It’s funny how the dysfunctions of the health care system and the uncertainty of science can be reflected in the tiniest things. Like a wart.
My older daughter has some Plantar warts on her feet. Because she’s 6, this is a big deal. They hurt. Taking care of them is neither trivial, nor something she can do on her own. We’ve been battling the warts for a couple of months now. They don’t yield easily.
This is not uncommon. Looking for alternatives, I emailed members of my community for help. The response was amazing, both voluminous and varied. Everybody, it seems, has a wart war story. Everybody has a remedy to offer. Everybody has seen some practitioner or another who has done something different, sometimes a little different, sometimes wildly different. Some people, following physician-prescribed treatment, battled warts for years. Years! Others were cured with a similar approach in weeks or less. What worked for person A didn’t for B and so on.
Already you should recognize the trouble this raises for comparative effectiveness of wart therapies. As with the treatment of other health conditions, heterogeneous effects are common in wart care.
WTF!* They’re warts. They’re small. Can’t we crush this plague?
Well, no. (Read Wikipedia.)
Like the common cold, Plantar warts are a problem, with viral cause, to which we have no sure-fire solution. There is no vaccine. Which treatment will be effective is highly variable. Provider practice patterns seem variable too, at least according to my informal, unscientific survey. Can’t we just find the region with the fewest warts and apply the practices there nationally?
It seems like a sensible idea, but it won’t work. I am sure practice pattern variation exists even within regions. In my small town I’ve heard of a half-dozen approaches alone. Warts are probably associated with many other factors having nothing to do with medical care. It’s hopeless.
Well, this will just not do. I want my child’s warts cured now. NOW! I will pay money, SERIOUS MONEY, to make them go away. I want a research program. I want a massive, all-out WAR ON WARTS!!! (And the common cold too.)
I’m joking, but only to make a point. Obviously it is not rational to spend billions of dollars fighting warts. I know that there’s not a lot doctors can do. Some treatment or another may help. Do I need six office visits to succeed? Must I really wait weeks to months to get an appointment with a nearby dermatologist? Wouldn’t reading stuff on the internet suffice? Will cryotherapy work or, if we think it does, will we just be crediting it for that which could have been obtaiend by placebo or over-the-counter salicylic acid?
Change a few words and you could ask the same thing about any number of health problems. By taking my daughter to several doctors, I’m clearly putting my money, or my insurer’s, where my mouth is (or, facetiously above, was). Some hundreds will be spent on fighting these warts. In time we will win. Meanwhile, every time I deal with this problem I reflect on all the issues it raises about our health system and medical knowledge in general. So, we will win, but at what cost?
They’re warts. And they’re driving me crazy!
* Or, in this case NWTF, “not winning the future,” on warts.