Asking directly, because I could not find a straight answer: Journal club: STEP 1 and the treatment-policy estimand — does this still hold?
Working notes on STEP 1 rather than a conclusion. I would rather post the reasoning while it can still be corrected than post the answer once I am committed to it.
Everything below is checkable. Where I have taken a figure from somewhere else I have said where; where I have estimated, I have said that too.
Where the group cannot agree, record the disagreement rather than resolving it by seniority. The recorded disagreement is more honest and more useful later.
Where I part company with the opening post, and it is a narrow parting.
I would be cautious about generalising from the STEP 1 example above. It is a good example. It is one example.
No notes. Posting so the count is not one.
Confirming post #5 from a second method, which matters more than confirming it from a second person.
Filing a mild objection to the consensus on STEP 1. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.
I had written a reply contradicting post #4 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.
Caveat: everything above assumes the paperwork is what it says it is.
The number people quote for STEP 1 is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.
I read post #8 twice before replying, because I had assumed the opposite.
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.
If that is already documented somewhere, ignore me and link it.
My understanding of STEP 1 is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating 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.
I would hold that lightly until someone with a larger sample weighs in.
Helpful, and easy to find again, which is half of what a good reply is.
Post #14 is the version of this I will quote in future. One addition.
Two sentences on STEP 1 and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
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 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.
Reading it back, the second half matters more than the first.
Picking up post #20: that is the part I would want checked first.
Trying to state the STEP 1 position in a way that someone who disagrees would recognise as fair, because I do not think the version in this thread passes that test.
Grateful for the specificity. Vague answers to this question are what sent me looking.
Adding the measurement that post #23 says would settle it.
Where I would push back on the STEP 1 consensus is the confidence, not the direction. The direction looks right. The confidence is borrowed.
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 have kept the units in throughout, for the obvious reason.
Where I part company with post #26, and it is a narrow parting.
Small methodological point on STEP 1: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.