You a being a little unfair here.

I do have some experience reading clinical trials. In this case I am unable to do so because only the extract and author comment are available. But I have learnt enough to realise you have to read between the lines. And you can do it too with a little practice.

As i pointed out, the authors clearly wrote the following in their commentary:

“Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

As you pointed out, they also wrote the following in the results section:

“Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.”

Elsewhere they said that the effect was moderate.
Finally, as I pointed out, they also said the following by way of introduction to the results:

“Many of the studies were judged to be at high risk of bias in one or more areas of trial design”

I’m not trying to score points here, but how would you put this all together, Michelle?
I got the distinct impression that Mark Crislip was not impressed and neither was I. You cannot take clinical trials at face value, otherwise what would you say about a meta-analysis of clinical trials of acupuncture that concluded the following:

“Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”

Yes of course, BillyJoe, you are just as competent as any other person on the internet to judge whether someone is “abandoning science” by not using your precise reading of the review. Thanks for the free medical advice. It was worth every penny.

*Yes it is the same review, I was confused by the different publishing dates.

The question then is: Can anything you do hurry this process along? The evidence based answer seems to be: No.

Given that they plainly spread, I’ll take mechanical removal even if they tend to recur at the original site. I’ve certainly had some that were successfully destroyed, even though the underlying virus is still active.

“You are not a doctor, much less a dermatologist. You are not qualified to make the claims you are making.”

Non-sequitur. Doctors and dermatologists are not necessarily competent to assess clinical trials and systematic reviews. Conversely, you do not need to be a doctor or dermatologist to assess clinical trials and systematic reviews. The doctors in this blog are a biased sample. But if you read comments by doctors on other websites, you’ll see a lot of ignorance about evidence based medicine, let alone science based medicine.

“Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

The above is from the authors’ comment.
Your quote is from the abstract.
Interestingly, they add the following:

“Many of the studies were judged to be at high risk of bias in one or more areas of trial design”

That may explain the difference between the two. The authors are making a conclusion taking into account the actual results obtained together with their assessment that there was a high risk of bias which would reduce the significance of the results which were only moderate in any case.

You ignore this in preference of a blog summary of a summary of a review. I think you are over stating the evidence and conclusion quoted and your suggestion that using SA on a wart is “abandoning science” is a huge exaggeration. You are not a doctor, much less a dermatologist. You are not qualified to make the claims you are making.

“Hopefully, the effect will be lasting”

Apparently hoping doesn’t help either.

Apparently 2/3 return within 6 months.
The remaining 1/3 either come back after 6 months or never come back because, in the mean time, the immune system has cleared the virus.
Has your treatment assisted the immune system in clearing the virus?
Apparently the evidence-based answer is….No.

Mark Crislip concludes his post with the following quote from Cochrane Systematic Reviews on the treatment of warts….

“Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with [salicylic acid]….None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy”

In other words, cryotherapy = salicylic acid = other reviewed therapies = placebo.
More or less.
Also, clearance =/= cure.
After all, one of the treatments for warts is serial curettage, which CLEARS the wart within minutes.
The only way to CURE warts is for your immune system to develop an immunity to the wart virus. This is how warts clear “naturally”. The question then is: Can anything you do hurry this process along? The evidence based answer seems to be: No.

also “Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.”

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0011182/

How is using Salicylic Acid could be considered abandoning science?

Those acids dissolved away the skin affected by the wart virus. Chances are that, though the wart has gone, the virus itself lies in wait to strike again. So I will back the odds and say that that wart will be back. You may be lucky of course. So, when it does come back, you can continue to treat it with acid and eventually your immune system will have enough of that wart virus attacking the skin of the body that it evolved to protect, and then that wart virus, along with the wart it is responsible for producing, will be gone forever. There is some suggestion that the acids’ assault on the wart helps to persuade the immune system to act, but there is little evidence that that is the case.

And, since everyone has abandoned science and promoted their own anecdotes, let me just add mine and say that I never at any time treated my wart with any chemical of any description.
Therefore nothing works.

I try to explain to my clients (I am a veterinarian in Australia) that Taipan venom is natural. The Inland Taipan being the most toxic terrestrial snake on earth, but fortunately for us here in Aus, Inland Taipans live in Central Australia, so unless you go to the Simpson Desert, you are unlikely to cross one.

No, I would not apply tea tree oil to any living thing.

Yes, ketones are natural, just ask a diabetic, and would be effective for glue removal.

Here in Canada, tea tree is marketed as a “natural” alternative for the treatment of a myriad of conditions, primarily, dandruff, head lice, and acne. From your post, I’m thinking you would not put it on a child.

I use nail polish remover (primarily acetone) to remove adhesive tape from a wall. Ketones are natural, no?

Did you blindly follow that protocol or did you ask for the clinical studies that demonstrate the efficacy of every element of that protocol and then refuse to follow that protocol unless and until that efficacy was demonstrated?

“doc”?

Let me tell you of the dogs that I have had to treat here in Australia, the home of tea tree oil (malaeleuca lineafolia or m. alternafolia) after owners have bathed the dogs in a tea tree oil shampoo. One lady took on a franchise for doing dog hydrobaths. She was told that “This is the shampoo that you will use.” A tea tree oil shampoo. She bathed her first dog at 4pm in the afternoon. Now, the head on the hydrobath hose is several iches wide; basically a shower head nozzle. The tendency is to spend most of the time with the shower head moving up and down the dog’s dorsal midline.

At 8am the following morning I was presented with a dog who had NO hair down its dorsal midline. In addition, the ingestion of tea tree oil is highly toxic to the liver and can, and has, caused neurological disorders in dogs bathed in a shampoo containing a relatively small amount of tea tree oil. Tea tree is potentially dangerous at ANY dilution. Its only practical use is for removing adhesive tape residue on walls etc. It does smell nice, it gives the impression of opening blocked airways, without actually doing so.

http://www.petpoisonhelpline.com/poison/tea-tree-oil/

DO NOT USE TEA TREE OIL UNLESS YOU ARE WEARING GLOVES AND REMOVING ADHESIVE TAPE FROM A WALL.

The vitamin C might have enough of a drying effect to make it break off. If you combined the vitamin C with high doses of salt ,…

IANAD. Better phrased, that statement would have specified that the C or C and salt mixture would be applied to the outer surface of the wart in an attempt to dry it out. By no means would I suggest that anyone ingest high doses of C and salt. The ‘high dose C/Salt’ remark was made specifically to poke fun at one of the dangerous methods being marketed to treat Lyme disease.

Ah, I wish that I had pulled that particular laser/wart protocol out of thin air or my nether parts, but no – it was a modification of our department’s protocol for extensive genital warts, mainly switching Tea Tree Oil for the podophyllin, mostly because the odor is more pleasant…

Given that humans do not synthesize AA the way the majority of other mammals do, apparently because of a missing enzyme, would you consider this worthy of investigation? Would it seem appropriate to try giving people similar amounts of AA to see what effect it had on then general health? It seems to me that this is the way science works – if you have a hypothesis and you have a prediction and you experiment to see if it is fulfilled. It seems that AA is involved in so many aspects of our health that there is no point singling out just one condition and trying to establish a ‘one cause => one effect’ relation which seems to be the point of RCT’s. In this sense, RCT’s seem to be designed as way to establish the effectiveness of single compounds on a single condition and so is of limited use for investigating overall health. In other words, the Science of Health is not the same as the Science of Medicine.