Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Body Temperature

Episode Date: February 10, 2020

This week on Sawbones, things are getting hot! Well, no, come to think of it, they’re doing the opposite. They’re getting colder. And by “they” we mean “we.” We’re getting colder, all of us. Probably. What should you do about it? Nothing. For now, you’ll just have to -- wait for it -- chill.Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We saw through the broken glass and had ourselves a look around.

Some medicines, some medicines that escalate my cop for the mouth. Wow! Hello everybody and welcome to Saw Bones, a marital tour of misguided medicine. I'm your co-host, just macaroid. And I'm Sydney Macaroid. You know, sit there certain constants in life that you tend to depend on. Constance, like in the alphabet. Yeah, like Q and S. I like that one. S is a good one. A lot of S's out there. Have you been seeing this? A lot of S's. there. Have you been seeing this? Lot of S's? Yeah. No. Constance that you depend on, things in the university,

the sun rises in the east and sets in the west, etc. Like Desmond. Like Desmond, you're constant. Yes, exactly. Lost humor. Just. There's somebody out there who appreciated that.

There are two people who are loving this right now. But in somebody out there who created the, there's two people who are loving this right now. But in medicine, which is always evolving, there's there's constantly you rely on. And but recently, one of those has been upended, you were timing. Yes, that's true. You've probably seen, there's been a lot of articles in the news recently that we have certain things that we always know to be true about the human body. There's so much we don't know, and we talk about that a lot on the show that there's so many things that we still sort of understand, but not really. But we have relied on the fact that the inside of your mouth is a steamy 98.6 degrees.

What commercial is that for? I don't know. Like a gum one. Probably. Anyway, we have relied on the idea that that that is the human body temperature. 98.6 degrees Fahrenheit, 37 degrees Celsius in case you're a fan of Celsius. I always remember it with the band 98 degrees and six degrees of Kevin Bacon. So 98 degrees, you can't just remember.

And then 98.6, that's the, the, what's together. Or 37. Okay, here she goes, folks. First, you asked a socialized medicine and now she wants to bring metric into it. I don't think I've allowed in that,

but we've always relied on that being true. And from that stems a lot of like what when is your temperature too low and when is your temperature too high and what is a fever. And now here the all these articles are out there that are calling that into question. And so we've had a lot of people tweeting and posting on our Facebook page and emailing to ask is this true? What do we do? How do we react? Everything is so frightening right now.

It's 2020. Trying time. We cannot rely on anything anymore. What do we do? Even in some of the doctor groups I'm in, there's been like, there's been a lot of people. What do we do with this information? How do we interpret it? Do you have better talk about sports?

So I'm assuming there's kind of default to the... We usually talk about doctor stuff. Yeah, I can. Sure. Thank you to Annie and Erica and Jordan and Lena for emailing about it. I know a lot of other people have tweeted in such, but I always check the emails.

That's where I get the. In case I don't thank you for a tweet, that's why. Anyway, we have discussed- That's not why that email is sawbonesatmaximumfund.org. We don't say it a lot. That's true. We should say it more. We have talked about fevers before. We've done a whole episode on fevers and what they mean, what their use is, what they could, what their purpose could be in the human body. And then the use of a fever is medicine, but we've never really dove into where did we come up? How do we have a body? Why do we know what our body temperature should be?

Where did we get that information? Who figured that out the first time and wrote that down? And why is that become such a kind of a law that it extends beyond medicine. It's just like common knowledge. Right. And of course in addition, if things are changing, what will that mean? What does that mean for us? So before we use thermometers, before there were thermometers, we measured temperature in medicine anyway by, well, you know, the way probably your parent has checked your temperature before.

