idea-016 · 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: the user. The general-practice veterinarian and the technician who flush a sedated dog's ears on a Tuesday, and the dog's owner who pays for it at the front desk before leaving.
How to read this: every slide is a condition, not a conclusion. A bracketed claim reference points into knowledge-base/candidates/idea-016.md — the number is the claim's position in its ## Claims list, the tag is copied from it and never adjusted here. A [no claim] marker means nothing in the file speaks to this. See docs/deck-spec.md.
Would have to be true: A US general-practice veterinarian would have to see canine otitis externa often enough, and flush enough of those ears in the clinic rather than sending the dog home on owner-applied topicals, that a per-procedure consumable becomes a recurring line on the practice's standing order rather than an occasional purchase.
Where it stands: The disease side is asserted but unsettled: Banfield's State of Pet Health has been reported at 15.8% of dogs diagnosed with otitis externa in a reporting year [claim 5: unconfirmed], and a 5-20% practice range with a 7.5%-16.5% pair is cited across veterinary dermatology sources [claim 6: unconfirmed] — the one primary figure actually retrieved is a UK one-year period prevalence of 7.30% in 22,333 dogs under primary veterinary care [claim 7: unconfirmed], which the file expressly says must not be substituted for the US number. The half that matters more here — what share of those episodes involves an in-clinic flush at all — is an explicit unsourced Generator assumption of 20-40% [claim 11: unconfirmed]. And the moment itself is a sedated or anaesthetised one: the intended-use statement requires it, but no numbered claim spoke to whether sedation is routine practice or the thing that suppresses the procedure, until this deck put it on record [claim 25: unverified].
What would settle it: The primary Banfield State of Pet Health report, attached by a human — the file's own note calls it the single highest-value free document in this TAM decomposition. For the flush share, a licensed veterinary practice-management dataset (VetSuccess/Vetsource or equivalent); no connector in this repo reaches veterinary procedure volume, because procedures reads Medicare human fee-for-service utilisation [claim 13: unconfirmed]. For the sedation question, the technique reviews already named in the file (PMID 15062624 "Otic flushing"; PMID 15030561 "Ear cleaning: the UK and US perspective") are free and one literature-detail call away.
If it's false: There is no recurring user, only an occasional one, and the consumable business model has no repeat cadence under it. Factor 3's rate leg and its addressable-share leg both collapse at once — and TAM below 2/5 is one of the rubric's three automatic kills.
Would have to be true: On every flush, the veterinarian or technician would have to set down the 5-8 Fr red rubber urinary catheter and syringe they already own and know, open a single-use kit instead, and set the depth collar, relief valve and graduated trap inside the anaesthetic time the practice already budgets for the procedure.
Where it stands: That the red rubber catheter and syringe is the incumbent technique is the Generator's assertion with no practice survey behind it — a PubMed sweep returned 20 records and none of them was a practice survey [claim 16: unconfirmed]. The switch itself is carried in the file as an assumption rather than a fact, and the adoption connector returns unverifiable by construction for clinician purchasing and procedure preference, so it is permanently unconfirmed absent primary research [claim 22: unconfirmed]. The setup-time and operability half — whether a technician can run three new controls correctly after one demonstration without adding time — was in no claim at all and is now on record [claim 26: unverified].
What would settle it: A primary practice survey of current ear-flush technique and equipment among US general practices — weeks and real money, and no connector in this repo touches it. For the setup-time half, timed usability sessions with a dozen technicians on a benchtop canine ear model, which is a bench cost rather than a survey cost.
If it's false: Two different breaks. If the red rubber catheter is not the incumbent, Factor 8 has been scored against the wrong competitor. If the kit adds minutes under anaesthesia, it imposes its cost on the most expensive and highest-risk minute of the procedure, and no safety argument recovers that — the device makes the flush worse on the dimension the practice actually manages.
Would have to be true: Three more people, and only three. The practice owner or inventory manager would have to add the SKU to the standing consumable order; the pet owner would have to consent to the flush with the kit's cost on the invoice; and nobody else — no payer, no institutional review, no prescriber outside the building — would have to approve anything.
Where it stands: The short consent chain is the file's own structural claim: the practice buys the consumable and the owner pays out of pocket at the point of service, with no CPT, HCPCS, LCD, NCD or third-party payer anywhere in the path [claim 14: unconfirmed]. The owner's yes is conditional on price tolerance, which the file carries as an explicit assumption about elasticity rather than a finding [claim 23: unconfirmed], and pet insurance is no backstop — roughly 6-7 million insured pets in North America against a US dog-and-cat population on the order of 150 million [claim 15: unconfirmed]. The distributor's yes is a viability condition and is stated on the viability deck's Slide 5 [claim 30: unverified].
What would settle it: The primary NAPHIA State of the Industry report, attached by a human, settles the insurance leg in one document — no connector in this repo reaches NAPHIA. For the owner's yes, a veterinary practice-management price list showing what an ear-flush line item currently bears, plus an owner price-sensitivity study; both licensed or primary, neither connector-reachable.
If it's false: The short chain is the good news in this lane and it is not what breaks. What breaks is the owner link: if owners decline the flush once the kit's cost lands on the invoice, the practice stops stocking it regardless of what the veterinarian clinically prefers, and the desirability case is decided by someone who never handles the device.
