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Evidence · Journal club · continued

Journal club: SURMOUNT-1, read without the press release posts 121–150

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

NG
np_gilmoreTL3Nurse practitioner21 May 2025#121
s.poulsen, post #5: The arithmetic on SURMOUNT-1 is the easy part and it is where the errors are, which is an uncomfortable combination. Show your working and someone will catch it. Go to post

Post #118 is the version of this I will quote in future. One addition.

The baseline characteristics table is the single most useful page for the questions that get asked here, because it tells you who the result applies to.

If anyone can point at the primary source I would be grateful.

4 likes in reply to #5 14mo
RM
r.mensaTL223 May 2025#122

Where the SURMOUNT-1 reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.

13 likes 14mo
PP
peak_purityTL3Analytical chemist24 May 2025#123

People arriving without having read it should be welcome and should say so, because a question from someone who has not read it frequently exposes an assumption everyone else made.

0 likes 14mo
NS
no.silvaTL226 May 2025#124
e.halonen, post #88: Confirming post #86 from a second method, which matters more than confirming it from a second person. If someone has run SURMOUNT-1 properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet. Go to post

Post #120 describes the usual case. This is about the unusual one.

The most useful thing anyone has posted about SURMOUNT-1 in this category was a table of what had been measured and by whom. That is what I would want again.

0 likes in reply to #88 14mo
PR
policy_readerTL2Regular27 May 2025#125
taper_table, post #116: Nothing to add on the substance. Thank you for taking the question at face value. Go to post

Building on post #122 rather than restating it.

On SURMOUNT-1, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.

If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.

7 likes in reply to #116 14mo
EA
e.adeyemiTL229 May 2025 · edited#126

Post #124 put the caveat in the right place and I want to underline it.

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.

I would be interested in a counterexample if anyone has one.

18 likes 14mo
MD
m.dalgaardTL3Regular30 May 2025#127

Two claims get bundled together under SURMOUNT-1 and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.

Almost every disagreement in threads like this one dissolves once you say which of the two you are making.

4 likes 14mo
FR
f.rasmussenTL21 Jun 2025#128

Clear enough that I do not think I have a follow-up, which is unusual.

1 like 14mo
EV
e.verhoevenTL22 Jun 2025#129
an.zamora, post #107: Narrowing post #104, because the general version has more than one answer. Posting my SURMOUNT-1 numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer. Go to post

I changed my mind about SURMOUNT-1 after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.

0 likes in reply to #107 14mo
RL
r.laurentTL24 Jun 2025#130
mi.almeida, post #8: Post #5 is right about the mechanism and I think understates the practical bit. Where the SURMOUNT-1 discussion usually stalls is that nobody wants to say "I do not know" and everyone is willing to say "it varies". Those are the same sentence with different clothes on. Go to post

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

5 likes in reply to #8 14mo
LP
l.parkinsonTL2Member5 Jun 2025#131
z.onwuka, post #119: 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. I would rather post the uncertainty than round it away. Go to post

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.

The rule of thumb is fine; the edge cases are where it earns its keep.

1 like in reply to #119 14mo
MN
ma.nascimentoTL27 Jun 2025#132

Post #131 is right about the mechanism and I think understates the practical bit.

SURMOUNT-1 is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

0 likes 14mo
VS
vial_slopeTL3Regular8 Jun 2025 · edited#133

Second this, and I would have said it less carefully.

18 likes 14mo
NH
n.hartmannTL210 Jun 2025#134

What I want from this SURMOUNT-1 thread is the list of things that would need to be true for the claim to hold. If we can write that list, we can check it.

7 likes 14mo
W
WendelboeTL2Member11 Jun 2025#135
k.adeyemi, post #109: I have been on both sides of the SURMOUNT-1 argument in this category within eighteen months, which should tell you how strong the evidence for either side is. 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 #109 14mo
AV
ai.vukovicTL212 Jun 2025#136
h.almeida, post #79: SELECT (N Engl J Med 2023): Semaglutide cardiovascular outcomes without diabetes. The first outcome trial in people without diabetes, which decoupled the cardiovascular argument from glucose control. Read the absolute numbers, not just the relative reduction. The right answer here may simply be that it has not been measured. Go to post

Reading this SURMOUNT-1 thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not.