Up the butt. What? Putting the thermometer up the butt, right? No, this is before thermometers. Oh. Justine. Oh, hand on the head then. Got it. I thought you meant before like digital because you can't put the

digital ones in your butt. I don't think. Okay. How many, how long are we going to talk about rectal thermometers in this episode? I don't know. You're the first one to mention them. So if there's a scoreboard, it's in the one Justin zero. We we tend to measure temperature when we don't have a thermometer or before humans had them by touching someone and seeing if they feel hot, which is still the way my mother insists on doing it because she refuses to own a thermometer to own a thermometer. Folks, we've brought them to their house and they just disappear. It's wild. Because she can tell if she touches you, if you have a fever. Right, a human thermometer.

On a side note, we actually, specifically, in studies that have looked at a maternal figures, maternal temperature measurement, we aren't terrible at this. Okay. Like, humans aren't actually as bad as you'd think as telling if someone has a fever just from touching them. There have been studies on this. Multiple studies throughout the decades, ever since the 50s, where we have largely based

on the idea of a mom feeling a child and trying to tell if they're febrile or not. But they did a meta-analysis of 10 of the most well-done studies in 2008. It was encompassed 3,694 children. What they found is that the sensitivity of diagnosing a fever based on touch, based on, I mean, again, a lot of these studies where a mom feeling their child to see if they thought they had a fever, range from 70 to 97%. What this, and when the, that's different, by the way, from the specificity, which was

a lot wider, 19 to 90%. And let me break that down. What that means is that we are pretty good at ruling out a fever, on include myself as a maternal unit myself. We are pretty good, about 89% good at touching a kid and saying, no, there's not a fever here. But when it comes to ruling in a fever, here, but when it comes to ruling in a fever, is this indeed, does this kid have a fever, or about 50-50? Okay. So, I thought that was very interesting.

Probably because of the range, right, between like, febrile and normal, right? Yes. You tell if it's above normal, but not necessarily febrile or not. And also, we are pretty good at feeling a kid and going, now, this kid does not have a fever. So I thought that was pretty interesting that actually maternal touch is not completely. And I think you could extrapolate that to paternal touch or parental touch or guardian touch. Well, these studies, they date back to the 50s.

And so I think a lot of them just make sense. Yeah, focused on that relationship, but um, but certainly I think you could extrapolate that to legal for dad's check their kids temperature. You could probably extrapolate that not just to children, but to people touching, you know, to adults touching each other to see if they have favors. But anyway, um, authormometer is preferable, especially if you're trying to make like a big major, do I go to the ER or not kind of decision? I'd say authorm thermometer is a better way to do that than touching someone's forehead, which if you're going to do it use the back of your hand

please. That's the you get a better more accurate feel. Okay. But get a thermometer. Just buy the thermometer. So the idea that we should use a device to measure temperature is obviously a very old one because it's uses expand far beyond medicine, right? Like that's not the only time we need to measure the temperature of something is when it's a human body. There are lots of situations in which knowing the temperature of anything. I mean candy making right there. There you go. Cooking meat. Good. Yes, important. I'd rather have well cooked meat than underdone candy, I guess. I'm certain there are many industrial examples that we will we would not approvingly. Imagine in this case we're noting some of those that we're aware of. And the idea that you could maybe use the expansion and contraction of a substance as that relates to temperature

in order to define an amount of heat, like something expanding and contracting, when it's heated and cooled, to tell you how hot or cold it is. That idea dates back to ancient Greece. And you see throughout history, all these attempts by different scientists to try to construct something that would accurately do this every time, and would give you precise results so that you could repeat it over and over.

And this water is always this temperature no matter how many times I dip this thermometer in it. A lot of these were made using water and air, and you can find all different, I mean, like Galileo had a version of a thermometer of sort of thermoscope, really, Santorio, Ferdinando de Medici. different, I mean like Galileo had a version of a thermometer of sort of thermoscope really Santorio, Ferdinando Dima-Dici, there are all these different scientists who created these devices, but they weren't standardized. There was no scale yet, like what did that amount of heat mean?

