Intended for healthcare professionals

Rapid response to:


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

Rapid Response:

Why Evidence Based Medicine doesn't seem worth the room it takes up.

After reading the article on the "systematic review of local wart
treatments" I had two responses: the first was to put my fist through the
computer screen. The second was to get up and have myself a dollop of a
really good port.

The article would make me conclude that what I've been doing for
almost 30 years to help patients of all ages get rid of their pesky,
painful, possibly dangerous, and unseemly lesions is buncombe, and
verging on quackery.

Well, my evidence based medicine, based on the accumulated results
from thousands of patients who have been sitting in front of me in my
office, suggests otherwise, and indicates that wart therapies of diverse
types are quite efficacious in a goodly percentage (i.e. almost all) of

I must say that the article, however, cloaked as it is in the nimbus
of science and written in the current stern fashion, is formidable, and
must have taken a lot of sweating and lucubration. From the my
clinician's standpoint, however, the authors' time could have been much
more productively and better spent: say, tending flowers, going to a nice
restaurant, getting slighty drunk, etc.

This article is the kind of stuff that, in my bumpkin opinion, makes
clinicians sigh and gag at the same time, while making lawyers, on the
other hand, drool with delight: what a splendid tool to use against some
poor shnook dermatologist or other doctor under the legal gun.

All in all, the article might be "scientific" in the extreme but
there is not, I'm willing to bet my bottle of port, any dermatologist
anywhere who is going to alter their therapuetic approach because of it,
or be swayed by it.

Competing interests: No competing interests

02 September 2002
Robert I Rudolph, M.D., FACP
Clinical Professor of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, PA U
1134 Penn Avenue, Wyomissing, PA 19610 USA