0 likes in reply to #79 13mo
CP
citation_peakTL3Regular14 Jun 2025#137

Post #135 describes the usual case. This is about the unusual one.

On SURMOUNT-1, I would rather understate and be corrected upward than overstate and be quoted. That is a house style here and it is a good one.

12 likes 13mo
FY
f.yildizTL215 Jun 2025#138

An hour is enough for one paper read properly and not enough for two read partly. The temptation is always to add the second.

4 likes 13mo
PN
p.novotnyTL2Regular17 Jun 2025#139

SURMOUNT-1: I have looked for the primary source twice and failed twice. Either it does not exist or it is somewhere I do not know to look, and I would like to know which.

7 likes 13mo
MB
m.balogunTL218 Jun 2025#140

Session format: read the paper before posting. The discussion is much better when everyone has. Start with the estimand and population, then methods, then results, then limitations. That order makes critique coherent.

1 like 13mo
JN
j.nascimentoTL220 Jun 2025#141
o.abrahamsen, post #110: Where the group cannot agree, record the disagreement rather than resolving it by seniority. The recorded disagreement is more honest and more useful later. The evidence for this is thinner than the way I have phrased it suggests. Go to post

Since SURMOUNT-1 keeps coming up, it should probably be a maintained page rather than a recurring thread. I am happy to draft it if someone with more direct experience will review it.

3 likes in reply to #110 13mo
CB
c.bakkerTL221 Jun 2025#142

People arriving without having read it should be welcome and should say so, because a question from someone who has not read it frequently exposes an assumption everyone else made.

10 likes 13mo
MB
m.brobergTL222 Jun 2025#143

On SURMOUNT-1 I would separate what is worth knowing from what is worth acting on. The first list is long and the second is short, and conflating them is how threads get heated.

22 likes 13mo
SL
s.leclercTL4 Moderator24 Jun 2025#144

Answering the question post #142 raises rather than the one it answers.

Reporting rather than recommending, on SURMOUNT-1. What happened is above. Whether it should have is a different question and not one I am qualified to answer.

0 likes 13mo
AW
a.wikstromTL225 Jun 2025#145
f.rasmussen, post #128: Clear enough that I do not think I have a follow-up, which is unusual. Go to post

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.

1 like in reply to #128 13mo
C
chromatogramTL4Analytical chemist27 Jun 2025#146

Checked the SURMOUNT-1 claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope.

6 likes 13mo
TD
t.dumitruTL228 Jun 2025#147

Reading rather than contributing, but this is the most useful thread I have found on it.

15 likes 13mo
EF
endo_fellow_rkTL3Endocrinology fellow30 Jun 2025#148

Everything in post #146 holds. The case it does not cover is the one I have.

Assigning the statistics to somebody who will read the analysis plan rather than the results section is worth doing in advance. It is the part that gets skipped by default.

I have separated what I observed from what I concluded, which does not always happen.

31 likes 13mo
TI
trough_indexTL3Regular1 Jul 2025 · edited#149
y.asante, post #86: Two people in this thread mean different things by SURMOUNT-1 and are disagreeing about the definition while believing they are disagreeing about the facts. Worth pausing to define it. Go to post

I read the earlier replies on SURMOUNT-1 twice before writing this, because I had assumed the opposite and wanted to be sure I was disagreeing with what was said rather than what I expected.

0 likes in reply to #86 13mo
EM
e.mwangiTL22 Jul 2025#150
z.onwuka, post #119: 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. I would rather post the uncertainty than round it away. Go to post

Post #146 and I disagree about the size of the effect, not about the direction.

A note on how SURMOUNT-1 gets discussed rather than on SURMOUNT-1 itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often.

3 likes in reply to #119 13mo