There was no there was no Fahrenheit yet to name it. So it was like very hot too hot. No, no, yeah. So there was no scale. It wasn't standardized and they mixed because they were using like air and water and a lot of these devices. They actually pressure would also influence the movement inside the devices. So it was both a barometer and what we would call probably a thermoscope. So these were not really great at measuring just temperature yet. There was one that was made with brandy that saw for this a little bit, but we still don't see a more reliable thermometer until 1714 when Daniel Fahrenheit makes one using mercury. And that's when we start to see it's a device

that can be used more precisely. What are the odds, by the way, that a guy named Daniel Fahrenheit would make a thermometer. That is wild. That's the guy's to show you folks. He never know. Well, fate, mystery, it's all out there.

Well, I mean, weird. In the years that fall, we're just going to let that go. In the years that followed, physicians started using these devices in clinical practice, started to get the idea that we already had the concept of a fever, right? And we talk about in the fever episode. It took us a long time to figure out the fever as a symptom

and not a disease in and of itself. But we understood that it was associated with a disease state. Sure, right. And so we saw some utility in trying to accurately tell if someone's temperature was elevated or not. And so thermometers entered medical practice. temperature was elevated or not. And so thermometers entered medical practice. Borhav was the first one to use it regularly

in clinical practice. You may remember him. My die. Of ruptured esophagus fame. Oh my, my. Borhav syndrome. That borhav? When you're in esophagus ruptures,

that's what we call it for that borhav. They're a handful of medical professionals who email me after things like this on our episodes that really appreciate it. You know who you are, these jokes are for you. Yes. I hope those emails come of free coupons to the asthma store. Anyway, they're the same ones that were very excited when I talked about ringer in the lactate, ringers, lactated ringers. Anyway, it is important to note that these thermometers were not easy to use when we're talking about patients. This is one thing if you're dipping it into a vat of like candy that you're making, right?

Like the candy, you don't have to ask it to hold still or anything. It's just there. You can kind of probably attach it to something. You don't have to ask it to hold still or anything. It's just there. You can probably attach it to something. You don't have to hold it. But these instruments could be up to a foot long. They were anywhere from like nine to 12 inches long, and they took about 20 minutes to register a temperature. Dang.

That's a long time to hold your butts. And you were usually putting it under the arm, an axillary temperature. Okay. And you... Less accurate we were usually putting it under the arm, an axillary temperature. Okay. And you, yes, tends to measure lower. And you had to hold it, like I said, you had to hold it there for about 20 minutes, and you had to read it in its position. You had to keep it, it wasn't like something where you could like take it out and look at it.

As soon as you took it out, it would start to change. So you had to read it wherever, right in the armpit, get right in there. No, it was just, I mean, it was a cumbersome device to use. I feel like mercury thermometer, by the way, are the thing, one of the things that like, separate us from the current generation of young people. Like I feel like if you had to,

I have such unpleasant memories of having to hold this gross glass tube underneath my tongue for extended periods of time. This is seldom, can I buy them on Amazon right now? I'm sure you can, I'm sure you can. They haven't just completely done away with them. No. I guess you can, I guess you need to still get one.

You can still get them. I have never used one like in an office or yeah, hospital setting because now we just all use the very digital varieties. So- Looks like mercury is not as popular anymore. Even the liquid and glass ones are, it looks like there's less mercury out there. Well although most people aren't going to accidentally break them, you can. Sure.

That was always my fear that I'd bite it in half and drink a bunch of mercury. I do not think you were the only child that had that fear. Okay, good, good to know. So these devices that I'm describing are the ones that Carl Reinhold August Wunderlich, I wanna say, probably that I listened to it. I think I'm saying it right.

Okay. Would use... It doesn't sound like you want to say. It sounds like you don't want to say. It sounds like you want to call him Carl. I don't call him Dr. Carl. No. Wonderlick is what I would, in my American English say. Would you succonduct his landmark study on what is the temperature of a human? What temperature are we? And Dr. Wunderlich was a, he was a German physician

from the mid 1800s. And like I said, he wasn't the first one to use a thermometer in clinical practice, but he was one of the first ones to say, well, I mean, this is cool, we can do this, but what do these numbers mean? We don't have any kind of standard, like what's the reference?

