Starting Is Half.

Abstract

A Korean proverb, capturing the wisdom of the ages, translates literally into English as “starting is half” (1). In a great journey, the first step is often the most difficult. In a major enterprise, just getting underway may take a tremendous effort. In physics, an object that is stationary is distinctly different from another object that is moving, irrespective of velocity or direction. In laboratory medicine, major improvements generally trace their roots to small beginnings. In this issue of Clinical Chemistry , Aarsand and colleagues, on behalf of the European Federation of Clinical Chemistry and Laboratory Medicine Working Group on Biological Variation and the Task and Finish Group for the Biological Variation Database, present a standard for the critical appraisal of biological variation (BV) studies and publications, the Biological Variation Data Critical Appraisal Checklist (BIVAC), introducing a new phase in the study of BV (2). Interest in BV goes back many decades. BV estimates are used primarily to set analytical performance specifications and to identify clinically significant changes in consecutive test results from an individual, but they may also be used to assess the usefulness of population-based reference intervals, determine optimal specimen type for a particular measurand, select the best test among alternatives, select the most informative units for expressing results, determine the number of analyses needed to establish an individual's homeostatic set point, and discover optimal conditions for specimen collection in circumstances of positional, diurnal, seasonal, or other patterned variation (3, 4, 5, 6). BV estimates have been published for a …