Read the primary source rather than the write-up and the two do not agree, so here is what is actually in it.
The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.
Where I think it is weakest: the follow-up is short relative to how long people actually take these drugs, so durability is an assumption here rather than a finding.
What I am after is how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases. If the honest answer is that nobody knows, that is a useful answer and I would rather have it.
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
Dr.MetabolicMD said:The gap between trial results and real-world results is consistent and it is not fraud.
Dr.MetabolicMD has the substance of this right. The condition it depends on is worth stating. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.
Dr.MetabolicMD said:The gap between trial results and real-world results is consistent and it is not fraud.
Pushing back on Dr.MetabolicMD here. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
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View ResultsThis one has a reasonably settled answer, so here it is. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.
Dr.RaviCardio said:Read four things before the headline number.
This matches mine closely enough to be worth saying so out loud. Posting only so the count is not one.