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When ever we describe NephMadness, the inevitable first question is “How do you determine the winners?” The answer as layed out in the rules section:

“The outcome of each match is determined by the two NephMadness Head Administrators (Drs. Joel Topf and Matt Sparks), who are both members of the eAJKD blog team. The results of these matches will have been determined before the beginning of the Contest entry period and will not be changed over the course of the Contest”

Matt and I just pick’em. We call this scripting the outcomes. This is not the only way to do it, the obvious alternative is to let the wisdom-of-the-crowd determine the winners. We call this popularity. One supporter of popularity, Dr. Roger Rodby of Rush University Medical Center, sent us an e-mail:

“This makes no sense, why not let the NephMadness participants decide based on the amount of votes, otherwise we are at the whim of two biased (everyone is biased) nephrologists. I’m not interested in what two people think, but what a population thinks.”

We would like to explain why we run NephMadness this way, especially after crowd favorites, rituximab and bioartificial kidney have lost.

During last year’s NephMadness tournament we did a hybrid of the two methods. For the first two rounds from 64 teams to 16 we scripted the answers, after that we left it to popularity. We noted a number of observations.

In almost every case where we used the popularity method, the better known technique/concept beat the lesser known one. For example MDRD equation beat the CKD-EPI equation. FeNa beat FeUrea. KDOQI beat KDIGO. Now, it could have been that the better competitor won out but we suspected what actually was happening was that when people are confronted with a confusing decision they just choose what they have heard of. This seemed like a hollow way to pick a champion. Plus, if the real NCAA tournament was left to popularity Kansas, Duke, or Kentucky would win every year. We wanted to capture the feel of the real NCAA tournament in order to create drama.

The 2013 NephMadness tournament turned out to be highly predictable. There were no upsets—how could there be? If the majority felt that one team was more likely to win, it always won.

You can steal a glance at what the population thinks by going to the statistics link in Tourneytopia:

There you can see that Rituximab is by far the dominant concept, with bioartificial kidney a solid second place. We think this is familiarity leading to votes. Rituximab is the biologic that has been licensed longer than any other. I don’t think it wins based on merit (because let’s face it, it is kind of a middling drug) but because of tremendous name recognition. Also, in the basic science division, bioartificial kidney is the only thing most people have heard of so it soaks up the lion share of votes, barely being diluted by other competitors in the bracket. This allows it to make it to the finals in 40 out of 260 brackets.

On the other side of the equation, are the regions that people are most familiar with, AKI and HTN. In this case the winner is split among a number of familiar concepts and so it comes out way behind the popular choices from the brackets people are less knowledgeable about.

In the end we were trying to build a compelling online game, and in order to do that we had to make choices. The project may have been successful with other choices but we are confident our choices make for the best game.

Our goal was to create a platform where we introduce nephrology concepts to start a dialogue and a conversation about nephrology. We want to showcase the wonderful things nephrology has to offer to medical students, residents, and fellows. The decisions that we made in the individual matchups were based upon discussions with leaders in the field (the selection committee of the regions) as well as the months of preparation we spent writing the dialogue and “scouting” reports. Our decisions are not arbitrary and we stand behind the choices we made. If you feel we made bad decisions tell us about it in the comments or on Twitter. We want to hear.

We don’t know if there will be a NephMadness next year but if there is, we are open to changes. How would you like to see the winner determined?

Click here to view all eAJKD content about NephMadness 2014!