Take two aspirin and call me in the morning

Written By: admin - Mar• 01•11

I guess it was somewhere around thirty years ago that doctor’s started to report about aspirin, when given to children with viral infections, causing “Reye’s Syndrome.”  Not that it was overly publicized, to this day many parents likely have never heard of this often deadly complication from aspirin use in children.

About on the expected time frame, after mass marketing aspirin, tylenol and other antipyretics to children and adults for decades The American Academy of Pediatricians is issuing a report that maybe trying to lower a mild fever isn’t always the best course of action.

Sweating Out a Fever WSJ
New Advice for Fighting Fever in Children WebMD
Treat kids’ discomfort, not fevers: Pediatricians’ report says Reuters

and according to Google some 328 articles and blogs on the same theme over the past week.  According to Dr. Janice Sullivan, lead author of the report, per the above linked Reuters article, fever is not always a bad thing,

That’s because fever can be help (sic) fight illness, by slowing down the reproduction of bacteria and viruses or stimulating the body’s immune response.
“That’s a benefit of fever,” Sullivan said, “and may shorten the time that your child remains ill.”

From WebMD,

Fever is not a danger itself; it usually is a benefit,” Henry Bernstein, MD, chief of general pediatrics at the Cohen Children’s Medical Center of New York, says in an email.


Experts stress that a fever isn’t an illness, it’s a response, probably an evolutionary adaptation to help fight infection. Setting the body’s thermostat (the hypothalamus gland in the brain) a few degrees higher slows the reproduction of bacteria and viruses and boosts white blood cells.

Well up to this point I don’t have too much difficulty with the report.  Isn’t this, by the way, a very common point brought up by those critical of many conventional medicine approaches, that they only treat symptoms and often make the underlying disease worse.  Well, I guess the American Academy of Pediatrics is admitting that at least in this case they were absolutely right.

There is the inane simplification that “fever is not a danger itself” as though it is simply too difficult a concept for parents to ever grasp that while a low fever may be beneficial a high fever may be bad and even dangerous.  And yes fever itself may harm or kill, as one commenter on the WSJ article stated,

“I disagree with this post. My 13 month old had a fever with no other symptoms … in the car on the way home from Urgent Care, he started having seizures. We ended up on PICU for 4 days and was advised to keep his fevers controlled to prevent future febrile seizures. Neurologist and other doctors informed us, it was the fevers that caused the seizures.”

Febrile seizures are not remarkably uncommon.  However, where things take a turn for the worse is when we find the report looking to shift blame.  Again from WSJ, “The report, aimed at calming what it calls “fever phobia … ” or from Reuters, “A lot of families have fever phobia,” Claire McCarthy, a pediatrician at Children’s Hospital Boston, told Reuters Health. “What’s really important is making the child feel comfortable.”  Ahhh, “fever phobia” that’s it is it?  It’s not the physicians fault, its mentally ill parents.  Now I’m waiting for “fever phobia” to be classed as a mental disorder in the next release of the DSM, just in time for the release of “Once Daily Febrilia(Tm) – For Life.”  Stupid mentally ill parents, its amazing they ever figured out how to have kids in the first place.

Parents frequently give too much or not enough medication, Sullivan said. Her report stresses that dosing should be measured by weight, not age or height.”  Or this gem from WSJ, “Yet many beliefs about them (fevers) are based more on culture, tradition and playground chatter than scientific evidence. Ads showing parents fretting over thermometers confuse things further.”  Playground chatter?  Playground chatter, Really??  The kids or the parents?  Going with the kids who are being treated by the parents not vice versa, I know me and my buddies were always up for a good discussion of “fever lore and culture” down at the sandbox.  Ads showing parents fretting over thermometers?? first of all, I can’t recall one, secondly, uhhhhh who made that add?

I don’t want to be too overly critical of this recent report, it is certainly a step in the right direction and acknowledges the concerns that many critical of the medical industry have voiced for years.  Where I take issue with it is in the both the condescending tone and the unnecessary oversimplification.  The cynic in me wonders if there would be any official push-back against these drugs if they were still on patent or expensive.  In any event let me try and rewrite what I think the recent report may be trying to get across.

“We in the medical community and pharmaceutical industry over the past hundred years or so have created, developed and vigorously marketed a wide variety of antipyretics, aspirin, acetaminophen, ibuprofen etc.  We held and promoted the position that it was beneficial to take these drugs for any number of indications, even to the point that, “take two aspirin and call me in the morning” became the cliche response of physicians to any illness.   Well, it now has become clear that we went too far and in many cases our advice was just plain wrong, sorry.  We do epidemiological studies on all manner of medical minutae, there’s likely no point at this time in trying to go back and estimate the number of children we harmed or killed with our bad advice, suffice it to say we were in error.

Any parent obviously knows that a fever is a worrying sign of illness, and any fever should be paid close attention to, while additionally all efforts are made to heal the child’s underlying illness.  While we previously marketed antipyretics to reduce fever in children it is now clear that, if the fever is not overly high, such an approach may interfere with the bodies natural healing process.  Such reasoning of course does not apply only to children.

