Sweat it out
Your article on the benefits of not treating fever prompted a d茅j脿 vu moment for me (31 July, p 42). In 1972, a small group of chairs of US academic paediatric departments 鈥� and me, a youngster from Canada 鈥� took part in a three-day workshop entitled “Management of fever” at the Centers for Disease Control in Atlanta, Georgia.
It was decided that treatment for fever should not be implemented before a patient’s temperature reached 104 掳F (40 掳C). This was subsequently presented at my medical school, but with little effect. About a decade later, the paediatric residents also presented similar data to show that treatment below that level was rarely necessary, again to little effect. The chief obstacles were nurses and older physicians, who wanted to feel that they were providing treatment. At least we managed to get rid of the alcohol baths, cold baths and cold compresses.
As a retired paediatric gastroenterologist, I have seen a number of children treated repetitively with acetaminophen (paracetamol) but with inadequate fluid intake, who developed hepatic toxicity, and one liver transplant patient who eventually required a second new liver after acetaminophen management of a spiking fever.
I agree with your article wholeheartedly. Antipyretics like acetaminophen or ibuprofen may be used with discretion for evident discomfort, but fever has therapeutic effects in the body, and getting rid of it only requires the body to use a considerable amount of energy to push the temperature back up when the drug wears off.
Some hospital burns units raise the room temperature to about 28 掳C to help burns patients, who maintain a normal body temp of about 38 掳C while in the early stages of healing. Now that’s forward thinking.
From George Mills
The Zulus in South Africa were known, at the first sign of malarial fever, to cover themselves with blankets and skins and lie in the sun for a whole day, to raise their body temperature as high as possible. The claimed result was a full cure by the following day.
This type of treatment was recorded by writers like Henry Rider Haggard in his book King Solomon’s Mines. Having no idea they were recording unique medical practice, such authors simply threw in these observations as interesting background information to give an exotic flavour to the story.
Early missionary doctors like David Livingstone introduced western medicine and put a stop to these alternative treatments, which might yet be resurrected.
Topsham, Exeter, UK
Elusive particles
You report that results from the Tevatron collider rule out a Higgs boson between masses of 158 and 175 gigaelectronvolts (31 July, p 5). It is worth remembering that while the quantum-mechanical standard model of physics provides the favourite prediction of its existence, there are alternative, apparently rigorous theoretical models that do not depend on the existence of the Higgs at all. In particular, the work of theoretical physicist predicts instead a heavy proton at 193 GeV. In short, the eagerly awaited results of experiments at the Large Hadron Collider in CERN, near Geneva, Switzerland, have implications for more than just the standard model theory.
Golden opportunity
Hazel Muir’s article on using urine as a source of urea for hydrogen production suffers from a lack of a systems approach, or, as it is now known, joined-up thinking (21 August, p 37).
Large amounts of energy are used around the world to produce nitrogen fertilisers, be they based on ammonia or urea. It appears a better option to utilise the urea in urine as fertiliser, especially as there will be many other valuable trace elements present, and make other use of the power presently used for fertiliser production.
To deny is human
While Star Trek‘s Vulcans would have enjoyed your special report on denial (15 May, p 35), we humans prefer to read stories that allow us to relate to our world, rather than raw data quantifying it. Stories, illogical or not, are more digestible than figures and graphs.
Your report handles the practice of denial in a typically distant and analytical way, responding with incredulous frustration to people who cling to irrational views despite evidence to the contrary. Unless scientists can come to terms with the human condition, logic will continue to meet stiff opposition from concepts that have more emotional appeal.
History is full of examples of scientists denying ideas and discoveries 鈥� from tectonic plate movement to the platypus. Acknowledging and catering to our human tendencies need not mean surrendering the intellect.
From Joseph Oldaker
Sandra White tells us that denial is a “sophisticated and healthy” response, because it makes us feel better (12 June, p 26). How far can this go? Happily setting up the sunlounger as the tsunami rolls in? I think we are talking “human ostrich syndrome”.