Your temperatures 99, okay. Next, you know, what do we do with that information? So he was the first one to put all that together. So some things about this physician, so that we kind of know what kind of fella he was. He practiced internal medicine and psychiatry, and he wrote in defense even before his kind of landmark work. The thing he is most well known for, I would say, is this

temperature stuff we're going to talk about. Even before then, he wrote in defense of the scientific method a lot, which I mean, I like. Yes, it's weird that he has to do that, but I guess the 1820. At this point in medicine, it's really interesting. It was kind of a crossroads for the practice of medicine in terms of, should we be more philosophical in our approach to medicine, which is how doctors had practiced since the beginning of history, and kind of like diseases and diagnoses and treatments

should fit into these like high-minded kind of theoretical views about the human body and the human psyche and like our place on earth and all these things or art versus science Right or should we just like study things figure out what works and do that and he was a strong believer and Introducing the scientific method to medical practice which does not sound like it should be. Revolutionary. Yeah, right. But was. Then he, like I said, wrote articles, begging other doctors, like, could we do the science, like, science-like?

Could we be scientists, please? Thank you. And one of the ways in which he sought to improve medicine as a science was by using standardized devices know, standardized devices to measure and record things to observe and record. That's part of scientific method, right? So he used the thermometer to to standardize what our understanding of a normal human body temperature is in order for us to further define what an abnormal human body temperature is. And he did this by measuring lots and lots and lots of temperatures.

Everybody's got a temperature. Everybody's got. That's true. Five minutes or 20 minutes. 20 minutes, 20 minutes. That's the thing. That's the thing you have to remember. So when he collected all this data that he would eventually publish, he was using one of these, there's one in the Mutter Museum, you can look at now if you are interested in Philadelphia.

They have one of his actual thermometers that he used. Obviously there was more than one. That's the one they have on display, I think is like nine inches long, but the instruments could be anywhere from nine to 12 inches They would measure they would try to measure every patient twice a day Like I said these were axillary so under the armpit temperatures and about 20 minutes a pop for these measurements taken While they were in position

So a cumbersome Process to collect all this data Because he did this for about 25,000 patients. So a lot, a lot, a lot of data. I mean, really, if you start thinking about for anyone out there who does like data analysis, statistical analysis, how many numbers he was compiling with paper and pen.

I mean, that's how he was doing this. He was just writing all this down. And so he collected all this data, and in 1868, he published his work on the subject that literally translated from the German was the behavior of self-heat and disease, or when it was published in English, on the temperature and diseases

a manual of medical thermometry. And in this landmark work published in 1868, he defined a normal human body temperature as 98.6 degrees Fahrenheit or 37 degrees Celsius. In addition, he made some other, you know, there were a lot of observations about human temperature. This is the most well known, but he also noted that our temperatures tend to be lower in the morning, so your body will hit its low between 2 and 8 a.m. and it will be higher in the evening, so sometime between 4 and 9 p.m., your body temperature is the highest.

Generally speaking, he found that women had higher body temperatures than men. He also thought that women's temperatures could fluctuate more readily. And old people tend to have lower temperatures than younger people. He also within this work defined a fever as a temperature of 100.4 Fahrenheit or 38 degrees Celsius. I wonder how old that definition is.

I wonder how he did the second one. The first one makes sense. It's just average. But the second one seems like you're kind of making a little bit more of a, I mean, your own sort of distinction there. It's a centigrade higher than normal. It makes more sense. It all tells us so much easier to keep track of.

