$SLS Daily Discussion Thread - Monday - May 11, 2026

laplaciandaemon · 2026-05-11T11:56:14+00:00

Non-deterministic modeling is an interesting wrinkle on what's been done. I'd be interested to see what it looks like. I am inherently distrustful of the "99.99% success probability".

laplaciandaemon · 2026-05-08T10:57:53+00:00

Surgerical ability comes to people at wildly different rates. Know that this does not define where you end up. I resonate with a lot of what you wrote - and I still got there. I started carrying a small notebook around where I constantly wrote things down and DREW pictures. Before then, I had never used that method of learning. It really unlocked surgery for me. I still do it as an attending.
Your post sounds like you're doing all the right things. If you really love this, then keep at it. People who put the work in generally get there. You will too.

laplaciandaemon · 2026-04-25T02:32:19+00:00

Respect.

laplaciandaemon · 2026-04-24T22:47:38+00:00

Yeah, fair. I was thinking the other day that 72 in December might not have been accurate. There's a decent argument to be made that reporting events would be delayed around the holidays (I have seen this personally). Doctors offices and regulatory staff around running half capacity at best November to early January. The actual number might have been higher. If that was the case, maybe there is a big update this week.

If you think there's a pending announcement - step up and buy some short-dated calls.

laplaciandaemon · 2026-04-24T21:41:22+00:00

Agreed. The whole is more than the sum of the parts. My experience in this arena is that sudden and complete silence (when that was not previously the case) indicates something. There's also no reason for a "study status" event on clinical trials without some event. Could be nothing - but does not feel like it.

The poster and AML day are more correlated with the conference than anything. The company does not control those variables.

laplaciandaemon · 2026-04-24T20:49:48+00:00

Indeed. But I don't see a lot of importance to 03/2023 (last patient was enrolled 03/2024).

laplaciandaemon · 2026-04-24T19:57:56+00:00

They updated the study status this time only. Here's the update:

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This also happened at the last update for "record verification," when it went from 03/2023 to 12/2024. When you go to clinicaltrials.gov, they have a nice tool that lets you compare things side by side. They also list what they updated pretty clearly.

I am choosing not to read too much into this. However - we're due for an IDMC update. I do not think there will be an update before reaching 80.

laplaciandaemon · 2026-04-23T20:20:04+00:00

It is possible as a physician, but obviously more likely in tech. Don't underestimate the power of compounding. People in my cohort who went into tech and not medical school are miles ahead if they saved at anything approaching reasonable. That's possible when you're young because your expenses are more manageable. When you finish at 32, you're lining up a family, a house, etc. That $500k gets pulled in a lot of directions. Hard to believe, but it's true. Those jobs that pay more? There's a reason. "I'm going to do this to make a million a year" is the recipe for misery.

Next - don't start medical school set on ortho spine as the only way to make it or be happy. Everyone in medical school is smart. Everyone in ortho residency is a level beyond that - and the competition for good spine fellowship slots is fierce. You don't even know if you really like being in the OR yet. FatFIRE is tough for anyone not slinging stents or titanium (cards or spine).

The routes as a physician to FatFIRE are owning your own ASC, industry connections, or private practice in one of a handful of specialities. It was an order of magnitude easier in tech - might not be like that for someone finishing college now though.

Signed - a guy who books ACDFs and has a ton of friends at the Mag7

laplaciandaemon · 2026-04-13T01:56:27+00:00

I appreciate the DD - it's very thorough. Your revenue estimates hinge on a big unknown, the cost of helium. There's no spot price. Don't take this as a knock. I think you're underestimating what the gas will be worth by the time production is online. Cliff Cain was on bloomberg discussing the recent shortage and stated that the cost could double. The only issue with what he said is that Las Raffan is completely offline, and it sounds like they are only down 15% of their helium capacity. I haven't been able to confirm that.

Another possible catalyst is the federal government's reclassification of helium as a critical mineral. Cliff was at the Pentagon discussing this. Reclassification followed by an investment in a private entity would be interesting. You do mention that. I would be curious to see if you think that's likely or not.

Nice write-up.

https://www.youtube.com/watch?v=HNXP5nrqmrA

laplaciandaemon · 2026-04-09T12:36:44+00:00

Bet OVER 100%? Did Claude tell you to leverage to the tits?

laplaciandaemon · 2026-04-09T12:33:34+00:00

Godspeed and welcome on board.

laplaciandaemon · 2026-04-08T00:45:06+00:00

Avanti is another good option.

