Health: He's my son, and I love him warts and all
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Thursday 19 August 1999
Then I discovered that I was submitting him to cruel and unnecessary treatment. Removing warts is neither painless nor costless but it is, apparently, pointless.
I owe this insight to Professor Jangu Banatvala and Dr Penelope Bridger, who have recently conducted an intriguing study of the wart-removing behaviour of GPs in Bromley, Kent. Professor Banatvala, of St Thomas' Hospital, is one of our foremost virologists (warts are caused by a virus) and former chairman of the Government's advisory group on hepatitis, so his advice is worth hearing. The doctors' study revealed that the 114 GPs in Bromley claimed pounds 60,000 to pounds 80,000 for removing warts from between 560 and 760 people in 1994. That's a lot of cash for a few bits of old skin.
Mostly the surgery was done by cryotherapy, that is, freezing the wart with a liquid nitrogen probe, which produces a painful burning sensation. On average, it required five visits to the GP.
There is a much simpler and cheaper treatment for warts. It is called time. The authors cite the findings of a survey that showed that one in 25 young people aged 11 to 16 had warts, but in 95 per cent of cases the warts disappeared naturally over a year or two. Only in transplant patients, who have long-term immunosuppression, and in those with the rare disease epidermodysplasia verruciformis, is there any risk of their turning malignant.
So why go to such lengths and expense to get rid of cutaneous warts which are harmless and transitory?
There is no once-only treatment that will cure all warts, and no treatment is 100 per cent successful. Most treatments work by destroying the epidermis (the outer layer of the skin) in which the wart virus resides, and for this, applying wart paint is as effective as cryotherapy.
The demand for removal by GPs is driven by schools, which refuse to let children swim if they have warts, or insist that they are covered.
But besides exposing children to unnecessary pain and suffering, the policy also deprives the NHS of precious funds. As the authors observe, for pounds 60,000-pounds 80,000 Bromley could buy almost 20 hip replacements, up to 100 cataract operations or at least a dozen coronary bypass operations.
Last week, a report from the Office of Health Economics showing that Britain still has one of the cheapest health systems in the Western world triggered a bout of hand-wringing about our beleaguered NHS. The miserly sums allocated to it by the Government were blamed for our poor showing on measures such as deaths from heart disease, where we head the international league.
Setting aside the fact that heart disease rates are influenced more by lifestyle than by the NHS, it is not just more spending but better spending that we need. There is still scope, as the wart report shows, for redirecting spending from treatment that is useless to treatment that is useful - and sparing a lot of patients unnecessary suffering.
I am curiouser than ever to hear the GP's verdict on my son.
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