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From the desk of Dr. Kevin, MD
“please do not inject something labeled ‘research use only’ because Chad from Planet Fitness had a coupon code.”
THE SATURDAY SCALPEL
WEEKLY MEDICAL RADAR
September 27 to October 3, 2026
This week in medicine: a weight-loss drug casually deleted a quarter of people's body weight, diabetes guidelines finally admitted humans have organs other than a pancreas, and apparently squeezing your muscles without moving might bully your blood pressure downward.
Medicine is having a normal one guys.
1. THIS NEW WEIGHT-LOSS DRUG JUST HIT 25%
There is a drug you’ve probably heard me mention before called retatrutide.
It targets three hormone pathways: GIP, GLP-1 and glucagon.
And now we finally have major peer-reviewed Phase 3 results.
The more you know:
Drug trials usually move through Phase 1, 2, and 3 before approval:
Phase 1 asks, “Is this reasonably safe, and what dose can humans tolerate?”
Phase 2 asks, “Does it actually seem to work, and what dose works best?”
Phase 3 is the big test: hundreds or thousands of people are studied to confirm that it works, compare it with placebo or existing treatments, and catch common side effects. If Phase 3 looks good, the company can apply for approval.
Phase 4 happens after approval, when the drug is used in the real world and rarer or long-term side effects can show up.
In 2,339 adults with obesity but without diabetes, the highest dose produced an average 25% weight loss over 80 weeks, compared with 3.9% with placebo.
Twenty-five percent.
So what you're saying is we made a medication and accidentally wandered into weight-loss territory historically associated more with bariatric surgery.
Very casual.
A second trial in people with obesity and type 2 diabetes found 18.8% average weight loss, versus 5.1% with placebo.
Gastrointestinal side effects were common because apparently you cannot lose a quarter of your body weight without your intestines filing some paperwork.
WHY YOU SHOULD CARE
Retatrutide is one of the most powerful obesity drugs studied this far into development.
But before somebody messages me asking which sketchy website sells it...
You don't buy it.
It is still investigational.
So please do not inject something labeled "research use only" because Chad from Planet Fitness had a coupon code.
Evidence: Two Phase 3 randomized trials, 3,491 participants.
Dr. Kevin importance meter: 10/10. Real Sh**.
2. DIABETES TREATMENT HAS FINALLY DISCOVERED THE REST OF THE HUMAN BODY
For years, type 2 diabetes treatment could feel like:
"Your blood sugar is high."
"Okay."
"Let's make the number lower."
Excellent. Nobel Prize incoming.
The new 2026 ADA/EASD consensus is much broader.
Now we know only reducing your blood sugar is lazy as f***. The goal is protecting your heart, kidneys, liver, body weight and overall metabolic health.
Which is useful because, interestingly, people with diabetes do in fact come with those organs installed.
The report also emphasizes early cardiovascular risk management and consideration of GLP-1-based treatments and SGLT2 inhibitors when appropriate.
And then we get the five S's:
Standing.
Stepping.
Sweating. (Or Sex - your call.)
Strengthening.
Sleep.
Basically every activity your Apple Watch has been nagging you about for five years.
It also says intensive lifestyle treatment targeting substantial weight loss can help some people achieve remission. (More on that later…)
And no, the guideline did not suddenly discover a magical cinnamon capsule from TikTok.
Specific dietary supplements are not recommended for glucose management.
WHAT YOU CAN DO
If you have type 2 diabetes, the useful question is no longer just:
"What's my HbA1c?"
Ask whether your treatment is also addressing your weight, heart and kidney risk. Otherwise don’t bother.
Dr. Kevin importance meter: 9.8/10. Your pancreas is no longer the main character.
3. 54% OF YOUNGER ADULTS PUT THEIR TYPE 2 DIABETES INTO REMISSION
This one is super wild.
Researchers took adults aged 18 to 45 with obesity and relatively early type 2 diabetes.
One group received usual care.
The other received an intensive program involving an 800 to 900 calorie daily diet, plus aerobic and resistance exercise.
After 24 weeks:
54% were in diabetes remission. FANTASTIC!
Usual care?
4%.
That is not a subtle difference.
