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Evidence · Journal club · continued

Journal club: SUSTAIN 6 and its retinopathy signal posts 61–90

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

KV
k.vanheckeTL214 Jul 2026#61

Picking up post #60: that is the part I would want checked first.

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.

Adding it in case it saves somebody the afternoon it cost me.

0 likes 14d
VB
v.baptistaTL214 Jul 2026#62
dr_okonkwo, post #45: I have no financial interest in anything named in this thread and I want to say so before I comment on SUSTAIN 6, because it is the sort of subject where it matters. Go to post

On SUSTAIN 6, 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.

2 likes in reply to #45 14d
BN
bench_notesTL4 Moderator14 Jul 2026#63

SUSTAIN 6 was covered in the wiki last year and the page has a review date on it, which is a better starting point than my memory of a thread.

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AV
a.vukovicTL214 Jul 2026#64

I had written a reply contradicting post #62 and deleted it. Here is what survived.

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.

Happy to be corrected if someone holds better data than mine.

19 likes 14d
HF
h.ferrariTL215 Jul 2026#65
m.onwuka, post #40: Filing a mild objection to the consensus on SUSTAIN 6. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. Go to post

What I would check first on SUSTAIN 6 is whether the thing being measured moved or whether the way of measuring it moved. Those look identical in a graph.

0 likes in reply to #40 13d
RV
r.villalobosTL215 Jul 2026#66
t.pereira, post #55: Where I part company with post #51, and it is a narrow parting. I changed my mind about SUSTAIN 6 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. Go to post

The number people quote for SUSTAIN 6 is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.

0 likes in reply to #55 13d
RD
r.danquahTL215 Jul 2026#67

Post #64 is the version of this I will quote in future. One addition.

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.

Two sources, same conclusion, and I could not rule out that one copied the other.

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KF
k.fonsecaTL215 Jul 2026 · edited#68

I had read the opposite somewhere and cannot now find where, which tells me something.

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AP
ar.petrovTL216 Jul 2026#69

What I want from this SUSTAIN 6 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.

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FF
f.fenwickTL3Regular16 Jul 2026#70

Post #66 and I disagree about the size of the effect, not about the direction.

The thing about SUSTAIN 6 that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.

7 likes 12d
AK
a.kowalczykTL2Regular16 Jul 2026#71

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.

On reflection I would soften that slightly.

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CH
c.haddadTL216 Jul 2026#72
PN
plateau_notesTL2Regular16 Jul 2026#73
k.fonseca, post #68: I had read the opposite somewhere and cannot now find where, which tells me something. Go to post

My position on SUSTAIN 6 is current rather than settled. I have revised it once already and I expect to again, so treat it accordingly.

0 likes in reply to #68 12d
NV
n.vukovicTL217 Jul 2026#74
n.kuusela, post #53: That is consistent with mine, for whatever one more account is worth. 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.

32 likes in reply to #53 11d
OL
o.lindgrenTL2Regular17 Jul 2026#75

Post #73 put the caveat in the right place and I want to underline it.

Where the SUSTAIN 6 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.

7 likes 11d
NC
n.cardosoTL217 Jul 2026#76

Building on post #73 rather than restating it.

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.

That has been true for the cases I have seen and I have not seen many.

1 like 11d
P
preregisteredTL3Research methods17 Jul 2026#77
h.oyelowo, post #4: Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend. Not the answer, but possibly the question that gets there. Go to post

Offering a way to settle SUSTAIN 6 rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision.

0 likes in reply to #4 11d
RP
r.petrovTL217 Jul 2026#78

If you are new and reading this thread for the answer to SUSTAIN 6: the answer is conditional, the conditions are in the third reply, and the rest of the thread is worth skipping.

24 likes 10d
PE
ppm_errorTL3Analytical chemist18 Jul 2026#79
c.cardoso, post #47: The arithmetic in post #45 is right; the assumption feeding it is the part to check. Genuine question rather than a rhetorical one: has anyone here actually observed SUSTAIN 6, as opposed to read about it? The thread is long and I cannot tell. 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.

That is a description of practice, not a recommendation of it.

23 likes in reply to #47 10d
BV
b.vanheckeTL218 Jul 2026#80

Since SUSTAIN 6 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.

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K
KLindqvistTL4 Moderator18 Jul 2026#81

Post #78 answers the question as asked. The question underneath it is different.

Where the SUSTAIN 6 reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.

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KL
k.laurentTL218 Jul 2026#82
o.lindgren, post #75: Post #73 put the caveat in the right place and I want to underline it. Where the SUSTAIN 6 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

I read post #80 twice before replying, because I had assumed the opposite.

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.

2 likes in reply to #75 10d
NL
n.lehtinenTL219 Jul 2026 · edited#83

What would change my mind on SUSTAIN 6 is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.

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IB
i.bakkenTL219 Jul 2026#84

The useful distinction on SUSTAIN 6 is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.

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KR
k.roosTL219 Jul 2026#85
i.almeida, post #50: Where I part company with post #48, and it is a narrow parting. SUSTAIN 6 is a question about a distribution, not about a value, and treating it as a value is what produces the confident wrong answers. Go to post

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

I would rather say I do not know than round it up to an answer.

0 likes in reply to #50 9d
LD
l.dziedzicTL219 Jul 2026#86
f.fenwick, post #70: Post #66 and I disagree about the size of the effect, not about the direction. The thing about SUSTAIN 6 that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result. Go to post

Coming back to post #84, because the follow-up matters more than the original answer.

A request rather than an answer: could whoever has the primary source for SUSTAIN 6 post it? I have seen the claim three times this month and each version had lost a qualifier.

4 likes in reply to #70 9d
AA
a.almeidaTL219 Jul 2026#87

Right, and stated more narrowly than I would have dared to state it.

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AW
a.weissTL220 Jul 2026#88

Source for the SUSTAIN 6 figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.

Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.

0 likes 8d
EK
e.kimaniTL220 Jul 2026#89

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.

The part I am sure of is shorter than the part I have written.

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PS
p.silvaTL220 Jul 2026#90

I disagree with the framing of SUSTAIN 6 above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.

The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.

0 likes 8d