“Again, FDA audits ruined a successful business model…”

September 27 to October 3, 2026

This week’s Scalpel: Skincare creams hiding prescription steroids, cannabis potentially effing up your sleep without you noticing, an anti-aging supplement failing a major clinical trial, and scientists discovering that paying people to quit smoking actually works.

Apparently, money is a powerful motivator. Who knew?

Scalpelheads, welcome back to another week of scientists discovering fascinating things, pharmaceutical companies making ambitious promises, and the supplement industry hoping nobody reads past the abstract.

I've gone through this week's medical research and pulled out ten stories worth your attention.

Some are genuinely exciting. Some are concerning. And a few should make you reconsider where your money is going.

More importantly, I'll tell you what the research actually means for your everyday life, because science is considerably less useful when it ends with "further studies are needed."

Although, sadly, further studies are often needed.

Let's dig into it.

The story

Imagine buying a perfectly innocent-looking skincare cream online.

It promises brighter skin, less inflammation, and miraculous results.

And somehow, it actually works.

Wonderful.

Except researchers tested 18 suspicious skincare products and discovered that six contained an extremely powerful prescription steroid called clobetasol.

A steroid that wasn't even listed on the label.

And some samples contained up to 9.2 times the concentration found in FDA-approved clobetasol creams.

So again, FDA audits ruined a successful business model: secretly put prescription drugs in skincare, market it as a miracle cream, and let the customer figure out the side effects.

Genius.

Except prolonged misuse of these powerful steroids can cause skin thinning, acne, pigmentation problems, and even hormonal complications.

The six products had accumulated more than 10,000 online reviews.

Because, as it turns out, five stars aren't a chemical analysis.

What I'd actually do:

Be suspicious of unverified online products promising dramatic results, especially for eczema, psoriasis, or skin brightening.

Pay attention to who markets it.

Look for transparent ingredients and reputable manufacturers. If a mystery cream works unusually well, don't assume that means it's safe.

And if you've been using one regularly, particularly on your face, ask a dermatologist or pharmacist to review it.

One important detail: the researchers deliberately selected suspicious products. This doesn't mean a third of all skincare contains hidden steroids.

Dr. Kevin's importance meter: 9.9/10

The story

You smoke a little cannabis before bed → You relax → You fall asleep → You wake up thinking you've slept like a Victorian aristocrat on a mattress stuffed with clouds → Nope!

Your sleep tracker might have some disappointing news.

Researchers investigated cannabis exposure and sleep in 1,266 middle-aged adults, including 891 who wore devices that objectively measured their sleep.

They found that greater cannabis exposure was associated with more interrupted sleep, lower sleep efficiency, and more time spent awake during the night.

The fascinating part is that people's own ratings of their sleep didn't show the same relationship.

What I'd actually do:

If you're using cannabis to sleep, don't judge its effectiveness purely by how quickly you pass out.

Pay attention to whether you stay asleep, how rested you feel, and your daytime energy.

If insomnia is persistent, cognitive behavioral therapy for insomnia (CBT-I) has much stronger evidence as a long-term treatment.

And remember, this was observational research. It doesn't prove cannabis caused the disrupted sleep.

Dr. Kevin's importance meter: 9.8/10

The story

If you've spent more than eleven minutes on longevity TikTok, you've probably encountered NAD+.

They market it like it's the molecule standing between you and becoming an immortal Greek sculpture.

It’s powerful, but will disappoint you if you need the result mentioned above.

One popular supplement designed to increase NAD+ is nicotinamide riboside, or NR.

Researchers wanted to know whether NR could actually slow Parkinson's disease.

So they conducted a serious Phase 3 randomized trial involving 410 people with early Parkinson's disease over 52 weeks.

The results?

NR didn't slow the disease.

In fact, participants taking NR experienced slightly worse Parkinson's symptom scores than those taking placebo.

The difference was statistically significant, although smaller than the threshold researchers considered clinically important.

Not quite the triumphant scientific breakthrough the longevity crowd was hoping for.

Imagine spending a year developing a rocket to Mars, pressing the launch button, and discovering you've moved the rocket three inches backward.

Technically, movement.

Just not the intended direction.

What I'd actually do:

If someone is selling you NR as a proven way to slow Parkinson's progression, save your money or just go the nearest Starbucks.

Caffeine helps with Parkinson prevention more than NAD+.

Now don't overinterpret the findings of this trial either. It does not prove that NR is harmful or useless for every healthy adult. It tested a specific treatment for a specific disease.

Raising NAD+ levels and improving meaningful health outcomes are two entirely different achievements.

Dr. Kevin's importance meter: 8.7/10

The story

For decades, we've told smokers to quit because cigarettes destroy their lungs, damage their blood vessels, and dramatically increase their cancer risk.

All perfectly valid reasons.

The problem is, they don’t give a sh**.

Nicotine addiction doesn't always respond to a well-organized PowerPoint presentation about lung cancer.

So researchers tried something different.

Money.

In a randomized trial involving 3,220 underserved adults, they compared several ways to help people stop smoking.

Here were the sustained quit rates at six months:

So adding financial incentives approximately doubled the quit rate compared with standard care.

Apparently, after years of complicated research into human motivation, scientists discovered something extraordinary.

People really like money!!!

Groundbreaking.

Although the more sobering finding is that even the best-performing group had a quit rate below 10%.

Nicotine addiction is no joke.

What I'd actually do:

If you're trying to quit smoking, don't rely on willpower alone… Ask for money to do it…

But seriously.. get structured support, discuss evidence-based medications, and look for cessation programs that offer rewards or incentives.

If you're an employer or healthcare provider, financial incentives may be worth incorporating into a larger quitting program.

