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Gail S. Marion, PA-C; K. Patricia McGann, MD
JAMA. 1993;269(10):1251. doi:10.1001/jama.1993.03500100047017.
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To the Editor.  —We are pleased to see the article by Mackowiak et al1 questioning the validity of current medical dogma concerning normal body temperature. There were, however, some points made by these authors that deserve likewise to be questioned.Though the study design does control for time of day, there are many other potential confounding variables mentioned in previous studies that were not considered.2-6 These include outdoor and room temperature, ingestion of certain medications that are available without prescription such as ibuprofen or acetaminophen, nutritional status, recent physical activity, respiratory rate, tobacco and alcohol use, the presence of denture material in the mouth, and the phase of the menstrual cycle for women. Most of these potential confounding factors would lower the temperature reading rather than raise it and therefore may account for the deviation from the long-accepted norm found in this study.The authors corroborated Wunderlich's observation


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