Two scans, six weeks apart, and the arithmetic of believing the difference
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
SURMOUNT programme
Page 15 of 19 of this archive, newest first.
SURMOUNT-1 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
The substudies, read properly: who was scanned, when, and with what
What was pre-specified, what was exploratory, and what was calculated afterwards by people who did not run the trial.
SURPASS-2 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
SURMOUNT-2 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURMOUNT-4 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Two-thirds back: the extension nobody expected to be the headline
What was withdrawn, from whom, after how long, and what was measured afterwards.
STEP 4 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
LEADER misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
SURMOUNT-4 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
What happens when the drug is taken away: three randomised answers
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
SURMOUNT-4 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Two sessions a week, and the evidence behind the prescription
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
STEP 4 misses on a secondary endpoint the coverage has not mentioned
A design note rather than a result: what the comparator was, and what that permits you to conclude.
Eating enough protein on a suppressed appetite is an arithmetic problem before it is a nutritional one
The practical difficulty is not knowing the target. It is meeting it on an appetite that has been pharmacologically reduced by half.
Randomised withdrawal is the cleanest design in this field and the least discussed
The regain trajectories, arm by arm, with the estimands named.
STEP 3 extension data: what happens after the trial stops
A design note rather than a result: what the comparator was, and what that permits you to conclude.
The advice is mostly reasonable. The certainty is not earned.
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
Seasonal use, holiday use, and the honest state of the evidence
The vocabulary is borrowed, the rationale is usually mechanistic, and the outcome data does not exist.