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Evidence · Journal club · continued

Journal club: SUSTAIN 6 and its retinopathy signal posts 91–120

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

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c.inglethorpeTL3Regular20 Jul 2026#91

Answering the question post #88 raises rather than the one it answers.

The reason SUSTAIN 6 keeps being re-asked is that the answer is conditional and people quote it without the condition. It is not that the answer is unknown.

1 like 8d
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h.bhattacharyaTL220 Jul 2026#92

The arithmetic in post #91 is right; the assumption feeding it is the part to check.

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 it because I spent an afternoon working it out and nobody should have to twice.

0 likes 7d
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cannula_driftTL3Regular21 Jul 2026#93

Right — I had this wrong and I am glad to have read it before it mattered.

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l.dialloTL221 Jul 2026#94
n.vukovic, post #74: 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. Go to post

What I would want before treating SUSTAIN 6 as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing.

7 likes in reply to #74 7d
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BGiordanoTL2Member21 Jul 2026#95

Everything in post #91 holds. The case it does not cover is the one I have.

My experience of SUSTAIN 6 contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.

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a.mwangiTL221 Jul 2026 · edited#96

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.

A guess, clearly labelled as one.

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c.delgadoTL221 Jul 2026#97

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

I would hold that lightly until someone with a larger sample weighs in.

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b.vestergaardTL222 Jul 2026#98
a.almeida, post #87: Right, and stated more narrowly than I would have dared to state it. Go to post

On SUSTAIN 6: 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.

4 likes in reply to #87 6d
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h.mbekiTL222 Jul 2026#99
e.verhoeven, post #35: Adding what did not work for me on SUSTAIN 6, since the failures never get written up and they are half the useful information. Go to post

Practical answer on SUSTAIN 6, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not.

7 likes in reply to #35 6d
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a.lindholmTL222 Jul 2026#100
s.vogel, post #14: Having read the whole SUSTAIN 6 thread before replying: the question in the first post has not actually been answered yet, and three of us have answered a nearby one instead. 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.

The general case is well covered; this is the awkward specific one.

1 like in reply to #14 6d
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a.delgadoTL222 Jul 2026#101

Everything in post #99 holds. The case it does not cover is the one I have.

Posting my SUSTAIN 6 numbers with the method attached so they can be discounted properly. Uncontrolled, unblinded, and collected by someone who wanted a particular answer.

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l.ibarraTL2Regular22 Jul 2026#102

SUSTAIN 6: 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.

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a.kirchnerTL223 Jul 2026#103
f.sjoberg, post #48: Sessions on negative or null results are consistently the most instructive and the hardest to get anyone to attend. Go to post

This settles it for me, at least until somebody posts a reason it should not.

26 likes in reply to #48 5d
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appeals_deskTL3Regular23 Jul 2026#104

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.

Worth reading the earlier posts in this thread before acting on mine.

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e.nilsenTL223 Jul 2026#105

I have been on both sides of the SUSTAIN 6 argument in this category within eighteen months, which should tell you how strong the evidence for either side is.

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fr.translation_moTL2Translator · FR23 Jul 2026#106

One caution on SUSTAIN 6: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.

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k.marchandTL223 Jul 2026#107
owen.brady, post #39: 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. If this contradicts something upthread, the upthread version may well be the better one. 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.

The mechanism is plausible, which is not the same as established.

0 likes in reply to #39 4d
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m.haddadTL2Regular24 Jul 2026 · edited#108

Taking post #107 at face value and following it one step further.

SUSTAIN 6 is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

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m.adeyemiTL224 Jul 2026#109

Whatever the answer on SUSTAIN 6 turns out to be, the method for getting there is the same: state the assumption, do the arithmetic in public, invite the correction.

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chromatogramTL4Analytical chemist24 Jul 2026#110

Following this. I have the same question and no better information than the first post.

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t.pereiraTL224 Jul 2026#111

Post #109 is right about the mechanism and I think understates the practical bit.

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.

Speaking for myself and not for anyone else who has posted here.

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f.villalobosTL224 Jul 2026#112

Coming back to post #108, because the follow-up matters more than the original answer.

Practical note on SUSTAIN 6: write down what you expect before you look. The number of times I have found what I went looking for is higher than chance would allow.

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c.grimaldiTL225 Jul 2026 · edited#113
ppm_error, post #79: 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. Go to post

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

That matches what I was told, which is not the same as knowing it.

0 likes in reply to #79 3d
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dr_okonkwoTL4 Moderator25 Jul 2026#114

SUSTAIN 6 is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.

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j.fonsecaTL225 Jul 2026#115

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

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PharmNotes_WhitfieldTL4Pharmacist25 Jul 2026#116

I read post #112 twice before replying, because I had assumed the opposite.

For anyone finding this later: the short answer on SUSTAIN 6 is that it depends on one thing, and the rest of the thread is people identifying which thing.

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n.kuuselaTL225 Jul 2026#117
l.diallo, post #94: What I would want before treating SUSTAIN 6 as settled: the method, the sample, and whether anyone tried to find the opposite result. Two of the three are usually missing. Go to post

This follows post #114 rather than contradicting 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.

Written in the hope of being told what I have missed.

0 likes in reply to #94 2d
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orbitrap_olaTL3Mass spectrometrist26 Jul 2026#118

I keep a log for SUSTAIN 6 specifically because my memory of it turned out to be systematically wrong in one direction. Six weeks of notes cost nothing and settled it.

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septum_entryTL2Member26 Jul 2026#119

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.

Worth saying I have only my own numbers here, and n is small.

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c.falkTL226 Jul 2026#120
j.restrepo, post #20: On SUSTAIN 6 the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that. Go to post

Two things can be true about SUSTAIN 6 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.

9 likes in reply to #20 2d