President's Letter

Sir William Osler, the great guru of both medical practice and medical education in the latter part of the 19th century spent a lot of time pondering fevers. “Humanity has but three great enemies; Fever, famine and war; of these by far the greatest, by far the most terrible, is fever.”

But perhaps it’s time to revisit the other side of fever, the therapeutic side of pyrexia. Certainly there are specific disorders that are characterized by fever patterns. The idea of “night sweats” comes to mind immediately. Fevers come in many flavors, some spike while others are intermittent and still others are relapsing. Theoretically, fever has been retained during our evolution because of its advantage for host defense. Prior to antibiotics one recognized treatment of syphilis was “fever-therapy” instituted by the Viennese physician Wagner-Jauregg.  Starting around 1917, he demonstrated that infecting syphilitics with malaria and allowing up to 12 fever episodes would help produce remissions of syphilis.  Malaria therapy was later replaced by the Kettering electronic heat cabinet in the U.S. with comparable results. One can only imagine the reimbursement code quagmire for administering malaria as a therapeutic agent. That heat is an unbearable environment for some pathogens may have some bearing on the latest finding in the “fever effect.”

We learn (December 2007 issue of Pediatrics) that many parents of children with autism are reporting that during febrile periods their children exhibit fewer autistic-like behaviors. Dr. Laura Curran (lead author of the study) of Kennedy Krieger Institute in Baltimore provides, “And as the fever disappeared, their autistic behaviors returned.”  Without any known pathogens with autism it’s not the same effect that involved syphilis.  Researchers theorize that the answer probably relates to the communication systems in brain cells.  It may be that brain cell connections work better in the presence of small proteins called cytokines that are produced by the immune system (according to Dr. Andy Zimmerman). Obviously the behavioral response in the presence of elevated fevers in children with autism needs further research.

While the fever-autism connection should be of interest to members of the AADMD I’m introducing the concept of “raising the temperature to do some good” for another reason. Members of the American Academy of Developmental Medicine and Dentistry are both clinicians and advocates for their patients. It’s the “advocate” side of the AADMD that needs the “heat turned up” from time to time. We need to be reminded that there are economic, cultural, professional and political reasons why there are too few members in our ranks. We need to remember that we are all obligated not only to keep up with the latest scientific inroads as they relate to patient care but also to keep up with our efforts to ensure the success and growth of our goals. We need to turn up the heat in our areas of influence. We need to constantly be taking the temperature of curriculum committees, managed care organizations, medical and dental school strategic planners, professional societies and the legislative landscape to ascertain exactly what we’re up against. As Samuel Shem wrote in The House of God (one of the reading rights of passage for medical students in the late 70’s), “If you don’t take a temperature, you can’t find a fever.”

Whether it’s spirochetes, cytokines or indifference that you are trying to manage, it might be worth considering turning up the heat. A little help from an exogenous pyrogen may be just what the doctor ordered.

Dr. Rick Rader has served as the AADMD President since September 2006 and will continue to serve in this capacity for the remainder of his two-year term. Dr. Rader also serves as Director of the Orange Grover Center in Chattanooga, Tennessee.