A very high fever is itself however, a long accepted and scientifically well documented sign of more serious illness, and may also by itself cause harm and interfere with healing.  Fevers may elevate rapidly which is again why we note that you are correct to keep a close eye on your child’s fever.  Another reason why one should be wary of attempting to lower a mild fever is that the drugs we have developed, advertised and prescribed for this purpose are far more dangerous then we first realized, again we are sorry, we believed we were doing good.  First we found the clear association of aspirin with Reye’s syndrome (a syndrome which is fatal in up to 30% of cases despite our best efforts), now we find that the largest percentage of pediatric toxic ingestion emergency room visits are caused by acetaminophen ingestion.  These drugs are powerful albeit dangerous medicines.  We realize that this is a great change from our previous position on such matters, though we felt it only necessary to prevent further possible harm.  Feel free to contact us if you have any level of concern over your precious child’s health, no matter how small.”

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  1. Susan Blake says:

    Hi Paul,
    Well just who is going to read this report? Parents? The people who should read it? You hit the nail on the head with its amazing they ever figured out how to have kids in the first place."

    I see all around me the scary ignorant parenting going on – going to insane degrees of protecting their kids and yet feeding them McD's 4 or more times a week, demanding anti-biotics for every little thing, and on and on. I don't think it helps that doctors don't seem to want to educate the parents – its great revenue!

    I've always said that there should be mandatory certification before one is allowed to have kids. Pity there isn't.


  2. Anonymous says:

    Well, I, for one, have seen the ad on TV showing the Mom holding a thermometer and fretting by saying "she's sick. What can I give her??" My question is: why do they feel they have to "give" the kids anything besides love, good food and a drink of clean water? Time is the best friend of a fever.

  3. Earthtonegirl says:

    Eagerly awaiting the next mind-blowing article you have in store…

  4. Anonymous says:

    Hi there,

    I have a inquiry for the webmaster/admin here at healthjournalclub.blogspot.com.

    Can I use part of the information from your post above if I provide a link back to this site?


  5. PDM says:

    Hi Susan,

    I do hear you, really however the main point I was trying to get across in the article is not that lots of parents are morons, it's that whenever the medical community changes its tune it never owns up to the fact that it was wrong. So instead of just saying "we have been to aggresively prescribing aspirin and other anti-pyretics", they, after pushing aspirin for fever for a century, now turn around and say the parents are mentally ill with "fever phobia" because they think its a good idea to treat their kids fever with aspirin. Why can't they (the pediatricians in this article) just own up to it and admit they are changing their position without insulting the parents?

    Perhaps the worst example of this "Blame the Parents" (BtP syndrome) or pyschopathology as it I like to call it was in the early days of autism when it was still rare and a number of health "experts" chose to blame the childs autism on poor parenting, emotionally distant mother's or worse. It wasn't until autism began to become so prevalent that these "experts" began to realize that gee if we keep up with this schtick of autism being caused by sexually frigid mothers we might piss off our whole customer base and have no business left at all. So that previously orthodox view as to the etiology of autism died a quiet and unheralded death.

    When I look at some of the treatments we use today certainly not aspirin but things like chemotherapy I do wonder if people in a more advanced future might look back and say, "gee what a dark terrible age, if I had my choice I would have went with the blood letting and leeches of the previous mellenia rather then the cruel nonsensical poisons of that age" I don't know maybe I'm being too dramatic.

  6. PDM says:

    Hi Anon,

    Maybe there are adds like that, I finally gave my TV the heave ho a few months back. But I think my other point is still valid, who is sponsoring these "She has a fever, what can I give her" adds? The same medical/pharmaceutical industry that has suddenly decided parents have fever phobia for actually buying into the past century of marketing aspirin and other anti-pyretics for fever? And really if a fever becomes overly high, along with serious medical attention one should look for appropriate means to keep it in check.

    I guess the whole other thing that really pisses me off about the tone and content of the articles I discussed is the implied notion that parents would somehow be phobic or irrational to pay close attention to their child with a fever. A fever is a reliable indicator that a child is sick. You are right the vast, vast majority of the time all that is needed is loving supportive care and something like tylenol or aspirin will just get in the way of healing.

    Then again, rarely though not extremely rarely, with a fast moving viral or bacterial infection one finds that a child is dead in 24-48 hours unless one moves at the drop of a hat. It is utterly irresponsible to coin a new "fever phobia" to imply parents are abnormal if they are concerned and attentive to their childs fever. All to cover the fact that pediatricians realize they were over marketing antipyretics in the past.

    Hell doctors don't make housecalls anymore, patients are routinely rushed, inconvenienced and looked down upon by physicians with the bedside manner of a brick, now it is somehow beneath a pediatrician to respond to parents concerns about their child's fever because they are being "fever phobic" bad parents to bother them. What would it take for an approriate consult with one's pediatrian, major blood loss, or is this just being hemophobic? Again I've been a bit dramatic but you get the idea.

  7. PDM says:

    Gee thx Earthtonegirl that's very sweet of you to say. Just for you I will try to have something about "Green Eggs and Ham" posted in the next day or two;-) If you ask me Dr. Seuss is pretty mind-blowing, don't you think?

  8. PDM says:

    Hi Peter,

    Yes, for this article if you link back to the site, the more the merrier. Though if you get a chance to drop me an e-mail and let me know what you are planning to use it in that would be a courtesy.