"THD as a “surrogate marker”
The article compares audio metrics like THD to surrogate markers in medicine. THD is useful, measurable, and worth optimizing, but it is not the final endpoint."
I have worked in many medicine areas where surrogate markers are used extensively. In many cases, these surrogate markers had demonstrated "HARD ENDPOINTS" as well, so even the regulatory authorities allow them.
To me a very striking example is vaccination for HPV. Theoretically, eliminating these viruses in the young would result in a lower incidence of uterine and related genital cancers. But you can't do a 40 or 50 year old study to show that giving the vaccine to kids would results in these adults having less cancers. So they chose "warts" as a "surrogate endpoint". The existence of genital warts was a good predictor of future genital cancers, so the trials had prevention of warts as an endpoint. When the vaccines were approved, they only had warts prevention as "data". Only decades later it was demonstrated that children who were vaccinated against HPV did not get genital cancers, and that warts did behave as an accurate surrogate marker.
Blood pressure control, LDL levels are good examples of useful surrogate markers.* But you will find these days that many people believe that GLP-1 weight loss is a good surrogate marker for preventing death or other complications. The science HERE is not completely settled. Maybe soon, but there are confounding variables of weight loss itself as a predictor of survival. The statistical analysis will be very tough and controversial. For example, some claim that GLP-1 drugs help with osteoarthritis but there is no biological plausibility for this. It is lower body weight that reduces the impact of osteoarthritis [pain], but people make claims...
When antivirals for hepatitis C were approved, the FDA wanted to know if viral eradication did prevent liver cancers and death. That was a very controversial subject, but now it is clear that viral eradication can be considered a cure.
If Lars wants to say that THD is not fully established, and he says that "listening experience" IS the endpoint, then he has to show the methods and demonstration for this argument. Otherwise, that statement is pure subjectivism. For now!
EDIT: * despite blood pressure control and LDL levels being widely accepted as good surrogate markers of survival (death), a drug manufacturer still has to conduct studies to demonstrate the hard point if they wish to make the claim. Otherwise, they can only claim LDL or BP control WITHOUT the hard endpoint. It costs a lot of money and takes a lot of time to do these studies. Many pharmacies companies try to take some shortcuts but in the end, a good study is what is needed.