STEP 1 is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers.
Journal club: STEP 1 and the treatment-policy estimand — does this still hold? posts 61–77
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
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Where the group cannot agree, record the disagreement rather than resolving it by seniority. The recorded disagreement is more honest and more useful later.
This is the version I would want a new member to read first.
The arithmetic in post #61 is right; the assumption feeding it is the part to check.
The figures usually contain the finding and the text usually contains the interpretation. Separating them for the first twenty minutes is a discipline worth keeping.
That is where I would start, not where I would stop.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
Counterpoint on STEP 1, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
Fair, and the limits you put on it are the part I will remember.
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Taking post #68 at face value and following it one step further.
The most common failure mode is spending fifty minutes on the effect size and ten on the population. Reversing that ratio would improve most sessions.
Not the whole picture, but the part of it I can speak to.
Before the thread moves on from STEP 1 — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
Worth separating two things that post #70 runs together.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
That holds under the stated conditions and I have stated them.
STEP 1 (N Engl J Med 2021): The pivotal obesity trial for semaglutide and the reference point for most subsequent comparison. Mean weight reduction was substantially larger than anything previously achieved pharmacologically.
Same conclusion as the reply above, reached differently, which is mildly reassuring.
STEP 1 is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.
Practical note on STEP 1: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.
On post #73 — agreed on the reasoning, with one qualification.
Reading order that works for these sessions: registry entry, methods, baseline table, primary result, then abstract last. Reading the abstract first anchors everything that follows.
If it helps: the failure mode here is usually boring rather than dramatic.
This topic was referenced in
- Journal club: SELECT, absolute risk, and how it was reportedEvidence › Journal club · 2 replies
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