By Debi Warner, Clinical Librarian, Anthelio Healthcare Solutions
Anyone who has had a wart can sympathize. Sean reports that his wart was as big as his thumbnail, was extremely itchy and that he had tried all sorts of things to get rid of it. Then he used his 12-bore shotgun and shot off his whole middle finger. Though he is doing well and the itching has stopped, he’s been sentenced to 100 hours of community service by the British courts for illegal possession of a firearm.
Searching on the internet for cures for warts is great fun. A physician from Oklahoma says mix as much salt as possible in petroleum jelly and cover with an adhesive nightly. I don’t know much about salt and petroleum jelly, but an adhesive, usually duct tape, is a known treatment.
The treatment of warts makes a good topic for introducing Evidence-Based Medicine (EBM). EBM is a process for providers to analyze what they read and decide if the treatment may be useful for their patients based on the evidence presented. Good doctors use both individual clinical expertise and the best available external evidence. The practice of evidence-based medicine is largely physician-centric.
To consider a treatment under the principles of EBM, it is necessary to divide the problems into parts. A process called “Pico” is used to identify the parts.
P= patient /problem. The problem statement usually begins: “In adult males with finger warts”
I= intervention. This is the attempt at treatment which is being considered: “does cryotherapy…”
C=comparison. This is another treatment serving as a basis for comparison. It can be either a different
treatment or a placebo or just doing nothing: “as compared to application of salicylic acid or
O=outcome. This is a statement of what the results of the treatment should be: “result in the removal
of the wart.”
Therefore, to construct a proper problem statement before going on to analyze the success of the different treatments, one would ask:
“In an inebriated 38-year old British male with a wart on his finger, does shooting off the wart, as compared to the many creams he used, result in the removal of the wart?” (Yup, so far, 100% of the time.)
The next step in the process is to do the research which compares the treatments. There is interest more recently in a child of EBM called “Comparative Effectiveness Research” (CER), especially in the light of healthcare reform. CER is more of an effort to directly compare available treatments. The official Institute of Medicine definition of CER is “evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.” The fact that CER can address cost and benefits at the policy or population level makes it more controversial.