenza virus, we start to feel unwell, so we take the fever reducing drug and off we go to work or school and infect many of the folks around us.

Our illness lasts longer than we expect, and we realize that we are too sick to go to work. We then go to our doctor's office to get a note for our employer. We cough or sneeze in the waiting room and inadvertently infect the pregnant woman who sits in our seat 30 seconds after we have left. (Viruses are great at surviving in a droplet borne fashion in the air that we breathe.) Her illness may have devastating consequences for her unborn baby. Better that, as pointed out recently by Dr. Scott Wooder of the Ontario Medical Association, we aren't there in the first place collecting a sick note for the boss.

We already know this about antibiotics. There's a broad understanding now that we need to limit the use of antibiotics by individuals in order to ensure that they remain effective for the population.

We are always looking for that magic bullet, Ponce de Leon's fountain of youth, Harry Potter's elixir of life, etc. without realizing the consequences to the population overall. Time and again over my medical career, I have heard about the latest miracle, medicine or supplement that is going to stop us from getting ill or make us healthier for longer. But it all comes down to common sense; eat well, exercise, and sleep well.

This latest study is yet more evidence that we would do well to understand how things work before we try to intervene. Let's be smarter in how we approach illness in our society.

There are circumstances when taking fever-reducing medicine is beneficial; as always, these need to be individualized in conversation with a health care professional. But let's not encourage people to take drugs for their fever unless really required.

Mother Nature often knows best, as did our mothers. Stay at home; drink plenty of fluids and rest. You will feel better for it and you will likely get better as quickly or quicker than if you take medications.

You will save your money; you will save health system funds, and you might just save the life of a friend, family member or neighbour.

David Price is professor and chair of the Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University; and a Hamilton family physician.

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