If you, yeah, if you go Celsius. Yeah. Yeah. So it's Celsius is metric, right? I don't have that wrong, do I? No, that's metric. It's metric. Okay, good. Yeah, it's so 37 as normal, 38 as a fever. That's according to Underlick and this study from 1868

and this definition, as I said in the fever episode, exists today. This is still what we are teaching at maybe at this very moment in medical schools across the country, across the world, 100.4 or 38 depending on where you are. How did it all get messed up? Well, I want to dig into all this data to help us understand why this is in question, but before we do that, let's go to the billing department. Let's go.

The medicines, the medicines that ask you let my God before the mouth. Okay. All right, so how do we continue to look at this data? That is way older than I thought it would be? Yes. So there are obviously some issues that I've already kind of alluded to that you may, if

you are someone like me who every time I read a study, I start trying to look for holes on it, not because I'm a skeptic, but because I want to make sure that I can believe all the data that's being presented and the conclusions that are being presented and the stuff that is in there actually leads to the conclusions at the end of the paper. That's important to know. And there are some issues. First of all, of course, axillary temps are not... The axilla taking a temperature under the armpit is not the preferred method.

So already, my doctor mind was going, well, it's not the best way to take a temperature. But if I'm doing this episode because there's data that shows perhaps the human body temperature is actually lower than we suspected, then the axillary temperature should have been lower, not higher. Right. So already, this has thrown off a little bit. Reading the device twice a day, 20 minutes in place. I mean, it was all very cumbersome to collect that data. But you would assume that 25,000 people that that would equal equalize with that many different.

You would assume, now he did have a fairly large margin of error. He felt that half a degree centigrade or 0.9 Fahrenheit wiggle room was allowed. Yes, that is a considerable amount of wiggle room when we start talking about what we think that the human body temperature actually is. I mean, we're not talking about giant fluctuations, necessarily in terms of sheer numbers. It's what does it mean that it's more compelling. But there's also, as I said, a statistical point to be made. How do you analyze 25,000 patients' worth of data without a computer?

Hmm. Just hard to do the actual math. I mean, I'm not saying you can't. Of course, people did. Of course, people function before computers. But it's a lot harder to decide, do I have a representative sample? Am I making sure, I mean, he was checking

both sick and healthy people randomly. How can he make sure that he got an even split of genders, that he got an even split of ages, that he got an even split of healthy and sick people of different times of day, of different things like day, of different, you know, things like throughout a menstrual cycle that can influence temperature or pregnant or not, pregnant or all these different things that can influence a body temperature. How do we know that he got

an even split in a representative sample? Those are hard, that's hard analysis to do with pencil and paper, and especially at this point in history So all the the ways that we analyze data when we collect a ton of numbers and then try to make conclusions from them A lot of those statistical methods of analysis had really Become set in place in the 1830s We're not that far out from then at this point and so so the idea that they would be in widespread, easy use by Vundo Lick and all of his researchers that he must have had working with them. I mean, he couldn't have done all this alone.

There's a lot of armpits for one. This would be very difficult to do. And again, that's not me saying it's impossible. Clearly, people collected and analyzed data before they had a computer to do it. But it would have been quite a challenge. And the idea that there is error in those numbers is not wild to think. You know, it's not a stretch to say, well, maybe the result aren't quite as reliable as we thought.

Which is why, I mean, really by the 1980s, people were starting to ask, did we get this right? Is this really, is 98.6 really the average body temperature? Is 100.4 really a fever? Should we really trust this data or maybe since it's been a while, should we check it, check it again, check again, check again. Check again. Let's just check again. And I think it's interesting because he was so committed to the scientific method and because he really did try to do the best he could with the tools and the instruments

he had of the day. A lot of researchers were kind of daunted by the number of participants they'd have to have in a study to confirm or deny the results. Right. I mean, he did 25,000 patients. That's a lot. That's a lot. That's a lot of people.

And so a lot of researchers were kind of reluctant to tackle this. So we start to see smaller studies to try to reproduce these results back in the 90s is when you first start to see people saying like, well, what's an easy place to start? I mean, let's take some temperatures and average amount and see where we're getting. And in smaller groups of studies seem to indicate that maybe 98.6 isn't completely accurate. And so the first thought was, well, maybe it was the instrument.

