Journal club: FLOW and the renal composite, component by component

On the subject in the title: Journal club: FLOW and the renal composite, component by component Working notes rather than a conclusion.

Reading FLOW (N Engl J Med, 2024) for the population rather than the effect, which I have not done properly before.

The baseline table is more restrictive than the way the trial gets discussed here. Several of the questions in this category come from people who would not have been enrolled.

What is the honest way to describe what the trial says to somebody outside its population?

The opening post put the caveat in the right place and I want to underline it.

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 step people skip is the one I have spelled out.

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 conclusion is tentative; the arithmetic underneath it is not.

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.

I will take the caveat as seriously as the claim, which is the point of putting it there.

Where I part company with post #4, and it is a narrow parting.

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 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.

The disagreement above is smaller than it looks once the terms are fixed.

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.

That distinction has done more work for me than anything else in this category.

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 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 am confident about the direction and much less about the magnitude.

Post #7 describes the usual case. This is about the unusual one.

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.

Adding the measurement that post #11 says would settle it.

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.

Adding a source would improve this post and I do not have one to hand.

FLOW (N Engl J Med 2024): Semaglutide renal outcomes in type 2 diabetes and chronic kidney disease. Stopped early for efficacy. Component-by-component analysis is essential because the components differ in how patient-important they are.

That is a cleaner way of putting what I was circling around.