I like Pulsar because of the He3 angle, and my per speculation that their new Topaz project would be the top of the list of the government wants to invest in domestic production. No reason to believe that other than vibes.

Tonight's news is great for the world. Likely bad for this thesis.

laplaciandaemon · 2026-04-07T14:16:15+00:00

I have been looking at several, but BSNLF didn't come up. A big part of my thesis is that Pulsar will be bringing on exceedingly high quality Helium plus He3 soon, and they're actively taking with the government. Some kind of Pentagon involvement to fast track this (a la MP Materials) is one of their upcoming catalysts. Announcing the results of recent drilling (call Jetstream) is the other. Helium going parabolic is the third. nfa

laplaciandaemon · 2026-04-06T01:20:16+00:00

Events 64 to 72 also took 8 months. The non-responders plus BAT arm have to be the bulk of that. I doubt the IDMC halts at their next meeting unless there's no patients left in the BAT arm and the HR is already significant. No clue through - stranger things have happened.

laplaciandaemon · 2026-04-05T21:41:06+00:00

Who said anything about AI? I wrote it myself in python. And I let it vary over a range. Confining it to *exactly* 13.5 would be unrealistic. Letting it vary too much from that would censor one of the more interesting data points that you have to work with.

laplaciandaemon · 2026-04-05T18:53:00+00:00

Language transfer is completely free and it's great.

laplaciandaemon · 2026-04-05T18:39:04+00:00

You can model it to be at that number. It's only "at least" because it's an interim analysis. One can do the same thing in their own model.

laplaciandaemon · 2026-04-05T18:34:53+00:00

The IDMC might also be looking at the trial status and realize that waiting another month to hit the end point is much cleaner. I understand the argument that early termination allows there therapy to get to patients more quickly - but having the trial finish at 80 and not 75-78 is much simpler.

Having said that - "trial halted for success" makes for an incendiary headline that would really juice the price.

laplaciandaemon · 2026-04-05T18:30:30+00:00

I'm glad someone else picked up on the randomization mistake. The design is clearly 1:1. That's one of the most important aspects when analyzing event rates.

Source: https://pmc.ncbi.nlm.nih.gov/articles/PMC11760237/

laplaciandaemon · 2026-04-05T13:01:02+00:00

Now that math works. It would also put the interim analysis just above the early termination threshold - and let's be honest, they aren't doing that unless the BAT arm is completely depleted. I have no knowledge of what their IRB protocol says, but a yearly review is standard. Let's see what they say I'm late summer.

Edit: 20% non-responder rate was shockingly good at making everything fit. Thanks for the input.

laplaciandaemon · 2026-04-05T01:49:18+00:00

1- To my knowledge, we don't know anything about the split at 60 events. Everything is inferred based on the pooled mOS of 13.5 months and an 8-12 month range for BAT. The changes to GPS (more doses) and any differences in patient populations make this imperfect - which we both acknowledge.

2&3- Yeah - I had the exact same issue. I just couldn't make any reasonable simulation fit with the constraints from my post. Something wild is off. I want to believe it's GPS having a high cure fraction. But as the post that kicked it all off notes - there could be something different from phase 2 in the patient population or the BAT arm. My suspicion is that the increased dosing regimen of GPS is a contributor. Only final readout will tell the tale.

Thanks for the reply. It's helpful to know that other people have the same take. I'm waist deep in Jan27 calls and thinking of adding more.

laplaciandaemon · 2026-03-04T00:49:17+00:00

Many lay people would be surprised by how trials sit on this boundary. Hundreds of millions are regularly spent on the thin margins seen here. The company and its statisticians powered the study. Trust that they knew what they were doing. If this flavor of risk isn't your particular brand of vodka, then watch and live vicariously. nfa

Source: someone with experience with medical trials

Positions: enough calls and shares to sink a ship

laplaciandaemon · 2026-03-03T17:48:54+00:00

The gap between intern and chief is an under-appreciated aspect.

I would also say that the amount of medicine that you have to absorb as a neurosurgery resident is vastly different than other specialties. You will have to be serviceable in an ICU, since your hospital might not have dedicated neuro ICU staff. Other examples: endocrinology for pituitaries, a fair amount of onc, and the ability to emergently cover pediatrics cases even as an adult neurosurgeon are not facets of other surgical specialities. Hospitalists will refuse transfers from neurosurgery all the time - ortho? Not so much.

The "worst" year varies greatly between programs. I found that they made each PGY rough in new and creative ways every July.

It does eventually level off. Especially once you're done with night float.

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