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A thought came to me last year. How could scientists or doctors know what the MG antibody attack is doing in all of the 640 skeletal muscles unless they biopsied every single last inch of them?  Can they really say that antibodies are attacking us everywhere all of the time? I don't have an answer to how that all happens either.
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You are right Annie,
there are so many assumptions we make in medicine.
It's OK, because we have to, as there is no way we can truly understand the complexity of those biological processes called disease.
At the same time, we need to be aware of the fact that we only have a fairly simplistic view of an extremely complex process.
In fact we are very far from fully understanding both the immune system and the complex control of muscle function. What we know is really the edge of the iceberg.
We can make pretty good educated guesses most of the time, but it is not surprising that they often fail.
It seems as if there are physicians who know everything and never make mistakes, and those that know much less and err.
The truth is that there are physicians who don't know everything and make mistakes, but don't admit this (and always find someone they can blame) and those who don't know everything and make mistakes and do admit them (and try to correct them).
There are those who read the medical literature and notice the gaps (and even try to do their own research to try and fill them) and those who use this net full of holes as an umbrella over the head of their patients (and blame them for getting wet).