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It is tempting to stare at the map when the territory is obscured by the fog of war. The rigor of the SCID very much hides the fact that several places on the territory have similar features but are miles apart. And then every observer loves certain places and hates working in others.

As bad as the state of diagnosis is (some say >50% for certain conditions) there is no way around a diagnosis for treatment as one needs to make decisions and these need to be based in whatever tenuous grasp one has on reality. At this point imho. we can only try to make sure all sources of bias, tendency to defend previous decisions, treatment capacity and financial considerations (diagnosis is key to insurance payments) are as far isolated from decision making as possible. There is lots to be done. SCID is only the symptom.




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