And no, these results don't mean nicotine-replacement therapy or other cessation medications are useless.

Dr. Kevin's importance meter: 9.6/10

The story

The HPV vaccine already does something rather impressive.

It helps prevent several types of cancer.

Which, personally, I consider a respectable achievement for something administered through a tiny needle.

But researchers in Sweden investigated more than 624,000 births (read the number again!) and found another interesting association.

Women vaccinated against HPV before pregnancy had approximately 5% lower odds of premature birth.

The association was somewhat stronger among women vaccinated before age 17.

Now, before someone launches a new campaign claiming the HPV vaccine guarantees a perfect pregnancy, absolutely not.

This was an observational study.

Vaccinated and unvaccinated women may differ in ways that explain some of the results.

Researchers cannot conclude that the vaccine itself prevented premature births.

Still, the findings are reassuring and potentially interesting.

What I'd actually do:

Get the HPV vaccine according to your country's recommendations if you're eligible.

Its established cancer-prevention benefits are already an excellent reason.

This study is not a reason to get vaccinated specifically to prevent premature birth, and HPV vaccination isn't recommended during pregnancy.

Dr. Kevin's importance meter: 9.8/10

The story

I’m sure they learned this from DJ Khaled.

Another one… Every damn week dude….

Just when you thought the weight-loss drug industry had developed enough medications to occupy an entire small airport, here comes another one.

Meet petrelintide.

A once-weekly injection being developed by Zealand Pharma and Roche.

Unlike semaglutide, it targets the hormone pathway involving amylin, which helps regulate appetite and fullness.

The companies announced results from a Phase 2 study involving 220 adults with overweight or obesity and type 2 diabetes.

At 28 weeks, participants receiving petrelintide lost up to 9.2% of their body weight on average, compared with 2% on placebo.

Blood sugar levels improved too.

And only 1.9% of petrelintide recipients discontinued treatment because of gastrointestinal side effects, compared with 1.7% in the placebo group.

Interesting.

But let's not start throwing confetti just yet.

These are company-reported topline results.

The complete results still need proper scientific scrutiny.

What I'd actually do:

Nothing yet.

Petrelintide remains investigational.

If you're interested in medical weight management, you can read our previous issue about something much more interesting in my opinion, also discuss treatments that already have strong evidence and regulatory approval rather than buying experimental peptides from a website that looks like it was designed in somebody's garage.

Dr. Kevin's importance meter: 8.3/10

The story

After decades of diet trends involving exotic powders, expensive supplements, and vegetables that look like decorative houseplants, researchers investigated a radical intervention.

Water. (Today we’re really going back to fundamentals. First, money… Now, water?What’s next, air?)

In a randomized study involving 437 children aged 8 to 13, researchers tested a six-week after-school program called H2GO! (very creative!)

It encouraged healthier beverage choices, involved families, and taught children strategies to reduce sugary drinks.

Twelve months later, children in the intervention group had a modest improvement in BMI z-scores compared with those receiving standard programming.

Not an enormous effect.

And here's the twist: the measured differences in sugary-drink and water intake between groups weren't statistically significant.

So we can't confidently say drinking more water alone caused the improvement.

What I'd actually do:

Make water the normal everyday drink at home.

Keep it accessible, offer it with meals, and avoid turning sugary drinks into a daily necessity.

But please don't turn family dinners into a military weight-management operation.

Healthy habits work better when they're sustainable, supportive, and free from shame.

Dr. Kevin's importance meter: 9/10

The story

Imagine having to remember medication every single day while living with a condition that can itself make consistent treatment difficult.

Missing doses can have serious consequences.

So this is potentially useful news.

The FDA just approved Weltruza, a once-monthly injectable version of olanzapine for adults with schizophrenia.

The approval followed Phase 3 clinical trial results demonstrating improvements in symptoms and functioning.

And unlike some existing long-acting olanzapine injections, this formulation doesn't require the same post-injection monitoring period.

That's genuinely meaningful.

Not because anyone has discovered a magical new molecule, but because they've made an established treatment potentially easier to manage.

Sometimes medical innovation doesn't involve reinventing the engine.

Sometimes it involves making sure the bloody thing actually starts every morning.

Or, in this case, once a month.

What I'd actually do:

If daily medication adherence is difficult, ask your psychiatrist about long-acting injectable alternatives.

They won't be right for everyone.

Olanzapine can also cause substantial weight gain and metabolic complications, regardless of how conveniently it's administered.

Dr. Kevin's importance meter: 8.6/10

These didn't make the main ten, but they're interesting enough to deserve a mention.

1. Urolithin A might affect brain blood flow.

2. The FDA is taking ibogaine research more seriously.

3. Your routine blood test might contain clues about dementia risk.

4. Medical AI keeps getting smarter.

5. The blood test promising to detect dozens of cancers is still under the microscope.

Last week, while the internet is busy arguing about why men can't handle a little acne from birth control, Max decided to do something outrageous. He actually talked to the freaking scientists. Dr. John Amory and Professor Richard Anderson, two leading researchers working on male contraception. They discussed what really happened with the infamous male birth control trials, why we still don't have a male pill, and what's coming next. So if you're tired of TikTok scientists with PhDs in talking out of their asses, you can read the summary of both conversations right here.

Dr. Max’s friendly chat with Professor Richard Anderson

Dr. Max’s friendly chat with Dr. John K. Amory, MD, MPH

Alright alright alright….

That’s the end of this week’s Scalpel I’m afraid.

Please let us know if you have 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 “Scalpel” so we know who the OG Scalpelheads are.

See you next week.

Yours,

Kevin Cutthebull MD

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