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PapersLocal treatments for cutaneous warts: systematic reviewCommentary: Systematic reviewers face challenges from varied study designs

BMJ 2002; 325 doi: (Published 31 August 2002) Cite this as: BMJ 2002;325:461

EBM Giving you Lemons? Make Lemonade!


I refer to Robert Rudolph's response(1) to the review on local
treatments for cutaneous warts by Gibbs et al(2). In light of Roger
Dobson's recent offering(3) I would like to suggest the following:

If evidence based medicine does continue to offer no support for Dr
Rudolph's treatment, he should adopt an attitude such as 'if life gives
you lemons, make lemonade'. Or, in medicine, 'let the absence of evidence
be no hindrance to making a buck.'

Why not become a quack?

You could employ the following whilst on Oprah:

1. Victim Status

The 'Medical Establishment' (whatever the hell that is) is
suppressing this wonderful, natural treatment in cohorts with multi-
national drug companies, the Government, aliens, communists and JFK’s real

2. Religiosity

State that Paul Waddling Gait III conducted experiments in his
backyard in 1800 and any speculation since is clearly heresy. This therapy
utilises a 'life energy' (something you modern Doctors can't seem to
grasp) so it shouldn't be subject to evil modern experimentation. Besides,
it cured your hair dresser's cousin's flatmate's dog's former owner's
illness when the Doctors only gave her 3.2 seconds to live, so it must

Mention that it's 'natural' again.

3. The Galileo Argument

Compare yourself to Galileo - since he was supposedly thought wrong
by his contemporaries claim that you must also therefore be right.

Ignore the fact that his ideas were tested and verified by his
scientific colleagues and that it was only the established religious
authorities that insisted on sticking to the existing psuedoscience.

4. Anti-Science

When confronted with inconvenient facts, simply reply:

'Scientists don't know everything!'

Diluting any active ingredient 30 million billion trillion times must
be a good idea for that reason alone.

5. Conspiracies

Claim that the Government is withholding the cure for cancer or any
other bold statement that implies that you are 'in the know'. Don't
suggest that the latest wonder herb is been grown in Area 51 though; you
can take a good thing too far.

6. Supply Pseudo-Proof

Refer to something published in the Lancet. People won't bother
reading the actual article to check if it really supports your argument.
It might, for example, have used only 12 non-randomly selected subjects,
no controls, no blinding of investigators and it may have reached no real

Regardless, use statements such as 'it proved conclusively' or say
the study 'rocked the scientific community' etc...

7. Use a Device

Anything with bright lights and dials that supposedly utilises some
poorly understood theory that was discovered by 'the ancients' will do.
Call it a psychophysicoquackometer that will analyse your 'life force',
cure cancer, realign your aura and make a lovely carrot cake all whilst
removing that nasty wart.

In summary, absence of evidence has not deterred many others from
making a mint. So make the most of it.


Tony Floyd


(1) Rudolph R. Why Evidence Based Medicine doesn't seem worth the
room it takes up. BMJ Responses. 2 September 2002

(2) Gibbs G, Harvey I, Sterling J, Stark R and Altman DG. Local
treatments for cutaneous warts: Systematic Review. Commentary: Systematic
reviewers face challenges from varied study designs. BMJ 2002; 325: 461

(3) Dobson R. Doctors fail to see the joke. News. BMJ 2002;325:561
(14 September)

(4) Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular
hyperplasia, non-specific colitis, and pervasive developmental disorder in
children. Lancet 1998; 351: 637-41.

Competing interests: No competing interests

23 September 2002
Tony Floyd
Medical Student
Newcastle University, Newcastle Australia