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If we going to debate this issue I suggest better armaments. The article based on this report had 64.3 % of the “providers” not including any of the Treat To Target (TTT) criteria. That means they did not even record Disease Activity Measures (DAM) or have shared decision making. The latter is in every office visit and activity measurements are the core to TTT. I do them all the time on every visit using a homunculus tool called Jointman. I question how the data was collected and quantified in this study. Not all who were measured were physicians but the data did not quantitate who did what to this level. They based their data on 4 measures: 1. Choose a target 2. Choose a disease activity measure 3. Shared decision making 4. Decision is either based on target and DAM or why TTT was not adhered to. According to their data 64.3 % had none, 33.1 % had one component, 2.3 % had two components and 0.3 % had all components out of 641 patients, 46 providers at 11 USA sites. The data was collected off of EHR data. How was that reliable? This depends on the interpretation of the record. WHAT! Providers with longer experience are said to have implemented more components of TTT.