That's the medical equivalent of one team arriving with a Formula 1 car and the other arriving on a shopping trolley.
The intervention group also lost about 8.4 kg on average, versus 1.2 kg.
BUT BEFORE YOU EAT THREE LETTUCE LEAVES AND CALL IT MEDICINE
An 800-calorie diet is fu***ng aggressive.
This was a structured intervention involving medical supervision, particularly important when people are taking diabetes medications.
Do not freestyle this because you watched a 37-second reel.
WHY THIS MATTERS
Being diagnosed with type 2 diabetes young does not automatically mean the disease can never improve.
For some people early in the disease course, substantial weight loss can produce remission.
Evidence: Randomized trial, 96 adults.
Dr. Kevin importance meter: 9.7/10. Apparently metabolism occasionally accepts an apology.
4. THE LAZIEST-LOOKING EXERCISE JUST BULLIED BLOOD PRESSURE
Researchers took 100 adults and had them perform lower-body isometric exercise three times per week.
Meaning your muscles are working hard...
while externally you look like absolutely nothing is happening.
Peak gym efficiency.
After four weeks, systolic blood pressure dropped roughly 9.5 mmHg and diastolic pressure around 5.5 mmHg compared with controls.
Then researchers tested how often people needed to continue.
One, two or three sessions weekly maintained much of the improvement.
Stopping?
Blood pressure started drifting back toward baseline. You snooze, you lose.
WHY YOU SHOULD CARE
Isometric training takes little time and almost no fancy equipment.
But this was a small, short trial, mostly in people without established hypertension.
So what we've scientifically proven is not:
"Cancel your blood-pressure medication and squeeze your legs really hard."
It may be another useful tool alongside established treatment and exercise.
Dr. Kevin importance meter: 9.5/10. Suspiciously efficient exercise.
5. HEARING AIDS DID NOT STOP DEMENTIA
You've probably heard some version of:
"Hearing loss increases dementia risk, therefore hearing aids prevent dementia."
Sexy hypothesis.
Tiny problem.
Biology occasionally refuses to read the headline.
A randomized trial followed 703 older adults who already had mild cognitive impairment and moderate to severe hearing loss.
After two years, hearing aids did not significantly reduce progression to dementia-level impairment.
There was an interesting secondary finding suggesting more cognitive improvement in the hearing-aid group.
But the primary outcome was negative.
And no, we do not throw away the primary outcome because the secondary one is prettier.
I wouldn’t call it science.
That's Tinder.
WHAT THIS ACTUALLY MEANS
Hearing aids are still valuable.
They can improve hearing, communication, social interaction and quality of life.
What you should not currently promise someone is:
"Put these in your ears and dementia has been defeated."
Evidence: Randomized trial, 703 participants, 24 months.
Dr. Kevin importance meter: 9.4/10. Useful reality check.
6. SEMAGLUTIDE MAY BE DOING MORE TO YOUR KIDNEYS THAN WE THOUGHT
Semaglutide (AKA Ozempic) already has this ridiculous résumé:
Weight loss.
Blood sugar.
Cardiovascular benefit.
Fixing your neighbour’s attitude.
But now researchers are trying to understand its kidney effects.
At this point Ozempic needs LinkedIn Premium.
In the REMODEL trial, 106 people with type 2 diabetes and chronic kidney disease received semaglutide or placebo for one year.
Semaglutide reduced urinary albumin by about 40% and produced several imaging and molecular findings suggesting healthier kidney blood-vessel biology and less fibrosis progression.
Important nerd caveat:
The trial's two main MRI outcomes were not significantly different.
So we're not declaring:
"SEMAGLUTIDE REGENERATES KIDNEYS, SCIENTISTS HATE THIS ONE WEIRD INJECTION."
Chill down.
WHY IT MATTERS
Large trials already suggest GLP-1 drugs can protect kidney health.
This study gives us more clues about how that might happen.
No treatment changes based on this experiment alone.
Dr. Kevin importance meter: 9.1/10. Mechanistically juicy.
7. EARLY MEDICALLY INDUCED MENOPAUSE MAY COME WITH A CARDIOVASCULAR PRICE TAG
Researchers combined data from 36 studies involving 2.62 million women. (A lot of people!!!!)
