Bill,

First I wanted to assure you that I'm not offended- I get exactly where you are coming from and sought to lob the ball back with the same vigor with which it was delivered!

Re "I don't know" : I could give you a big sermon about medical certainty in various parts of the world but the consistent observation is that most patients enjoy uncertainty even less than doctors. Most patients hope for cut-and-dried solutions and may become frustrated if presented with a series of dependencies and on-the-other-hands. Also this is why topics like fibromyalgia are problematic at the moment- because there's more uncertainty than usual which is frustrating for patients, payors and providers trying to figure out what reasonably is a "treatment" to be covered versus what may be considered a recreational or lifestyle choice packaged as treatment. People with fibromyalgia may be aghast that the only treatment that works for them, suddenly is denied by a faceless bureaucrat in an office in Maine who decides that massage isn't coverable. Contrast with adult asthma whose options are well understood and there hardly is dissent. Reasonably you can relate asthma to the sorts of certainty in other careers like programming, but that's not typical of medicine.

Anyway, Merry Christmas!