To the Editor In a Special Communication published in a recent issue of JAMA Internal Medicine, Doust et al1 raised timely concerns about modifying disease definitions, which, in essence, addresses what constitutes a disease and is a fundamental question for modern medicine where diseases are often diagnosed without symptoms and signs. However, the checklist proposed mixed the criteria for modifying a disease definition (items 6 through 8 in Table 2) with the reasons (item 3) and consequences (items 1, 2, and 4) of making the change. For defining a disease, the risk of the condition and the benefits and harms of interventions should be set as primary determinants.