With great interest, we read a series of letters discussing the
potential protective role of fevers in infection. 1-3 We would like to
point out that these theoretical and clinical considerations are not new,
but had been proposed and carefully studied. In addition, the presence of
potential benefits of symptoms is not unique in fever, but universal, and
may lead us to a better understanding of "health".
The first recognition of beneficial effects of fevers could track
back to the 1920s, when Julius Wagner Jauregg won the Nobel Prize in
Physiology or Medicine for his discovery of the therapeutic value of
malaria inoculation in the treatment of dementia paralytica. He was the
first scientist to provide evidence that inducing a fever could ameliorate
the severity of infectious diseases. With further studies, it was
recognized that moderate fevers indeed represented a type of host defence
response and could increase the survival rate of infected hosts 4,5.
The protective role of seemingly abnormal symptoms is not unique to
fever. Another common example is cough, which serves as an effective and
crucial means to eliminate mucus from the respiratory tract. Misuse of
antitussives in productive coughs may cause severe consequences including
asphyxia.
What we would like to emphasize, is that with these recent
publications and discussions, it is possibly the right time to call for a
re-evaluation ofthe meaning of "symptoms", "diseases", and "health".
World Health Organization defines health as "a state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity".6 In contrast, Georges Canguilhem rejected health
as a fixed entity that could be defined statistically or mechanistically,
but suggested that health represents a person's ability to adapt to his
environment.7,8 This proposal emphasize on the interdependence between
human beings and their psychological and social circumstances. In this
view, all symptoms and signs are no longer simple abnormalities, but
represent the body's adaptive responses to environmental changes. This
includes fevers as protection for infection and coughs for asphyxia. Of
course, these assumptions require further investigation. But we suggest
that laboratory and clinical scientists should pay more attention to the
potential adaptive and protective values of symptoms, rather than their
aversive features alone.
Rapid Response:
Adaptive and protective values of symptoms
With great interest, we read a series of letters discussing the
potential protective role of fevers in infection. 1-3 We would like to
point out that these theoretical and clinical considerations are not new,
but had been proposed and carefully studied. In addition, the presence of
potential benefits of symptoms is not unique in fever, but universal, and
may lead us to a better understanding of "health".
The first recognition of beneficial effects of fevers could track
back to the 1920s, when Julius Wagner Jauregg won the Nobel Prize in
Physiology or Medicine for his discovery of the therapeutic value of
malaria inoculation in the treatment of dementia paralytica. He was the
first scientist to provide evidence that inducing a fever could ameliorate
the severity of infectious diseases. With further studies, it was
recognized that moderate fevers indeed represented a type of host defence
response and could increase the survival rate of infected hosts 4,5.
The protective role of seemingly abnormal symptoms is not unique to
fever. Another common example is cough, which serves as an effective and
crucial means to eliminate mucus from the respiratory tract. Misuse of
antitussives in productive coughs may cause severe consequences including
asphyxia.
What we would like to emphasize, is that with these recent
publications and discussions, it is possibly the right time to call for a
re-evaluation ofthe meaning of "symptoms", "diseases", and "health".
World Health Organization defines health as "a state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity".6 In contrast, Georges Canguilhem rejected health
as a fixed entity that could be defined statistically or mechanistically,
but suggested that health represents a person's ability to adapt to his
environment.7,8 This proposal emphasize on the interdependence between
human beings and their psychological and social circumstances. In this
view, all symptoms and signs are no longer simple abnormalities, but
represent the body's adaptive responses to environmental changes. This
includes fevers as protection for infection and coughs for asphyxia. Of
course, these assumptions require further investigation. But we suggest
that laboratory and clinical scientists should pay more attention to the
potential adaptive and protective values of symptoms, rather than their
aversive features alone.
1. Fowler AW. Fever as nature's engine? BMJ 2009;339:b3874. (31
December.)
2. Dixon G, Booth C, Price E, Westran R, Turner M, Klein N. Part of
beneficial host response? BMJ 2010;340:c450. (26 January.)
3. Barlow G, Lillie P, Nathwani D, Davey P. Some clinical data. BMJ
2010;340:c905
4. Kluger MJ. Fever. Pediatrics 1980;66(5):720-4. (16 February.)
5. Kluger MJ, Kozak W, Conn CA, Leon LR, Soszynski D. Role of fever
in disease. Ann N Y Acad Sci 1998; 856:224-33.
6. Preamble to the Constitution of the World Health Organization as
adopted by the International Health Conference, New York, 19-22 June,
1946.
7. Canguilhem G. The Normal and the Pathological. Zone Books, U.S.
1991.
8. [No authors listed]. What is health? The ability to adapt. Lancet
2009. 373(9666): 781.
Competing interests:
None declared
Competing interests: No competing interests