Why would any real skeptic suggest pamol as a treatment to reduce fever? It’s standard medical practice, and has been used for decades, and THEREFORE, according to skeptics, is ASSUMED to be the truth.
There is no doubt paracetamol “works” by reducing fever. But does the word “proven” solely relate to whether a product does what the label says it will do? What about the underlying science about fever? There is a huge bolus of medical literature which makes plain the following:
1) Fever is an immunologically driven process which switches on various parts of the immune system, in order to give the person with a fever an adaptive advantage, as the fever speeds up the efficiency of getting rid of infectious pathogens. Therefore, when the immune system switches on fever, it is for the benefit of the host, and is the correct physiological response to infection. There are few “ifs” and “buts” about this fact.
2) Chemically suppressing fever decreases the ability of the immune system to work, and hands the adaptive over to the pathogen.
3) By giving the advantage to the infection, antifebrile drugs can INCREASE the severity of illness, and INCREASE the chances of dying.
And I'm not putting up links to pubmed URLS in this post, because skeptics should be able to find these in a twinkling of a rational skeptic eye!
(And most anyone else with a brain, already knows these URLS. Because we, the real skeptics usually have to have full text articles to defend ourselves from those physicians suffering from the disease mentioned in the bottom paragraph...)
Even the World Health Organisation knows, and admits this and publishes it on their website, so why is the use of PAMOL with fevers in anyone, actively supported, encouraged and implemented by doctors, nurses and hospital policy – and – as per the Sunday Star article, .... the SKEPTICS?
Everyone ASSUMES that the standard practice of chemically dousing a fever, is a scientifically proven and beneficial treatment, when it isn't.
Now for the medical speak: Last year, one of the medical profession’s experts on everything relating to infectious disease, Dr Robert Chen, wrote a Lancet editorial about a medical article, which showed that the use of paracetamol during vaccination, reduced the amount of antibodies after vaccination.
I wrote him this email:
Sent: Tuesday, 3 November 2009 9:09 PM To: 'firstname.lastname@example.org'; 'email@example.com'; 'firstname.lastname@example.org'; 'email@example.com'; 'firstname.lastname@example.org'; 'email@example.com' Subject: Vaccines and paracetamol, Lancet October 17, 2009.
Dear Dr Chen and Dr Prymula,
(I have copied in the editors of the Lancet, and the Lancet Infectious Diseases, because to me, this is, and has been, a very important issue, and it is time it was dealt with properly.)
Dr Chen: Your article in the 17 October 2009 Lancet says that the findings of Prymula that paracetamol significantly reduces the antibodies formed after some vaccines given to children, are surprising, and that he’s the first to examine the issue. Yes in humans, but not in animals or in a broader context.
Please find attached Ryan et al, 2006 (labelled HPV vax paracetamol) in which it was shown that paracetamol suppresses antibodies from Gardasil in mice. Please also find attached Yamaura et al 2002 (labelled p supp antib mice) which shows that the effect of paracetamol extends to mitogens as well as antibody suppression.
Please find Australian Prescriber in which Dr Shand discusses the effect of paracetamol on disease, and Shalabi’s two articles explaining how paracetamol down regulates the immune system in terms of disease.
Please find attached the WHO bulletins which comment on how paracetamol increases disease severity and death, and should not be used during infection.
Please access for yourself Plaisance 2000 ARCH INTERN MED/VOL 160, FEB 28, 2000 et al, discussing how the use of paracetamol with influenza increases the duration of the disease in humans by several days: clearly a function of immune suppression. I have attached a news media article about Plaisance 2000 Pharmacotherapy about the same topic (Which also begs the question as to why paracetamol is STILL routinely prescribed for the flu, particularly those for whom a longer duration could lead to serious complications).
The medical literature for over a decade now, has clearly described paracetamol as a potential immune suppressant, and it is probably this action which is behind the association between the use of paracetamol and the subsequently much greater risk of some babies getting asthma later in life. Paracetamol may suppress the way “tolerance” for normal antigens is developed in the neonate, in a similar way to derailing the immune system during infection and at vaccination times.
