Midterm Exam — Parts I–III

Forty points. Seventy-five minutes. Closed book unless your instructor states otherwise; the four-line rating format in Section C may be reproduced on the board.

Covers Chapters 1–19 — the method (Part I), metabolic peptides (Part II), and growth and repair (Part III).

A note on what is being tested. Almost nothing on this exam asks you to recall a verdict. It asks you to produce one, from evidence you are given, using the rules. A student who has memorized Appendix A and not learned Chapter 5 will do poorly, which is the intended behavior of the instrument.

Every invented example on this exam is labeled [constructed teaching example]. Nothing labeled that way is real, and none of it should be cited, repeated, or used outside this exam.

Section A — Multiple choice (12 points, 1 each)

Choose the single best answer.

A1. The book's central thesis is best stated as: a) Peptides are a promising new class of medicine that has been unfairly maligned. b) Most peptides sold today are unsafe. c) "It's a peptide" tells you almost nothing; the evidence separating two peptides can be enormous. d) Peptides work through mechanisms too complex for non-specialists to evaluate.

A2. Under Rule 1, an evidence rating attaches to: a) A molecule. b) A claim, with a population and an endpoint. c) A manufacturer. d) A regulatory decision.

A3. A ❌ rating means: a) The molecule is dangerous. b) The molecule has been proven not to work. c) The claim's hype outpaces its evidence. d) The compound is illegal.

A4. The main reason most peptides cannot simply be taken as ordinary pills is that: a) They are too large to be manufactured in tablet form. b) They are degraded by digestive proteases and cross the intestinal wall poorly. c) They are unstable at room temperature. d) They are always regulated as injectables.

A5. Which represents the stronger state of knowledge about a claim? a) No adequate trial has ever been run. b) An adequate trial was run and the result was negative. c) They are equivalent. d) Neither tells us anything.

A6. A compound's receptor binding is confirmed exactly as predicted, and no clinical outcome data exist. Under the rules, this: a) Justifies an upgrade to ⚠️. b) Justifies an upgrade to ✅ if the mechanism is well established. c) Justifies no upgrade at all; mechanism licenses a hypothesis, not a rating. d) Justifies a downgrade, because mechanism claims are usually marketing.

A7. The same GLP-1 receptor agonist, at the same dose and duration, produced roughly −15% body weight in adults with overweight or obesity without diabetes and roughly −10% in adults with type 2 diabetes. This difference is most directly a lesson about: a) Dose selection. b) Trial quality. c) Population. d) Endpoint choice.

A8. The incretin effect refers to the observation that: a) Insulin secretion is greater after oral glucose than after intravenous glucose producing the same blood glucose. b) Glucagon rises after a meal. c) Appetite falls as blood glucose rises. d) Gastric emptying accelerates after a protein meal.

A9. Growth hormone secretagogues differ from growth hormone itself in that secretagogues: a) Are absorbed orally in all cases. b) Act on a gland that then acts on tissues, adding a layer of variability. c) Have longer half-lives by design. d) Are approved for more indications.

A10. The evidence base for BPC-157's healing claims is best characterized as: a) Multiple large randomized controlled trials with mixed results. b) One large randomized controlled trial with a negative result. c) Substantial animal and preclinical work with no adequate human outcome trial. d) Extensive human observational data with no animal work.

A11. The risk that a gray-market vial contains something other than what its label says is: a) A reason to downgrade the molecule's rating. b) Independent of whether the molecule works, and belongs in a separate field. c) Only relevant for compounds with no approved indication. d) Eliminated by a certificate of analysis.

A12. A trial reports that a treatment lowered a blood marker associated with disease risk. The marker is: a) A hard outcome. b) A surrogate endpoint, and accepting it as benefit is a bet that moving the number moves the outcome. c) Irrelevant to evaluation. d) Equivalent to a mortality endpoint if the association is strong.

Section B — Short answer (18 points, 3 each)

Two to four sentences each. Precision is graded; length is not.

B1. Rewrite the following as a claim that could actually be evaluated, and name the two things you had to supply: "This peptide supports faster recovery."

B2. Distinguish the two kinds of ❌. Which one represents the stronger state of knowledge, and why do most readers get this backwards?

B3. Explain, using Rule 6, how one molecule can correctly carry ✅, 🔬, and ❌ ratings at the same time, without any of them being wrong.

B4. Chapter 6 asks you to write field 12 — what would change my mind — early, before you are invested in a compound. Give the reason, and state what an entry with an empty field 12 has become.

B5. A compound sold without any approval has "no reported side effects." Explain in two sentences why this is not the same as "no harms."

B6. A compound's human data were generated by one route of administration, and it is being sold and used by a different route. State what this does to the evidence base, and name the dossier field where this discrepancy becomes visible.

Section C — Extended item (10 points)

Read the constructed source below and rate the claim it makes, using the four-line format. Then answer the two follow-up questions.

[constructed teaching example] — the following product page is invented for this exam. COMPOUND Q does not exist. Nothing below is real, and none of it should be repeated outside this exam.

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COMPOUND Q — advanced tissue support

Clinically studied. In a published study, participants taking COMPOUND Q showed a 47% improvement in tissue repair markers compared to their starting values over eight weeks.

COMPOUND Q is an exact fragment of a protein found naturally in the human body, and it binds directly to the receptors involved in healing — the same pathway your body already uses.

Thousands of athletes trust COMPOUND Q. Not evaluated by any regulatory agency.

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C1. (6 points) Produce the four-line rating.

CLAIM:
EVIDENCE:
RATING:            [✅ / ⚠️ / ❌ / 🔬]  +  [date]  +  [if ❌: absent / present-and-negative]
WOULD CHANGE IF:

C2. (2 points) The page makes two appeals that carry no evidentiary weight under the rules. Name both and say which rule each one would violate if you let it influence your rating.

C3. (2 points) One phrase in the source describes the comparison used in the study. Quote it, and explain what is missing from it.

CLAIM:            COMPOUND Q accelerates tissue repair -- population unspecified
                  by the source; endpoint stated as "tissue repair markers,"
                  which is a surrogate, not healing.
EVIDENCE:         One study, design unstated. No comparator -- the change is
                  "compared to their starting values," i.e., within-subject
                  before-and-after, not versus placebo or standard care.
                  Population, size, and duration beyond "eight weeks" unstated.
                  Endpoint is a surrogate. No replication described.
                  Conspicuously absent: any controlled human outcome trial.
RATING:           ❌  [date]  -- kind: evidence ABSENT
WOULD CHANGE IF:  A randomized controlled trial in a defined injured population,
                  with a clinical healing outcome (e.g., time to return to
                  activity or imaging-confirmed repair), an active or placebo
                  comparator, adequate duration, and enough participants to
                  detect a clinically meaningful difference -- replicated.

Related: Chapters 1–19 · Appendix C (the twelve fields) · Appendix D (reading a trial) · Appendix F (red flags) · Appendix H (worked evaluations) · Appendix M (answers) · Claim Evaluation Rubric · Final Exam · Practical Evaluation Exam