Maybe thermometers are different. Maybe they're better now. I'm certainly they're better now. So why don't we get that Thermometer from the Motor Museum and Check it out how well we just get it and we measure some stuff with it And we use a modern thermometer next to it Yeah, that makes sense. Yeah, right and see how accurate it is

Yeah, I guess though I would worry that like something is chameleon it's very old at this point, right? It's a very old thermometer. I would worry that like something could have changed about the thermometer itself. What could have changed us and what what would have been made of these old thermometers? Glass. Yeah. The mercury got old in it. Well, yes, but the glass. I mean, the glass is the thing here. What? I don't know, it's good. Glass can change over time. That's true, because it's all sand. It's all hard sand moving around. It's good. The sand moving around.

You're thinking more critically. This is a first. This is as close to a compliment as you get. I'm going to say for the moment, please continue. I appreciate that you're thinking that way, because that is exactly one of the thoughts. So they did this. Let me start with they did this study.

They took the thermometer that they have at the Mooter Museum and they, in the 90s and some researchers used some standardized temperature water baths. We know exactly what temperature this water bath is and let's measure it with this thermometer and we can compare it to a modern thermometer and see how close we can get. And the old thermometer that Vunderlick would have used was did measure higher consistently, they found higher than the temperature. Okay.

So that was very interesting data. And so then some people said, well, that's the problem then. That's why we've had it wrong all these years, because the thermometer's wrong. The thermometer were wrong. That seems to be an easy solution to this question. Now, what you said, though, is true.

A lot of researchers noted glass does change over time. The smallest change in the size of the bulb could change what the eventual result on the thermometer, what the reading would be. This is a really old thermometer. Are we sure it wasn't more accurate, you know, a hundred years ago than it is now, but it did call some things into question. So they continued to repeat studies throughout the later 90s and into the early 2000s on smaller groups of participants at first. And they consistently showed lower average temperatures

than the 98.6. They consistently got, the first one was like 98.2, which is 36.8 was the average. And there was a more recent one that was 97.7. And the most recent in 2017, analyzed over 35,000 patients. It's a lot of temperature readings. Like 250,000 temperature readings, I think.

And they came out at 97.9. Awesome, pretty low. Yes. But considerably less. So we're beginning to think like, maybe it wasn't just thermometer difference. Maybe, I don't know, our humans getting colder. So that's one of the two questions.

I think that's not where I would jump to, I wouldn't think. That is, I mean, if you're, if you have to keep it up in mind, remember you have to ask the question. And the two questions that arose from this, all this data. And I think, I think one is the one that I am hearing asked most frequently right now of me because of these news stories. The number one question is, what is a fever? Because I think that there are a lot of proponents of the, the so-called low grade fever who are now rejoicing in triumph.

You just raised your eyebrows at me in a very challenging way. All I'm saying is that if it's over 100 or sick, that's all I'm saying. There are a lot of people who have for a long time contested that 99, 99 point, literally anything, degree temperature is a, quote unquote, low-grade fever. And we are taught in medicine that there is no such thing really as a low grade fever. Unless what you mean is 100.4 is the lowest possible fever. So I guess that is a low grade fever as compared to 101,

102, 103, which would be a higher grade fever. These really aren't distinctions though that have a clinical significance to us. So it's not necessarily something that I'm going to base any decision making off of. And we have always dismissed that, like, well, 99 is in a fever. So it's not, it's a low grade nothing. It's just not a fever. However, based on these new numbers, in theory, a fever would start around 99.5 degrees Fahrenheit. And so then the question is.

