Why make a diagnosis?

I read with interest Dr Evan Sadler's commentary regarding the papers by Goodeve and colleagues and James and colleagues in a recent issue of Blood.¹ 

Since 2 large studies failed to associate a mutation with people followed in bleeding disorder clinics who have mild type 1 von Willebrand disease, why give them a diagnosis? Fair-skinned people are more at risk of sunburn and melanoma than dark-skinned people. Do they have “premelanoma syndrome”? We just advise (prescribe) sun block. Similarly, if a person has a mild bleeding history, bruises easily, is blood type O, and their ristocetin cofactor is slightly low, why all these machinations about “making a diagnosis”? Just write a note in their medical record about your rationale for prescribing DDAVP before their dental extraction.

In certain clinical situations, we should consider other therapeutic paradigms than making a diagnosis before treating.

Correspondence: Richard Lipton, Hemophilia Treatment Center, 270-05 76th Ave, Oncology 350, New Hyde Park, NY 11040; e-mail: rlipton@lij.edu.