Clever Is Not Enough: NOSPECS Is Form in Search of Function

The NOSPECS mnemonic helps students to examine systematically the eyes and orbits of patients with Graves' ophthalmopathy. NOSPECS and related numerical indices are unsuited to recording the results of treatment for Graves' ophthalmopathy because they do not distinguish between primary causes and secondary events. They do not discriminate between what is important and what is not. They do not reflect the effectiveness of treatment directed toward only one component of the index. An alternative is proposed in which investigators conducting clinical trials are asked to specify the potential benefits of therapy. Specific measurements are suggested that may be used in support of each claim. These data should be provided separately, not lumped in an overall index.