Nuneaton, Warwickshire, UK
Serotonin by proxy
Linda Geddes reports that the long-term use of selective serotonin re-uptake inhibitors (SSRIs) in people with depression and panic disorder actually decreases serotonin levels through an unknown mechanism, rather than increasing them as traditionally thought (24 July, p 12).
In fact, the mechanism of this apparent decrease is well known. Since the effect of SSRIs on brain serotonin cannot yet be detected directly in living people, the work she was citing () measured not serotonin but its metabolite 5-HIAA, which is made inside neurons. Much of the brain’s 5-HIAA output is made from serotonin released to act on receptors and then taken up by the serotonin re-uptake pump, so it is a useful measure of the activity of serotonin neurons.
But once the re-uptake pump is blocked with an SSRI, serotonin can no longer get into the neuron to be metabolised. As a result, 5-HIAA output falls and can no longer give us any useful information about what is happening to serotonin out in the spaces between neuron synapses. Nonetheless, animal studies reliably demonstrate that SSRI treatment increases synaptic serotonin while decreasing 5-HIAA.
We already know that 5-HIAA falls in human cerebrospinal fluid after treatment with SSRIs, but the group Geddes refers to has pioneered the less invasive method of detecting 5-HIAA output into the blood passing through the brain.
The finding that 5-HIAA output was higher in depressed and anxious patients is exciting. It might be due to increased serotonin activity, but the fall after SSRIs does not indicate a return to normal because 5-HIAA no longer reflects synaptic serotonin.
Human intelligence
Timothy Taylor’s hypothesis that we will evolve to be less intelligent due to our reliance on technology (21 August, p 48) resonated with other New 杏吧原创 articles I have read on emotional intelligence, and “good old-fashioned artificial intelligence” 鈥� which relies on the idea that intelligence can be broken down into a series of modules. But none of the definitions of intelligence in these articles seems satisfactory to me (without even getting into the debates over consciousness).
It seems to me that in this whole area we are still at the “Here be monsters” stage in terms of the evolution of human understanding. If Taylor’s novel idea “that humans are going to continue to get less biologically intelligent” is a significant insight, that implies there is some quality in our mind above those covered by our current definitions of intelligence. This “supraconsciousness” may be directing the course of our mental evolution, shaping the potential in our minds that has hitherto been expressed as our biological and emotional intelligence.
From Leigh Jackson
The human brain is exceptionally large compared with that of other mammals, but not when compared with other primates, notes Alison Motluk (31 July, p 38).
A major difference between primates and other mammals lies, however, in the granular region of the prefrontal cortex, thought to be important for functions such as comprehension, planning and perception. This is present only in primates and is significantly larger in humans than in other species. Clearly, size 鈥� in the right place 鈥� does matter.
London, UK
Keep it dirty
You report the testing of graphene as a new antibacterial agent (31 July, p 19). I can’t help but feel we should be careful about exposing our cellular structure to materials that are harmful to other organisms, especially when we are unsure of the mechanisms by which they work.
We are all made of cells, and everything our cells come into contact with has the potential to do us harm as well as good. A good indicator that the outcome may be harmful is the action such materials and chemicals have on other organisms, and the death of those organisms by means we don’t understand should make us cry “be careful”, not “let’s wrap our food in this stuff”.
Happy contrasts
You report that depression decreases an individual’s perception of visual contrast (17 July, p 15). Is this a one-way link? Has anyone investigated the effect on depression of using differently coloured or polarised lenses to produce a greater contrast between the visual signals reaching the eyes?
For the record
鈥� We incorrectly named one of the companies involved in the development of the CliniHub portable disease detector. The company is XenBio Fluidics (28 August, p 19).
鈥� Further to the information we supplied on our Letters page about our neuromarketing study (21 August, p 26), we held a focus group for a selection of female New 杏吧原创 readers, which included discussion of cover designs.