The strongest argument against my own position on SURMOUNT-4 and continuation versus withdrawal, stated as well as I can state it, since nobody else has yet.
0 likes 15mo
Evidence · Journal club · continued
Journal club: SURMOUNT-4 and continuation versus withdrawal — a second dataset posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Norrington, post #26: 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. Adding it because I spent an afternoon working it out and nobody should have to twice. Go to post
An update on my earlier SURMOUNT-4 and continuation versus withdrawal post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain.
b.solberg, post #33: An update on my earlier SURMOUNT-4 and continuation versus withdrawal post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain. Go to post
I had written a reply contradicting post #35 and deleted it. Here is what survived.
SURMOUNT-4 and continuation versus withdrawal would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.
j.marchetti, post #25: On SURMOUNT-4 and continuation versus withdrawal: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one. Go to post
Confirming post #35 from a second method, which matters more than confirming it from a second person.
What I would tell a new member reading about SURMOUNT-4 and continuation versus withdrawal for the first time: the confident posts are not the reliable ones, and the reliable ones are longer.
Collapsed as off-topic by two members at trust level 3 or above
This follows post #39 rather than contradicting it.
Small methodological point on SURMOUNT-4 and continuation versus withdrawal: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.
Confirming post #39 from a second method, which matters more than confirming it from a second person.
Posting my SURMOUNT-4 and continuation versus withdrawal numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.
28 likes 14mo
I had written a reply contradicting post #38 and deleted it. Here is what survived.
Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend.
0 likes 14mo
m.nascimento, post #13: Quietly grateful for the plain phrasing. Not every thread gets that. Go to post
What I want from this SURMOUNT-4 and continuation versus withdrawal 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.
e.kuipers, post #23: Building on post #22 rather than restating it. SURMOUNT-1 (N Engl J Med 2022): Tirzepatide obesity trial. The largest mean weight reduction for a pharmacological intervention at publication. Read the categorical thresholds carefully — they can exaggerate separation. Go to post
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.
Collapsed as off-topic by two members at trust level 3 or above
Useful. I had the fact and not the reason, which turns out to be the important half.
The practical version of SURMOUNT-4 and continuation versus withdrawal is three sentences long. The rigorous version is three pages and reaches the same conclusion with the conditions attached.
0 likes 14mo
VPoulsen, post #20: 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. Go to post
SURMOUNT-1 (N Engl J Med 2022): Tirzepatide obesity trial. The largest mean weight reduction for a pharmacological intervention at publication. Read the categorical thresholds carefully — they can exaggerate separation.
Noting that I have skin in this question and have tried to discount for it.
On post #46 — agreed on the reasoning, with one qualification.
Two questions I would want answered before drawing anything from the SURMOUNT-4 and continuation versus withdrawal data above: how were the cases selected, and what happened to the ones that dropped out.
14 likes 14mo
Collapsed as off-topic by two members at trust level 3 or above
I read post #49 twice before replying, because I had assumed the opposite.
Where the SURMOUNT-4 and continuation versus withdrawal 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.
f.danquah, post #15: Two things can be true about SURMOUNT-4 and continuation versus withdrawal 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. Go to post
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.
Same conclusion as the reply above, reached differently, which is mildly reassuring.
Wickramasinghe, post #4: 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. Reading it back, the second half matters more than the first. Go to post
Taking post #53 at face value and following it one step further.
If you are new and reading this thread for the answer to SURMOUNT-4 and continuation versus withdrawal: the answer is conditional, the conditions are in the third reply, and the rest of the thread is worth skipping.
I read the earlier replies on SURMOUNT-4 and continuation versus withdrawal 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.
12 likes 13mo
k.farrugia, post #22: Small correction to my own earlier position on SURMOUNT-4 and continuation versus withdrawal. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely. Go to post
Worth separating two things that post #53 runs together.
Worth stating the null on SURMOUNT-4 and continuation versus withdrawal before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
Fine by me. I had wanted a stronger conclusion and there is not one available.
0 likes 13mo
Collapsed as off-topic by two members at trust level 3 or above
The arithmetic in post #57 is right; the assumption feeding it is the part to check.
On SURMOUNT-4 and continuation versus withdrawal 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.