If the difference is the same. Yes. So the question is, have we been wrong to use this cut off for a fever? That's one big question that arises from this kind of shift. I would say that before everybody freaks out and starts checking their temperature and thinking

about all the times that maybe they were sick and they didn't know it. They didn't know it. I would clarify, and this is an important point, the people who did this study, the researchers, the doctors who actually did this study, are not proposing that we change any standard temperatures, guidelines, definitions, any normal ranges based on this study. They say that. They're not proposing that we change this. They're just saying, this is interesting, we need to think about it. I got to give it to these guys, measured, you know, 35,000 different people at the end.

They're like, hey, listen, this was a big waste of time. No. Don't do anything different. Just throw us in the trash or sorry. No. This is a big waste of time. They're good scientists. Okay, but you're all other, you're all thing. They're good scientists because they're saying this is compelling to know, but we don't necessarily know that it changes what we do as doctors. Like it changes maybe some things we know about the human body, but should that change our medical practice? Well, we've used 100.4 as the cutoff

for a clinically significant infection for a really long time now. And we've made it this far. Is that the argument? Like, we've made it this far. We've based our management strategies on this, right? Sure, right. And we don't really have any compelling data to suggest that if we have had been calling 99.5 a fever all these years,

that we would have done anything different, or treated people differently, or saved a life, or prolonged a life, or started in medicine sooner. You know, I mean, I think it's hard to make that kind of case because we've used that standard for so long. I'm not saying it's impossible. I just think to draw that conclusion from this study would be completely out of bounds.

That would be a complete over exaggeration of what the data really says. A fever is a symptom. It is not dangerous. We know that the top ends, we still know like the temperatures that we need to worry about, right? Like if you have a fever of 101, of course you're sick, but that 101 degree temperature is not going to harm your body.

If you have a fever of 106, please get to the hospital immediately. Right. Yes, that is concerning. Those numbers haven't changed. And we still over treat fevers, as we talked about in our fever episode. There's just because you have a fever, it doesn't necessarily mean we have to do anything about it. Sure.

About the fever itself. Right, right, right, because it's the symptom. Yes, yes. So I would say that does this change our understanding of a fever, not in a huge clinically significant way. It's interesting. And certainly, if you're feeling sick and your temperature is 99.5, maybe you're a little more inclined to take the day off, stay home and recuperate. And you don't have to feel like you got to justify it with a temperature of 100.4 to you or your boss or anybody else.

But I would say that it doesn't really change a lot about what we understand about a fever. But the second question is the more interesting one, because what if it is that we're getting colder? What if it isn't that their thermometers were wrong? What if the human body has actually gotten colder? And the most recent study, the reason this is in the news, is because of a study that was just published, that looked at all this data from all these different

studies and said, can we figure out if humans are actually getting colder, and it wasn't the thermometers. And so researchers took data from human temperature data that was collected between 1862 and 1930. Another chunk that was collected from 1971 and 1975, and a third chunk that was collected from 2007 to 2017, and compared these three different data sets over time, and found that we are indeed trending downward and body temperature. That's why.

Why would that be? A steady downward trend in body temperature. Why? This was led by Dr. Julie Parsonet. And I believe it was like every decade, we go down like .05 degrees. Leigh-in. Yeah. And it was really interesting.

And they found a way to control because they had the data set, the earliest one that was from 1862 to 1930, that's a pretty wide range. They could control from decade to decade, which removes a lot of the thermometer variability and they still found the downward trend. That's so weird. So they really don't think it's a thermometer tech issue.

It really appears to be based on this study, it really appears to be that we are getting colder. And again, they say the same thing. We're not proposing that you change any guidelines. Please just continue doctors with your current standard of medical care. It's just a thing is we're all getting colder, but everybody just be, if you'll pardon the pun, chill about it.

