Among many unresolved issues in the treatment of cystic fibrosis (CF), certainly two of the most important decisions that clinicians and patients with CF must face are when and how to aggressively combat this multifaceted disorder to achieve the best outcome. In their article (see page 20), Johnson et al provide compelling data in support of aggressive intervention to improve long-term outcomes in patients with CF. This observational study, which utilizes data collected in the Epidemiologic Study of Cystic Fibrosis database, reviews the management of > 18,000 patients with CF, aged 6 to > 18 years, collected over a 2-year period (1995 to 1996). Based on standard CF interventions prescribed at the physicians’ discretion, they found that in CF centers where patients were monitored and treated more frequently, there were “significant and clinically relevant differences across sites in lung health as measured by FEV1.” The thesis that increased patient surveillance leads to increased intervention and yields improved outcomes is reasonable, and it has important ramifications for patient management, despite the potential confounders associated with the use of observational study data to infer best practice habits. That said, these findings leave the issues of exactly when and how frequently (as well as with which agents) to intervene unresolved.