What would change my mind about repair peptides: a specific answer — one year on

What would change my mind about repair peptides: a specific answer — one year on I have a specific reason for asking rather than idle curiosity, and the context is below.

Session topic: STEP 1 (N Engl J Med, 2021). Please read it before posting; the discussion is much better when everyone has.

The question I would like us to start with is what the trial set out to estimate, rather than what it found. Once that is on the table we can talk about whether the design could have answered it, and only then about the numbers.

Specific things I would like covered: the population and how far it generalises, how discontinuation was handled, whether the comparator was a fair one, and what the absolute rather than relative effect looks like.

I will summarise at the end and the summary will feed the relevant digest page.

the opening post answers the question as asked. The question underneath it is different.

The absence of adequately powered published randomised human trials is the central fact about BPC-157. This site states that plainly rather than hedging. Mechanistic plausibility does not substitute for it.

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

Oral versus injected administration claims for BPC-157: the preclinical work studied injection. Oral claims are common in supplier marketing and poorly supported by published evidence. If you are comparing orality between compounds, that is a distinction worth noting.

Worth separating two things that the opening post runs together.

Publication patterns in the BPC-157 literature: a large proportion of the evidence comes from one research group. That is not necessarily wrong — one group can do excellent work — but it is worth noting when evaluating the breadth of support for a claim.

post #5 is right about the mechanism and I think understates the practical bit.

Stability of BPC-157 in solution: what has been measured in published work covers specific formulations under specific conditions. Extrapolating to a reconstituted preparation in a different diluent at a different concentration is an extrapolation, acknowledged as one.

Why plausible mechanism is not evidence of effect: a mechanism that is chemically or biologically plausible can fail in practice for dozens of reasons — bioavailability, off-target effects, metabolism, clearance, or simply that the mechanism does not do what the theory predicts in a living system. Plausibility is necessary for hope but not sufficient for evidence.

I disagree with the reply above, and I think the disagreement is substantive rather than terminological.

The distinction being drawn does not survive when you look at the published data for this specific question. I would be glad to be shown wrong on this, because the version I am arguing against is more convenient.

Practical note that does not fit anywhere else. Whatever you conclude from this topic, write down what you did and when. The single most useful thing in your own records is not any individual result; it is that they are dated and consecutive.

What would change the position on repair peptides: adequately powered, published, peer-reviewed randomised controlled human trials with pre-specified outcomes. That is the standard applied to every other therapeutic claim on this site and it is the standard applied here.

post #10 is right about the mechanism and I think understates the practical bit.

Analytical identity of BPC-157: a 15-residue peptide with an unambiguous mass (≈1419.5 Da). Identity confirmation by LC-MS is trivially easy, which means there is no excuse for an unverified identity on this compound.

For anyone arriving from search engines: this subcategory discusses published preclinical work and the absence of published clinical work. It does not endorse or recommend these compounds.

Thank you for the correction. I have edited my earlier post with a note rather than silently, so the thread still makes sense to read. The error was mine and it was the kind that comes from remembering a figure instead of looking it up.

I read post #12 twice before replying, because I had assumed the opposite.

The distinction between "no evidence it works" and "evidence it does not work": we have the first for these compounds. That is genuinely different from the second and the distinction matters, but it also means treatment plans based on these compounds are being built on theoretical grounds, not empirical ones.