Would have to be true: The veterinarian would have to accept a $12-25 per-procedure consumable in place of a catheter and syringe costing a few dollars, and give up the tactile feedback of a technique they trained on, in exchange for a pressure ceiling and a measured-return endpoint whose reading has never been shown to track what is actually left in the canal.
Where it stands: The price is the Generator's stated assumption, not a quote — veterinary consumable pricing has no connector in this repo at all [claim 12: unconfirmed] — and it is being set against an incumbent the file itself describes as ad-hoc and nearly free [claim 16: unconfirmed]. The trade the user is being asked to make rests on the instilled-versus-recovered comparison actually functioning as a usable clinical endpoint, which is an untested engineering and clinical hypothesis: a PubMed sweep for canine ear-canal fluid-recovery or residual-volume work returned zero records [claim 24: unconfirmed]. Whether the practice can pass the cost through without suppressing procedure consent is an assumption on the file, with the adoption connector returning unverifiable by construction [claim 23: unconfirmed].
What would settle it: Distributor catalogue pricing for comparable veterinary consumables for the price baseline (licensed desk research). For the endpoint, the cadaveric or benchtop fluid-recovery measurement described on the feasibility deck's Slide 5 — nothing short of measurement resolves it, as claim 24's own note says.
If it's false: If the recovered-volume reading does not track residual volume, the user is paying per procedure for a number they cannot act on, and the product's differentiator becomes decoration on a disposable catheter. Factor 6 loses half its story, and Slide 5's belief argument loses the evidence it was going to rest on.
Would have to be true: A general-practice veterinarian would have to already regard tympanic rupture, ototoxicity and post-flush vestibular signs as complications they meet often enough to re-equip for — and then would have to be shown a published canine irrigation pressure number, not a description of a mechanism.
Where it stands: The failure modes are documented, and the file is careful that the literature cuts both ways: PMID 20636566 reports 62 hearing-loss cases over 2002-2009 of which 16 followed ear cleaning, "but the prevalence is low"; PMID 15062624's review states the benefits of otic flushing "exceed its risks"; PMID 16050820 found no vestibular or BAEP effect for one TrisEDTA/PHMB flush in 20 dogs with bilateral myringotomy [claim 8: unconfirmed]. Whether practising veterinarians feel this as a live problem was in no claim in the file and is now on record [claim 27: unverified]. The number they would want does not exist: a targeted PubMed search this pass returned no canine irrigation-pressure rupture threshold, and the device's cracking pressure therefore has no numerical basis [claim 9: unconfirmed].
What would settle it: Structured interviews with twenty or more general-practice veterinarians and veterinary dermatologists on how often they see flush complications and what would change their equipment choice — a survey, not a lookup, exactly as the adoption connector's own output says. The number itself comes from the cadaveric canine temporal-bone study named in claim 9.
If it's false: The entire sales argument is safety against a risk the buyer does not believe they have. The product then competes on price and convenience against a near-free catheter it already loses to on both, and Factor 6's mechanism story — the one thing this device is for — stops being a purchase reason.
Would have to be true: In the first handful of clinics handed a trial box, someone would have to reorder once it ran out, without a representative in the room prompting it.
Where it stands: The reorder behaviour is on record as an assumption and nothing more [claim 28: unverified], sitting on top of the switching assumption the file already carries [claim 22: unconfirmed], for which the connector explicitly names primary research — interviews, survey, published preference study — as the only route.
What would settle it: A 10-20 practice trial with unprompted reorder as the single endpoint: a human act, no connector, and cheap relative to anything on the feasibility deck. Cheaper still and first: the twenty-vet interview from Slide 5 [claim 27: unverified], which costs conversations rather than inventory.
If it's false: A trial that ends in no reorders falsifies claims 22, 27 and 28 together, at a fraction of the cost of the bench programme claims 9 and 24 call for — which is the argument for running it before, not after, the cadaveric work.
Every condition above with nothing verified behind it — the [no claim] markers, plus the unverified claims this deck itself put on record. Read this slide first.
Nothing on this deck has a verified claim behind it. The two verified claims in the candidate file are both regulatory — the 807.65(b) veterinary exemption and the human-use scoping of the premarket duties — and neither says anything about whether a veterinarian wants this. That is the expected shape: the rubric scores no factor for user desire, so this deck is reporting a pipeline fact as much as an idea-specific one.
If only one thing from this chair could be checked: whether general-practice veterinarians regard tympanic rupture, ototoxicity and post-flush vestibular signs as risks they meet often enough to change what ear-flushing equipment they buy [claim 27: unverified].
Every other condition on this deck is downstream of it. Price tolerance (Slide 4), the switch away from the red rubber catheter (Slide 2), and the reorder (Slide 6) are all arguments about how much a buyer will pay to remove a hazard — and the file's own literature reading [claim 8: unconfirmed] shows the veterinary literature is not unanimous that the hazard is large. It is also the cheapest condition here: twenty structured interviews, no bench rig, no licensed dataset, and it can be run before a dollar goes into the cadaveric programme.
Naming it is not a recommendation, a gate, or a kill. It is the answer to "check what first."