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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

Re: Is the practice of dermatology based on science or anecdotal opinion?

A very nice, reasoned response from the good Dr. Mann.

I happen to worship medical science and investigation as much as
anyone, and frequently bend the knee in real astonishment at the altar of
dermatologic research. I truly hope that the investigative energies of
the speciality continues at it's furious speed, and I applaud the advances
made by researchers. My perception and practice of the field constantly
change because of the findings of my investigative colleagues.

What I don't relish reading, however, are articles on EBM. I
personally find that much (most?) EBM material unreadable, unusable, and
unimportant. It's stultification carried to the nth degree.

I learned many years ago, being a staunch cynic, that much of the
medical literature is junk. It's taken me 30 years of continual practice
to hone this skill, and I think I'm still compos mentis enough to realize
what studies are poorly and indifferently done, and to appreciate the
occasional good and important paper.

On the other hand, there is absolutely nothing, in my opinion, which
can equal the "in front of your face" evidence that a particular
therapeutic success gives us physicians. This is, despite the ululations
of the EBM folk, very powerful ammunition for the practice of medicine in
the office, and provides us with many of the arrows in our therapeutic

I'll continue, none the less, to flog myself into a stupor trying to
read and digest EBM articles, but I've yet to find one that has really
made me change what I do.

I love science, but I also like anecdote. After all, an anecdote is
often an antidote when science fails.

Competing interests: No competing interests

04 September 2002
Robert I. Rudolph, M.D., FACP
Clinical Professor of Dermatology, University of Pennsylvania, Philadelphia, Pa USA
1134 Penn Avenue, Wyomissing, Pa 19610, USA