I read with interest Dr. Mackowiak's article [1]. In his troubling conclusion he implies that fever may have a salutary benefit for the species that overrides the needs of the individual. It is disconcerting when a physician or scientist attributes a teleologic role to either a disease or a biological response. Scientifically, it must be considered fanciful to assume that fever has an evolutionary basis in promoting survival of a "hopelessly infected and potentially contagious individual. ..." The author proposes that fever acts as an evolutionary stimulus to promote the survival of a species at the expense of an individual. On the surface, his assumptions seem plausible and are reminiscent of hypotheses generated by the early racial hygienics movement, which presented as axiomatic the belief that disease was useful in eliminating those who were ill or not fit in order to promote the survival of an immunologically strong species [2, 3]. No such theories of the influence of disease on the social biology of humans have ever been subjected to careful analysis or testing. Although it may seem far-fetched to a modern audience, unsupported theories of the utility of fever or infection to strengthen the more "gifted" elements of the species have historically led to a scientific and medical concept of heredity with profound political and moral implications [4].

I encourage the editors of this and other prestigious journals to consider seriously the broader implications of unsupported perspectives that may often have as their origins unsupported genetic or social principles, especially in the light of the history of such theories in the 20th century [5].