Chapter 39 — Exercises

How to use these. No answers are provided. Several exercises have no single correct response — they are asking you to produce something (a question, a distinction, a stopping rule) that you will then judge against the standards in the chapter. Items marked † are the harder ones; they either require you to combine Chapter 39 with material from earlier chapters, or they ask you to notice something about your own reasoning rather than about a text.

Nothing in this set asks you to plan, obtain, or use any compound. Where an exercise describes a person taking something, the exercise is about the conversation, not the substance.

Part 1 — The shape of the room (§39.1)

A. In two sentences each, describe what the patient is braced for and what the clinician is braced for at the start of a peptide conversation. Then state the one thing both of them actually want.

B. §39.1 names three structural pressures on the encounter. List them, and for each one write a sentence explaining why it is a feature of the system rather than a fault of the individual.

C. A patient opens with "a friend of mine has been taking something and wanted me to ask you about it." Name two things that phrasing is protecting against, and one thing it costs the conversation.

D. † The chapter argues that "I don't know" is professionally expensive. Describe a specific mechanism by which a system that rewards confidence would produce less accurate clinical advice about obscure compounds, even when every individual clinician is honest and well-intentioned.

E. Rewrite this sentence so it engages a claim rather than a category: "That's all just unregulated internet stuff."

Part 2 — Disclosure (§39.2)

F. State the four clinical reasons the chapter gives for disclosing everything you are taking. For each, write one sentence describing the specific failure that occurs without disclosure.

G. §39.2 insists on giving clinical rather than moral reasons for disclosure. Explain the argument for why the moral framing makes disclosure less likely.

H. Explain, in terms a friend with no science background would follow, why a compound that slows gastric emptying creates a consideration for someone about to be sedated.

I. List five procedures involving sedation that a person might not mentally file as "surgery." For each, state whether the peri-operative issue in §39.2 would apply.

J. † A reader says: "I'll tell them if it ever becomes relevant." Identify the logical problem with that policy, using the differential-diagnosis argument specifically. Your answer should explain why relevance is a judgment the patient is structurally unable to make.

K. Write, in your own words, the two or three sentences you would actually say to disclose an undisclosed exposure to a clinician you have seen for years. Then read it back and remove anything that is a justification rather than a fact.

L. † The chapter says a clinician who cannot be told things is one worth reconsidering, and is careful to say this is not a judgment about their competence. Reconstruct that argument in your own words. Then state the strongest objection to it and how you would answer the objection.

Part 3 — What your clinician needs (§39.3)

M. Write out the five items from §39.3 for a real or hypothetical exposure. Keep the whole thing under 120 words.

N. Explain the asymmetry in §39.3 — what each party typically knows and does not know — and give a concrete example of a question a clinician would answer wrongly because they were missing the patient's half.

O. Why does the chapter insist that "I haven't noticed anything" is worth reporting? Give both the reason for your own care and the reason relating to §39.10.

P. † Take the sentence "I'm taking BPC-157." Rewrite it to be more accurate in the sense Chapter 34 requires, and explain in one sentence what the rewrite adds that the original omits.

Part 4 — The five questions (§39.4)

Q. Write out the five questions from memory, then check them. For each, name the concept it is testing and the chapter that established the concept.

R. Apply all five questions to a non-peptide claim: a screening test, a supplement, a physical therapy protocol, or a surgical option. Write the five questions in the form you would actually ask them for that claim.

S. STEP 1 and STEP 2 differ in one designed way. Name it, state the consequence for the average result, and explain which of the five questions the difference belongs to.

T. † Question 4 converts a hope into a falsifiable prediction. Write a falsifiable prediction for something you are currently hoping will improve — anything, medical or not. It must have a magnitude, a way of observing it, and a date. Then note honestly whether you are reluctant to write the date, and why.

U. † Question 5 must be asked before starting. Explain the mechanism that makes it nearly impossible to answer honestly afterward, referring to Chapter 6. Then write a stopping rule with all three components the chapter names.

V. A clinician answers question 5 with "nothing, really — it's harmless, we'd just keep going." What has that answer told you? Write your next question.

Part 5 — Evidence, uncertainty, and the two failure directions (§39.5–§39.8)

W. You have one study you want to discuss. List the four basics you must be able to state before the appointment, and write them out for a study you have actually read.

X. Rewrite each of these to open a conversation rather than close one: 1. "This study proves it works and I'd like a prescription." 2. "Everyone online says this works and doctors just haven't caught up." 3. "I've read the literature and I disagree with you."

Y. For each of the following, identify which of §39.6's three sentences you are hearing — "we don't know," "it doesn't work," or "I don't know" — and write the follow-up question you would ask: 1. "I've honestly never come across that one." 2. "There's nothing published in humans that I'm aware of." 3. "That was tried and the trial was negative." 4. "There's no reason to think that would do anything." 5. "Let me look into it and come back to you."

Z. † Item Y.4 is deliberately ambiguous. Explain why, and state what makes it different from Y.2 and Y.3.

AA. Distinguish engaging with a claim from dismissing a category, using two example responses of your own construction. Then explain why a category dismissal is a failure of the conversation even when the verdict is correct.

AB. "What would change your mind?" can be asked as a challenge or as curiosity. Write the same question in both registers — same words, different framing sentences around it — and describe what you would expect each version to produce.

AC. † A clinic recommends a compound, dispenses it from its own inventory, and operates on a monthly membership. Write the conclusion the chapter would reach about this practice. Your answer must be neither credulous nor cynical, and must state explicitly what the structure does and does not tell you about the compound.

AD. Explain why "a doctor recommended it" and "a stranger online said it worked for them" are closer to each other in evidentiary terms than most people assume. Then name what actually distinguishes them.

Part 6 — Limits, the dossier, and the repeated game (§39.9–§39.10)

AE. List the five things a clinician cannot do for you. For each, write one sentence on what a patient sometimes expects instead.

AF. † The chapter rates "medical supervision reduces the risk of using an unapproved compound" as ⚠️ rather than ✅ or ❌. Argue the case for ✅, argue the case for ❌, then explain why the chapter lands where it does. Your answer should distinguish the direction of an effect from its magnitude.

AG. Write out Field 11 for your top dossier entry verbatim, then convert it into a question using the pattern in the chapter. State which rating tier it was and which conversion pattern you used.

AH. Do the same conversion for three more dossier entries, choosing entries in different rating tiers. Note for each whether the conversion was easy.

AI. † One of your conversions was probably harder than the others. Go back to that verdict and diagnose it against the three failure modes the chapter names — general impression, distaste for the sellers, or a verdict attached to a molecule rather than a claim. Then rewrite the verdict so it converts cleanly.

AJ. Name two diagnostic capabilities a clinician who has known you for years has that a new one does not, and state what each depends on.

AK. † Explain why a clinician's impression of an unstudied compound is likely to be biased toward success. Identify the selection mechanism, name the chapter that describes it in the online context, and describe the one-sentence intervention a patient can make.

AL. Write the sentence you would say at your next appointment to report an outcome that was nothing — no benefit, no harm, stopped. Keep it under twenty words.