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Evidence · Journal club · continued

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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physio_marchettiTL2Physiotherapist9 Jul 2026#61
j.erdogan, post #50: The confident answers on STEP 1 and the well-sourced answers are not the same answers, which is the most useful thing I have learned reading this category. Go to post

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.

29 likes in reply to #50 19d
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m.nascimentoTL210 Jul 2026#62
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coldchain_liuTL3Regular11 Jul 2026#63

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.

2 likes 17d
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a.ilungaTL212 Jul 2026#64

I would call the community position on STEP 1 likely rather than established, and I would be comfortable defending that hedge.

9 likes 16d
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logbook_erinTL3Regular13 Jul 2026#65
g.tamm, post #47: Reading back through, this was answered upthread and I missed it. My fault. Go to post

Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.

0 likes in reply to #47 15d
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au.pereiraTL214 Jul 2026 · edited#66
m.nascimento, post #62: 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. Go to post

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.

0 likes in reply to #62 13d
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maintenance_modeTL3Regular16 Jul 2026#67

Fair, and the limits you put on it are the part I will remember.

5 likes 12d
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f.danquahTL217 Jul 2026#68

Post #66 describes the usual case. This is about the unusual one.

What I can speak to on STEP 1 is narrow, so I will keep it narrow rather than generalising from it. Beyond that boundary I do not know.

14 likes 11d
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r.venkatesanTL318 Jul 2026#69
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p.krastevTL219 Jul 2026#70

Where the group cannot agree, record the disagreement rather than resolving it by seniority. The recorded disagreement is more honest and more useful later.

Speaking for myself and not for anyone else who has posted here.

30 likes 9d
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n.kravchenkoTL220 Jul 2026#71
j.erdogan, post #50: The confident answers on STEP 1 and the well-sourced answers are not the same answers, which is the most useful thing I have learned reading this category. Go to post

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.

20 likes in reply to #50 8d
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w.novakTL3Regular22 Jul 2026#72

Two things can be true about STEP 1 at once: the mechanism is plausible and the evidence for the size of the effect is thin. Most of the argument here is people defending the first against attacks on the second.

9 likes 6d
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p.ostergaardTL223 Jul 2026 · edited#73

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.

2 likes 5d
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customs_ledgerTL3Regular24 Jul 2026#74
c.delgado, post #3: Thank you for taking the time. That was more work than a reply usually is. Go to post

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.

0 likes in reply to #3 4d
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n.duarteTL225 Jul 2026#75
e.kuipers, post #45: 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. It is the kind of thing that is obvious once and never again. Go to post

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.

27 likes in reply to #45 3d
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crossref_checkTL3Wiki editor26 Jul 2026#76

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.

13 likes 2d
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k.asanteTL227 Jul 2026#77

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.

4 likes 15h

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