Targets and targeting.
Using the vocabulary of ballistics in medicine for emphasis can result in misleading exaggeration and semantic confusion. The dual meaning of target as either aiming point (aim at) or outcome (aim to achieve) creates a muddle in the efforts to comply with quality assurance initiatives. Disentangling the two meanings allows new approaches to the clinical technology required in a modern health care environment. An example can be shown in new strategies for the management of renal anemia with iron and erythropoietin. The potential to shape outcome distributions through validated, preemptive intervention thresholds offers the predictable results required by patients and payers. Using the management of patient cohorts as a platform for outcomes creates no necessary conflict with individualized clinical care. Future guideline statements should include the likely characteristics of compliant outcome populations, as a prompt to clinical goals and as an indication of the necessary cost and effort of compliance with treatment standards. Overemphasis in language is no substitute for considered clinical methodology.
Will
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Department of Renal Medicine, St. James's University Hospital, Leeds, United Kingdom. csjejw@stjames.leeds.ac.uk
D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D003627:Data Interpretation, Statistical; D004921:Erythropoietin / Q000627:therapeutic use; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care; D012660:Semantics; D009626:Terminology as Topic; D016896:Treatment Outcome; D006113:United Kingdom
D004921:Erythropoietin; D007501:Iron