They found that menopause caused by surgery or medical treatment was associated with higher cardiovascular risk.
Overall, there was about a 25% higher composite cardiovascular risk and a 22% higher stroke risk.
The increased mortality risk appeared especially important when menopause occurred before age 45.
Turns out removing ovarian hormone exposure years earlier than nature planned may have consequences beyond no more periods.
IMPORTANT CAVEAT
Most of these studies were observational.
That means we can see an association.
It does not let us confidently say medically induced menopause directly caused every bit of the increased risk.
Hormone treatment, underlying disease and other factors… They are important.
WHAT YOU CAN DO
If you experience menopause early because of surgery or medical treatment, cardiovascular risk deserves an actual conversation.
Blood pressure.
Lipids.
Smoking.
Exercise.
Weight.
And appropriate menopause treatment discussions.
Be serious about this, ask your doctor to track everything carefully.
If your doctor refused → change your doctor!
Dr. Kevin importance meter: 9.5/10. Very relevant, especially under 45.
ON MY RADAR
Trevogrumab + semaglutide
Potentially preserving muscle during major weight loss.
Very interesting.
Still experimental.
Nobody buy mystery peptides from a man named "BioHackKing42069."
Survodutide
Another Phase 3 obesity drug produced meaningful weight and HbA1c reductions in people with obesity and diabetes.
Normally this would be massive news.
Unfortunately retatrutide walked into the same week waving a 25% number around like an asshole.
Urine RNA testing for bladder cancer
Scientists are studying whether RNA floating around in urine could help detect bladder cancer and predict treatment response.
Very cool.
Not ready for population screening.
Your toilet is not yet a diagnostic laboratory.
Give them time.
Psychedelic adverse effects
A U.S. survey found substantial self-reported bad experiences among people using substances including psilocybin, LSD, MDMA, ibogaine and 5-MeO-DMT outside tightly controlled trials.
Important distinction:
People saying, "I took this and something bad happened" is useful real-world information.
It does not automatically prove the drug caused every reported event.
Turns out uncontrolled psychedelic use is methodologically difficult to study.
Who could have predicted this.
THE 3 THINGS I'D REMEMBER THIS WEEK
1. Obesity medicine is moving insanely fast.
Twenty-five percent average weight loss from an investigational drug would have sounded ridiculous not long ago.
2. Muscle matters.
If weight-loss medications keep becoming more powerful, preserving strength and function becomes increasingly important.
3. Medicine keeps rediscovering that simple things matter.
Exercise. Smoking cessation. Weight management. Sleep.
Very disappointing news for anyone waiting for a $79 powder called Mitochondrial Quantum Longevity Matrix™ to do all of that instead.
That’s it ladies and gentlemen…
Now it’s your turn. Reply and tell us your thoughts on this episode.
Any suggestions? Recommendations? Topics you want us to cover?
Let us know, we read them all.
Also, not many people read the whole thing!
Reply with “I read it all” so we know who the OG Scalpelheads are.
See you next week.
Assuming medical research has not accidentally invented immortality by Friday.
Yours,
Kevin Cutthebull MD
Retatrutide for Obesity and Knee Osteoarthritis , New England Journal of Medicine
Retatrutide for Obesity and Type 2 Diabetes , The Lancet
Management of Hyperglycaemia in Type 2 Diabetes, 2026: ADA/EASD Consensus Report , Diabetologia / Diabetes Care
RESET for REMISSION Trial: Intensive Lifestyle Intervention in Young Adults With Type 2 Diabetes , The Lancet Regional Health Americas
Isometric Exercise Training and Blood Pressure , BMJ Open Sport & Exercise Medicine
Hearing Intervention and Cognitive Decline in Older Adults With Mild Cognitive Impairment , JAMA Neurology
Semaglutide and Kidney Disease in Type 2 Diabetes: REMODEL Trial , Nature Medicine
Iatrogenic Menopause and Cardiovascular Disease Risk , JAMA Network Open
Trevogrumab Plus Semaglutide for Preservation of Lean Mass: COURAGE Trial , EASD / The Lancet
Smoking Cessation Duration and Microvascular Complications in Type 2 Diabetes , JAMA Network Open
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