If everybody could just calm down, we got bigger problems right now. You just happen to also be getting colder. So why? Why are we getting colder? Earth's getting hotter. We're balancing it out. Okay, both of these things are true that we are getting colder and Earth, well, we think that Earth, we know that Earth is getting hotter. We think that we are getting colder. However, that is not causal relationship. You do have to, that is not. You have to ask the question, why is woman once told me you have to ask the question, Sydney? Yes, and I'm telling you, no, it is not, while the earth is indeed getting warmer, it is not because the earth is getting warmer that humans may well be getting colder. Got it. Earth is getting warmer, humans getting

colder, we are, no relation. We're in agreement. Earth's getting warmer, human's getting colder. We are in a relationship. We're in agreement about this. Well, so the theory that Dr. Personette puts forth in the study and then the other researchers, because we're not sure. But the theory is that back before we lived most of us in homes with temperature control and like regular hygiene and the ability to change our clothes and wash ourselves and eat food that isn't contaminated

and get vaccines and all these different things. Back before all of that, humans were exposed to a lot more microbes on a regular basis. We were constantly being invaded by bacteria and viruses and fungi and parasites and all this. And so we always had this sort of baseline, maybe inflammatory cytokine release in our bodies. So if you took our temperatures, you were much more likely to find these elevated temperatures because we were always kind of hot because our bodies were always in the midst of reacting to something.

Like a low level body was working over time with all these different bad invaders. Yes. And now the environment is doing a bit more of that for us. Yes, I think it's a combination of less inflammation because of our environment and temperature control Because we most of us tend to live indoors now And that the combination of of those things has just led us to be colder now We're just colder our temperature tends to be 97.9

Around that seems to me, but something lower. What does that mean for the future of humans? I don't, I mean, I don't think anybody really knows. I don't think it's necessarily, no one is suggesting that it's detrimental or bad. No one's saying anything about it. It sounds like they're just saying we're getting colder and everybody just go about your day. And it won't continue forever.

I mean, certainly everybody would assume it would level off at some point. You would hope. But it seems like, and again, this is one study that indicates this, and it is always important. The reason I talk a lot about the way that I approach a study, you can't, every time you read a scientific study, even a really well done one, even one that I can't with my little skeptic scope, what it calls in.

This is real with macaroemerch.com, you can't really skeptic scope. Even if it's a really well done study, and it's like the evidence is really compelling that they have arrived at, the conclusions are really compelling, and the data supports them. One study cannot change

at complete scientific paradigm. We cannot shift our entire understanding of a scientific principle, of a medical principle, the human body of the world of the earth based on one study. It's gotta be reproducible. We have to continue to be able to see those same results when we check it again and again and again.

Otherwise, you could miss something. Otherwise, there could have been a variable you didn't know about. Something that confounded it. And so it's always important when you hear these things in the news, it's really interesting. Of course, everybody wants to hear about it and read about it.

Fascinating. Right. What does it mean? Reading colder. Why? Why is it a man else? But I would not approach it with fear or trepidation. It's interesting.

Perhaps we've expanded our knowledge of the way the human body works, the way we're constantly changing and evolving and adapting to our environment. It's fascinating, it's interesting. We can incorporate it into our vast body of medical knowledge, but it is nothing too fear. It is nothing to like change your entire perception

of what your body temperature and what your body's doing and what a fever is. All right. And of course any good scientists would tell you, we got to try it a few more times before we're sure about the results. Folks, thank you so much for listening to our podcast, Solboons. Hey, if you want to come see us live, you can do that. If you go to bit.ly-4s-20-funny, you can get get tickets to CS and Cincinnati on February 19th, opening

for my brother, my brother and me. There's a link to get tickets there, act fast though. There's a running low. We have a book called the Soulbones book and you can pick it up at Amazon or wherever fine books are sold. Thanks to the Max Fun Network for letting us be a part of their extended podcasting family and thank you to the taxpayers for the use of their own medicines as the intro and outro of our program that is going to do for us though for this week so until next time my name is Justin McRoy i'm Sydney McRoy and as always don't drill a hole in your head Alright! Maximumfun.org

Comedy and Culture Artist-owned? Audience-supported. At X-Mem Fund dot org. Comedy and culture. Artists don't. Audience supported.