« first day (1 day earlier)      last day (18 days later) » 

Narusan
Narusan
02:31
I'm very late to the party. From what I understand, @Lukas4235 your main initial question/argument is the following: Fever is a biological response to fight infection. As such, can this response ever be an over-reaction that one needs to treat?
Maybe first to show that in general, "physiological" responses to pathogens can turn dangerous themselves: It is now more or less accepted that severe cases of Covid-19 lead to a syndrome called cytokine storm, which is excessive release of pro-inflammatory cytokines by the immune system, which damages the lungs and causes acute respiratory failure. Immunosuppression increases survival in severe cases of Covid-19. This is an example where a viral infection is treated with immunosuppression
Narusan
Narusan
02:50
You are true that studies aiming to show that fever treatment significantly improves outcome were negative, i.e. nejm.org/doi/10.1056/NEJMoa1508375. However, in their trial design they set the power to 80%, meaning from the trial design itself there is a 20% chance that treating fever significantly improves outcome but the study did not detect it. To show with high confidence that a treatment does not have an effect, you usually need a much larger number than [cont'd]
Narusan
Narusan
03:06
to show that a treatment has an effect. Evolutionary speaking, the goal of fever is a sort-of arm's race to outlast a pathogen. It can be evolutionarily beneficial for the entire population if select individuals die due to excessive fever if this conveys better survival for the cohort. Evolution does not take into account modern medicine and stuff like antibiotics, which render the physiological effect of fever leading to an improved immune response sort-of obsolete.
You can also look at it the other way: Treating fever does not worsen outcomes due to (hypothetically) reducing the effectiveness of the immune system. Many patients with fevers are miserable and their quality of life generally improves upon reducing body temperature to reasonable amounts, so why not do it? Antipyretics are (usually) well tolerated. But you are right that fever treatment is not an absolute necessity for patients to recover.
Another good analogy is pain treatment. Pain is a biological response to a harm to tissue integrity [citation needed, for sure better definitions exist] which is biological/physiological. Yet we still treat it (because otherwise patients are miserable), and because in some setting the pain itself is harmful. Back pain caused by muscle tension often leads to a compensatory posture, which, in turn, exacerbates the tension and thereby worsens the pain
 
6 hours later…
Lukas4235
Lukas4235
09:30
thank you. This is just one study. Every review and every study ever done that I could find reached the same conclusion. In animals, adverse effects can be detected. I also noted that data don´t show adverse outcome in humans, but still can we be sure that in resistant strains or certain populations it might be problematic? or for long term clearance of pathogens? NSAID also interfere with antibody response, resolution factors, and thrombocyte aggregation, kidney function...
Cytokine storm is a truely good argument, which I also mentioned in my first answer to inflammation.
Also I got the impression that as I said its often treated just because, especially in children because parents don´t know better as those two reviews show.
The real unresolved question is whether hyperpyrexia is a different phenomenon than fever. Does antipyresis work here?
 
5 hours later…
anongoodnurse
anongoodnurse
14:30
You state you don't use absolutes. Just in this post alone (about hyperpyrexia):
- "When we analyze the literature we see unanimously that treating fever does not result in better outcomes." (You haven't read every study ever published...)
- "If I just ask without providing a context I´ll get the standard medical answer written **on every site.**" (Have you tried them all?)
- "I discussed with many other people and **they all were getting angry** hence my "warning". (Um, I've been following your posts. No one got angry with you. Not even me. You had a post deleted for giving medical advice…
-"...medical professionals still believe that a fever rises to hyperpyrexia if not treated with antipyresis." (I'm a medical professional and I don't believe that.)
- "...you are showing **no understanding at all**..."
-"**all the doctors I talk to and pharmacists** are certain that fever can get too high."
(How many is 'all' - have you spoken to hundreds of us? Or is it one? Two? Because I don't believe this is true of many professionals. In fact, I never heard this, **ever**, from anyone, until you stated this. (This is a true representation of my experience.)
This doesn't include the many comments which have been deleted in which you use absolutes, and in other posts (deleted or not) in which you use absolutes.
As I said, this weakens every statement you make, and in my case, it makes me unwilling to engage in a manner which takes a lot of time (writing a good answer.)
@Lukas4235
Lukas4235
Lukas4235
15:18
excuse me but there is sth as a scientific consensus. Yes we can never tell anything for sure but if the by far greatest amount of publications in humans and animals show no benefit it can be called unanimously no?
People getting angry has nothing to do with those posts here. This is my experience.
YOU exactly wrote that once fever gets too high it becomes hyperpyrexia aka a high fever?
Yes I get the impression that you wanna misunderstand me. After all you are complaining About my language rather than just answer a question. This whole Thing could have ended already with a simple Explanati…
All the people I talk to is my own experience. Could be two people or twenty and it´d still be correct. Its rather ignorant to disregard the papers analyzing this. Even if its 60 % of only parents its still concerning. And you should know that parental expectations also influences Treatment decisions. Or nurses, it seems that you just wanna prove you´re Right and disregard the whole literature on Fever phobia or overtreatment. The Researchers are all biased and making up Things Right?
But I am glad that I can just disregard all reviews on fever phobia, all papers on infection complications form NSAIDs etc. now, because a stranger on the web told me it does not reflect their experience.
Lukas4235
Lukas4235
15:33
Its like you saying NSAID help with pain and fever and I counter
"This is an absolute statement, there are many cases where it does not help...."
gotta notice that this is a ridiculous way of having an argument
 
3 hours later…
anongoodnurse
anongoodnurse
18:25
@Lukas4235 - No. Unanimous means all, not most.
I don't "wanna" misunderstand you. I don't "wanna" misunderstand anyone. But I do believe my words are being twisted (is that because you "wanna" do so?)
Yes, fever can reach the category of body temperature called hyperpyrexia. It's still a fever. It's a very high fever.
I'm very far from ignorant, and I am not ridiculous. If you think anything in this argument is ignorant or ridiculous, look inward.
You, too, are a stranger on the internet.
Lukas4235
Lukas4235
18:57
ok. So thats your view: it is physiological and still a controlled regulation meaning that both the heat producing system and heat dissipating system are in balance and our bodies kind of cook themselves.
I would have guessed that we have e.g. some interruption maybe by tissue damage of neurons that deactivate sympathetic nervous system

« first day (1 day earlier)      last day (18 days later) »