Philip A. Mackowiak, MD
Mackowiak PA. Fever: Blessing or Curse?. Ann Intern Med. 1994;121:984. doi: 10.7326/0003-4819-121-12-199412150-00041
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Published: Ann Intern Med. 1994;121(12):984.
I am grateful to each of the authors for their interest in my article and for their thought-provoking reflections on theories of evolution. Of the questions they raise in their letters, the most perplexing concerns the basic unit of evolution.
Dr. Schwam maintains that the basic unit of evolution is the gene. Genes certainly play a fundamental role in the process; however, the proposition that “genes making copies of themselves” is the essence of evolution, although provocative in its simplicity, does nothing to enhance our understanding of why some genetic traits survive and others disappear during evolution. It also does not explain why fever, a biological process controlled by many genes, protects the host in certain situations and harms it in others. Similarly, if survival of the individual is the essence of evolution, why would a physiologic response (fever), maintained for more than 400 million years of the evolutionary process, accelerate the demise of individuals with sepsis? Perhaps, as Dr. Ubel suggests, the occasional pernicious effects of fever simply reflect the fact that evolution is an imperfect process. I cannot disprove this hypothesis but find it intellectually unsatisfying.
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