The most revolutionary idea I learned as a student at the National College of Naturopathic Medicine back in the day was that fever is good. Fever is Nature’s reaction to infection, and our best course of action is to ‘let it ride,’ an expression that I don’t recall using until I read it in Gurdev Parmar’s new book, Arming the Immune System. As naturopathic doctors we learned to encourage a fever. It was the most important topic Anna MacIntosh taught us in our first year of study.

As I recall it, Dr MacIntosh’s class was about how to read and critique scientific papers. Nevertheless, she had us read the famous lizard paper, the one that describes how lizards, fish, and other cold-blooded animals move to the heated portion of their terrariums or aquariums when infected by bacteria in order to raise their body temperatures so as to mimic the endogenously triggered fevers in warm-blooded animals. Fever is a universal strategy that higher organisms employ to fight infection, a technique of immune stimulation that has been conserved in evolution since almost the beginning of life.

The term ‘revolutionary’ might not be appropriate to describe such a conservative strategy, yet our naturopathic approach to encouraging fever seemed revolutionary when it was introduced in comparison to the commonly held view that fever should be suppressed. Up until then, I was of the modern school of thought that viewed fever as potentially dangerous and best suppressed with antipyretic measures.

The benefits of fever are the focus of our colleague Gurdev Parmar’s new book, Arming the Immune System. Really, fever is pretty much what the entire book is about. Dr. Parmar describes the fever research in greater detail than we touched on during naturopathic training, in part because much of what he has to tell us is new research.

For those of you who are unfamiliar with Gurdev’s naturopathic practice, he specializes in naturopathic oncology and is best known for treating his patients with hyperthermia, localized and whole-body hyperthermia. In fact, he is chiefly responsible for introducing hyperthermia treatments to modern naturopathic oncology and has likely supervised more hyperthermic treatments than not just any other naturopathic doctor in North America but likely more than all of us put together. Yet this aspect of his experience is barely touched on in his book. I had hoped to read more information gained from his experience.

Instead of being a book written for his friends and colleagues eager to learn from him, it feels like the book is targeted for a general audience who Dr. Parmar wants to convince of the benefits of fever in fighting disease. His writing style has been dumbed down considerably from the precise diction we appreciated in the Textbook of Naturopathic Oncology, which Dr Parmer was the driving force behind, into a style of chummy familiarity that pushes the limits of informality. I confess that I may sometimes be guilty of similar lapses, such as referring to authors of scientific papers as ‘guys’, but usually one of my diligent editors will catch me doing so and correct my choice of words. Simplifying one’s choices in words to be more understandable to those lacking an advanced medical education requires more than referring to individuals as ‘guys’ and a plurality of specific things as ‘stuff.’ As much as the book seems to be carefully written, it lacks the polishing touch of an editor and professional proofreader. Perhaps this is a matter of economy, but I found myself reading with a red pencil in hand so I might circle errors. But that’s me and I hope others aren’t so cursed with a similar habit. Really, I am not the one to talk about this, guilty as I often am of sloppy writing myself.

Fever and hyperthermia are not exactly the same thing. A fever is an endogenous response in the body to a perceived threat, usually an infection, in which the body’s temperature set point is increased so that body temperature rises. Hyperthermia is when the body’s internal temperature is increased by an external heat source, and normal compensatory measures are insufficient to prevent overheating. Hyperthermia is perhaps closer to heatstroke than a fever. A naturally triggered fever may have more benefit in fighting infection or cancer than artificially induced hyperthermia. Various techniques have been used over the centuries to trigger fever responses. Perhaps the best known are the cancer treatments of a century ago pioneered by William Coley, who used live pathogenic bacteria to trigger infections and fever, or he employed bacterial extracts that he called ‘toxins’ to fool the body into thinking an infection was present. In his book, Parmar provides one of the most complete histories of Coley’s contributions to cancer treatment that I have yet had the pleasure of reading. He goes on to put these techniques into the context of modern immunotherapy treatments.

What I would have enjoyed reading would have been a similar history of the development and use of the hyperthermia treatments Parmar uses in his clinic, in particular, how Dr. Parmar became so interested in these techniques, and more about both his experience and the research he has conducted on such artificial fevers. I had assumed prior to reading that Parmar’s book would turn into something of a sales-pitch for his clinic, but he refused to go there. Oddly enough I find myself disappointed that he didn’t. I was hoping that I would have been able to hand cancer patients this book to read and when finished or even before they were finished, they would be sold on the potential benefit of hyperthermia therapy and be making plans to go see Gurdev or be trying some DIY technique to induce hyperthermia at home, using some combination of sauna, herbs, hot tubs, or infrared heating pads. If it was a sales pitch, it was way too soft a sell and lacked any tangible push to close the sale. Gurdev, for all his success in practice, turns out to be a humble guy and not quite the self-promoter.

The wholehearted support for ‘letting fevers ride’, that is not suppressing the body’s natural inclination to run a fever, is welcome to a point. There are two concerns regarding fever that I would have preferred to see addressed early on. The first is the long-standing belief that high fevers in infants may trigger febrile seizures. The second are the fevers that may occur in neutropenic cancer patients whose immune defenses have been trashed by chemotherapy. Dr. Parmar does address concern over febrile seizures adequately but late into the book, at a point that a concerned parent may have already put the book down. If Gurdev touched on the concern of neutropenic fevers in cancer patients, I must have missed it. Do we want our cancer patients to catch some sort of infection and run a fever during the course of treatment? I am not sure. I have a long list of questions in this regard and would have liked to read more specific responses as to where Dr. Parmar’s opinions point.

In the past I have found fault in the literary contributions of colleagues because they or their publishers have, in order to save on printing costs, omitted references. This is not a problem here; in fact, Gurdev has done a superb job, including citations for every study and key idea he mentions. If I were to complain about anything, and those who know me expect I pretty much always will find fault somewhere, it is that the book ends too soon. Summing up what’s written, basically Gurdev tells us that ‘fever is good, it arms the immune system to fight infection and cancer, and therefore we should not suppress fever.’ But that’s where his book ends. Gurdev does bring up a tantalizing suggestion that perhaps our modern efforts to suppress fever may contribute to our modern preponderance of immune disorders and ongoing elevated cancer incidence. That’s where the book ends. Perhaps there is a second book on the way. I’m hoping so as there is certainly more to this story.