It is a surprise (to me) that paracetamol has not been banned for use where there is an infection, because of it’s known effects on the immune system.
If you were sick with the swine flu and had asthma or other conditions which could place you at risk, wouldn’t you want your immune system to work as well as possible ??!
Knowing that paracetamol derails the immune system, would you be happy if you knew (that your doctor didn’t know that) paracetamol might increase the severity of the flu and also your chances of dying?
Why is paracetamol always the first line medication for infections and the flu?
You talk about paracetamol’s importance in relation to other vaccines. Given that vaccines can interact, and antibody levels can drop for some diseases, when combined with other multiple vaccines, without paracetamol, it would seem that there are two issues intertwined issues here. The already known effects of paracetamol on the adaptive immune system in BOTH disease and vaccines, and the known interaction of vaccines, which can also drop antibodies. Both are separate, but relevant. As you add more vaccines, even without paracetamol, interactions can cause the same effect.
Dr Prymula: While you are the first to look at this issue in humans (Dr Chen, why did it take so long?) I was surprised that your paper did not contain any of the papers I have attached, since they add considerably to the immunological rationale.
In the light of Shalabi’s and others medical literature proving that paracetamol has a fundamental detrimental effect on the immune system (there are several older papers which show that the use of paracetamol in bacterial infections and meningitis, increases severity and mortality), and that paracetamol suppresses antibodies in mice… and after Gardasil, can either of you explain to me why paracetamol’s affect on the immune system came as a surprise to you, and why it is that you appear to be hesitant to describe the research on the mechanisms already uncovered?
I realise that that might broaden the issue out more to include infections as well, but perhaps it’s time for that to be done.
His reply follows:
From: Chen, Robert (Bob) (CDC/CCID/NCHHSTP) [mailto:rtc1@CDC.GOV] Sent: Wednesday, 4 November 2009 9:11 AM To: Hilary Butler; firstname.lastname@example.org; email@example.com; firstname.lastname@example.org; email@example.com; firstname.lastname@example.org Subject: RE: Vaccines and paracetamol, Lancet October 17, 2009.
Dear Ms. Butler,
Thank you for your email bringing this literature to my attention. Unfortunately results in animals are not always predictive of results in humans. Our commentary explained "why it took so long". A previous study of acetaminophen with whole cell pertussis vaccine showed there was no impact. So it was assumed that the same would be true of acellular pertussis (and other) vaccines. This may seem obvious in hindsight, but given limited resources, one has to prioritize which wheels you choose to reinvent given slight changes in understanding.
I suggest you make the case for your hypothesis on paracetamol's impact on the immune system in a peer reviewed journal.
I pointed out in return, that it’s ironic to be asked to do something which I’d already done, more than once, and each time, my articles were turned down.
After all, what medical school did I got to? What would a mere mother know, in comparison to these lofty “experts”? (Or skeptics for that matter). The use of the word “hypothesis” in relation to this issue is actually pretty insulting and dismissive.
What’s really sad is that in spite of the fact that the medical literature contains more than any rational sane person would want to know which would stop them using paracetamol to treat fever, the current dogma continues to be; “Got a fever? Ram down paracetamol!” to which some skeptics assume is fact, and cheerfully, thoughtlessly, subscribe.
If you turn up sick at hospital, and refuse to use paracetamol, you are treated like some sort of uncaring criminal, who doesn’t want to “ease” the discomfort fever causes.
This quote from the American Scientist, Volume 82, November – December 1994, page 524, in an article written by Linus Pauling about vitamin C, would seem applicable to the paracetamol topic as well:
“Physicians of course, are a bit more skeptical and outspoken, and, in general, they don’t have the background of knowledge…. They don’t know enough to say that he has been successful so often in the past that he’s probably right this time. Physicians don’t try to form opinions of this sort anyway. They just do what the medical authorities say to do. Of all of the professions, the medical profession is the one in which the individual practitioners do the smallest amount of thinking for themselves.”
Given that skeptics unquestioningly believe unquestioning physicians about the use of Pamol in fever, where does that leave the thinking of skeptics?