My current book is on biomarkers and I don' mind telling anyone that is heavy going. While the objective is noble, much of the current activity is best desribed a frenetic. More consideration needs to be given to projects that provide real "value-added" to the overall health care system. As noted by Dr. P. O Collinson in a recent note on Cardiac Markers in the British Journal of Hospital Medicine ( http://www.bjhm.co.uk/ ), while scarcely a week goes by without the description of a new and novel biomarker for cardiovascular disease, there are only biomarkers (troponins and b-type natriuretic peptide) in routine use. More consideration should be given to developing biomarkers that will markedly impact the health care process. On a similar note, another UK-based group published a comment in the American Journal of Gastroenterology ( http://www.acg.gi.org/physicians/journal.asp ) noting that histological demonstration of dysplasia is still the primary marker for cancer in inflammatory diseases of the gastrointestinal tract.