idea-013 · desirability deck
Every slide states a condition that would have to be true, then reports where it stands using the candidate file's own claim and its own confidence tag. A deck never upgrades a tag, invents a number, or recommends anything, and there is no ask slide.
The chair: an adult with a mature, uncomplicated, non-surgically-reconstructed ileostomy who today wears a continuous-wear adhesive pouch — and the WOC (wound/ostomy/continence) nurse who trains them, and who would have to train them again for this.
How to read this: every slide is a condition, not a conclusion. A bracketed claim reference points into knowledge-base/candidates/idea-013.md: the number is the claim's position in its ## Claims list and the tag is copied from that line as it stands today, never adjusted here. A [no claim] marker means nothing in the file speaks to the condition. See docs/deck-spec.md.
Rebuild, 2026-09-29. Rebuilt after the Verifier's second pass moved the earlier deck write-backs (claims 15-21) from unverified to unconfirmed: each was run through the adoption connector, which returns unverifiable by design for what a person would do. That move is not progress on desirability; it is the file recording that no connector can ever answer these questions and only a human-attached study can. This build appended claims 22 and
verified ones are a CFR classification and a
repo-state check; none of them speaks to whether anyone wants this.
Would have to be true: A countable population of US adults with a mature, standard ileostomy would have to be experiencing pouch leakage and peristomal skin irritation often enough — weekly rather than occasionally — that they are actively looking for a different collection interface, not just a better-fitting pouch.
Where it stands: The population figure in the file is for any ostomy, not ileostomy: 725,000 to 1,000,000 Americans and about 100,000 new ostomy surgeries a year, from patient- organisation materials rather than a primary dataset claim 5unconfirmed. The file carries no ileostomy-only count; the viability deck puts that gap on record claim 26unverified. The pain is stated as a range across unnamed studies: 18% to 76% leakage incidence, about 37% of those weekly, over 81% of those with leakage also reporting skin irritation, with no PMID (PubMed identifier) cited claim 6unconfirmed. Nothing in the file measures whether any of these people are looking for an alternative to pouching at all [no claim].
What would settle it: Named PMIDs for the leakage studies, so literature-detail has something to run; an ileostomy-specific prevalence source (the viability deck's Slide 3); and, for "actively looking", a human act: a structured survey of ileostomy patients reached through WOC nurses or a patient organisation. No connector reaches the last one.
If it's false: If the people with leakage are a small, occasional minority, every other slide in this deck is addressed to a user who is not in the room. Factor 3 (TAM (total addressable market)) loses its only framing of who would switch.
Would have to be true: Every day, the patient would have to size, insert and later remove a soft silicone valve at their own stoma orifice by hand — an act with no counterpart in standard pouching — and keep doing it after the novelty wears off.
Where it stands: Stated as an assumption since the file was generated, and now checked as far as any connector can go: adoption returned unverifiable, no interview or preference study is attached claim 15unconfirmed. The companion question, whether patients can learn to do it safely without a clinician present, sits on the feasibility deck's Slide 6 claim 21unconfirmed. The only human precedent in the file is 14 patients in a 1981 study, all post-continent-ileostomy surgery with a failed nipple valve — a different population, a different device, and an abstract-level read claim 11unconfirmed.
What would settle it: A human act: a moderated concept test with ileostomy patients, showing the insertion sequence and asking what they would do, followed later by a handling study on a non-functional model. Neither is reachable from this repo.
If it's false: The product has no user. The mechanism, the pathway and the price all become moot, because every one of them assumes a patient who self-inserts daily.
Would have to be true: A WOC nurse would have to be willing to teach a patient this insertion routine and field the calls when it goes wrong, rather than treating it as extra training time and liability compared with fitting a pouch — and a DME (durable medical equipment) supplier would have to stock it, and a payer pay for it.
Where it stands: The nurse's willingness is an assumption, adoption returned unverifiable, and no study is attached claim 16unconfirmed. The supplier and payer links are viability questions and are stated there (viability Slides 1 and 2): what exists today is a set of ostomy supply codes priced at a few dollars per unit claim 18unconfirmed, and no claim speaks to whether a supplier would stock a novel item [no claim].
What would settle it: A human act: structured interviews with practising WOC nurses, asking specifically what training, what failure-rate evidence and what liability cover they would need before teaching this. WOCN Society members are the natural sample; no connector reaches them.
If it's false: If the nurse says no, the patient in Slide 2 never meets the device. In ostomy care this deck assumes the nurse is the person who fits appliances and teaches their use; no claim in the file establishes that role [no claim]. If the assumption holds, this condition can fail the product even if patients want it.
Would have to be true: The patient would have to accept emptying a small, low-profile cap several times a day — including overnight, because a flush reservoir holds less than a continuously-filling pouch — and accept that a stuck or failed valve happens at their own stoma, in exchange for less bulk and less adhesive on their skin.
Where it stands: The trade is on record as this deck's assumption and nothing has been checked claim 22unverified. The failure modes the patient would be carrying — valve occlusion by particulate effluent, leakage past the seal, irritation at the collar — are the Generator's own reasoning about a device with no prototype claim 13unconfirmed. The reservoir's capacity and the emptying interval are not in the file at all, so "several times a day" cannot yet be turned into a number [no claim]. What it costs them in money is a viability question (viability Slide 1) claim 19unconfirmed.
What would settle it: Two things in sequence: a bench measurement of reservoir capacity against ileostomy output (feasibility Slide 1), then a human act — a diary study or concept interview asking patients how many emptyings a day and a night they would tolerate.
If it's false: If the cap has to be emptied more often than a pouch, or overnight when a pouch would not, the product removes one burden and adds a worse one, and the "reduced adhesive exposure" benefit stops paying for the switch.
Would have to be true: A patient already frustrated by leakage would have to believe that replacing their pouching system is a better answer than adding a leak alert to it — and there is now a US-cleared leak alert to compare against.
Where it stands: The file's own premise that the leak-sensor competitor had no US clearance is refuted: Coloplast's Heylo was cleared as K252140 (an FDA 510(k) clearance number) on 2025-10-06, indicated for detecting ostomy appliance leakage in people with an ileostomy or colostomy aged 12 and over claim 4refuted. So the comparison a patient or nurse would actually make is on record as this deck's assumption, unchecked claim 23unverified. Whether patients prefer a valve and cap to their current pouch past a trial period is an assumption adoption cannot answer claim 17unconfirmed. The only outcome evidence for any indwelling ileostomy valve is the 1981 14-patient series in a different population claim 11unconfirmed.
What would settle it: A human act: in the same patient interviews as Slide 2, present three options side by side — current pouch, current pouch plus a leak alert, valve and cap — and record choices. For the clinical-evidence half, the nurse interviews in Slide 3 should ask what study a nurse would need to see; the file does not say.
If it's false: If a leak alert on the existing pouch satisfies most of the patients in Slide 1, the reachable user narrows to people whose problem is the pouch itself — bulk, skin, body image — rather than leakage, and Slide 1's population estimate shrinks with it.
Would have to be true: Before anything is built, a small number of structured conversations — WOC nurses first, then ileostomy patients they refer — would have to show a clear share of patients willing to try daily self-insertion, and nurses willing to teach it. An observation that falsifies it: nurses consistently naming insertion trauma or training load as a reason they would not offer it.
Where it stands: None of those conversations has happened. Every stakeholder condition in this deck is either unconfirmed because the connector cannot answer it claim 15unconfirmed claim 16unconfirmed claim 17unconfirmed or freshly on record and unchecked claim 22unverified claim 23unverified. The file also records that no domain dossier exists for ostomy care claim 14verified, so there is no curated clinical context in this repo to build the interview guide from.
What would settle it: A human act: a customer-discovery round run by whoever picks this up at Stage 7, interviewing nurses before patients because, on this deck's assumption, the nurse is the first gate (Slide 3). A domain dossier on ostomy care would be the cheapest preparation inside this repo.
If it's false: If nurses and patients reject daily self-insertion in conversation, the bench and regulatory work on the other two decks would be answering questions for a product nobody would use.
Every condition above with nothing verified behind it. That is every condition on this deck. The one verified claim cited (claim 14verified) is a repo-state fact about a missing dossier, not evidence about a user. Read this slide first.
adoption cannot answer it).
The shape of this list is the finding. The rubric scores no factor for whether a user wants the thing, and every stakeholder claim this candidate has sent to the Verifier has come back unconfirmed because adoption is unverifiable by design. The desirability questions can only be answered by people talking to patients and nurses; no further Verifier pass will move them.
If only one thing from this chair could be checked: whether adults with a mature, standard ileostomy would be willing to learn and keep performing daily self-insertion and self-removal of a valve at their own stoma, in exchange for less pouch bulk and less adhesive on their skin claim 15unconfirmed.
Why this one: every other slide assumes it. The nurse's yes (Slide 3), the emptying trade-off (Slide 4) and the comparison with a leak alert (Slide 5) all depend on a patient who has already agreed to handle a valve at their stoma every day. It is also the cheapest to check: a round of conversations, before anything is built.
Naming it is not a recommendation, a gate, or a kill. It is the answer to "check what first."
_shared/plain-language.md