“Judge experimental treatments by the evidence for your specific condition, not by how excited the internet gets…”

October 17–24, 2026 | Your weekly dose of scientific bullshit detection, and useful health advice.

Well hi again…

Welcome back, Scalpelheads.

This week, we've got a cancer drug that could save patients from major surgery, a personalized vaccine putting cancer on the defensive, an AI system embarrassing doctors on diagnostic tests, and evidence that your walking speed might reveal more about your health than you'd like.

Oh, seems like treating mental health conditions properly is more useful than telling people to just think positively.

Typical science breakthroughs, I know.

Let's get into it.

For decades, treating rectal cancer often meant chemotherapy, radiation, surgery, and potentially a permanent change to how you use the bathroom.

Not exactly anyone's dream vacation.

But the FDA just approved something remarkable.

A drug called dostarlimab, which helps your immune system recognize and attack cancer.

In one study involving 50 patients with a specific type of rectal cancer, every single patient had no detectable cancer after treatment.

Exactlicato! All 50.

And in a larger study of 154 patients, nearly three-quarters had avoided chemotherapy, radiation, and surgery after more than two years of median follow-up.

Here's the catch before you impulse buy anything.

It only applies to certain tumors with faulty DNA-repair systems, representing roughly 3% of locally advanced rectal cancers. Long-term outcomes still need confirmation.

Why you should care: Traditional treatment can permanently affect bowel function, fertility, and quality of life.

What you can do: If diagnosed or know anyone with locally advanced rectal cancer, ask whether the tumor has been tested for dMMR or MSI-high status.

That one question could dramatically change the treatment options.

Do you need to panic? No.

But cancer research didn't stop there.

We've spent decades throwing treatments at cancer. Now scientists are getting personal. Literally.

Merck and Moderna developed an mRNA vaccine tailored to mutations in each patient's tumor.

In a Phase 3 trial involving 1,137 patients with high-risk melanoma removed by surgery, combining the vaccine with Keytruda reduced the relative risk of recurrence or death by 42%.

Very impressive.

Why you should care: Personalized cancer treatments could help prevent cancer from returning after surgery.

What you can do: Spread the news, if someone have high-risk melanoma, they can discuss existing immunotherapy and clinical trials with their oncologist.

Do you need to panic? No.

Now let's leave cancer behind and talk about a condition society has spent years treating like a motivational deficiency.

You know the usual ADHD advice.

"Just focus."

"Stop being lazy."

"Have you tried making a schedule?"

Brilliant. Someone call the Nobel committee.

A massive review covering nearly 16 million people found that ADHD was associated with a 71% higher risk of death from all causes.

Suicide mortality risk was also 89% higher.

But here's where things get interesting.

Among people with ADHD, medication use was associated with a 25% lower risk of death.

That doesn't prove medication directly prevents death. These were observational studies, and other factors could explain part of the difference.

But it does reinforce something important.

ADHD isn't simply a productivity inconvenience. It can affect safety, mental health, and everyday functioning.

The takeaway: ADHD is no joke or a TikTok trend. It has to be properly assessed and evidence-based treatment should be discussed.

And speaking of psychiatric conditions people casually misunderstand...

Now you might think OCD is wanting your desk organized, and that’s it.

And you’d be wrong.

It's a condition that can trap people in hours of intrusive thoughts, anxiety, and compulsive behaviors.

And researchers just tested an unusually concentrated treatment.

In a randomized trial of 119 adults, one group received four days of intensive exposure therapy.

The comparison group received eight weeks of unguided online cognitive behavioral therapy.

Three months later:

That's a substantial difference.

The treatment works by helping patients confront feared situations without performing their usual compulsions.

Essentially, teaching the brain that anxiety doesn't always require an emergency response.

Important detail: This wasn't compared with standard therapist-delivered CBT, and four days doesn't guarantee a permanent cure.

The takeaway: If you struggle with OCD, ask about exposure and response prevention, including intensive programs.

Because effective treatment beats being told to simply "stop worrying."

Which brings us to another mental health story, except this one involves mushrooms and an impressive amount of enthusiasm.

Seems like somewhere along the way, psilocybin went from experimental psychiatric treatment to something people discuss like it's the answer to every psychological problem.

Depression? Mushrooms.

Anxiety? Mushrooms.

PTSD? Mushrooms.

Your neighbour’s dog barking? Mushrooms.

Research published this week examined 70 clinical trials and 172 media articles covering psilocybin.

The verdict?

Media coverage often made the science sound much more established than it actually was.

Most clinical trials focused on depression, while headlines enthusiastically expanded the potential benefits to conditions with little or no trial evidence.

Look, psilocybin research is genuinely promising for certain conditions.

But promising doesn't mean proven, and a small trial isn't a medical revolution.

The takeaway: Judge experimental treatments by the evidence for your specific condition, not by how excited the internet gets.

And while we're discussing technology getting ahead of itself, Microsoft has entered the examination room.

Microsoft tested an AI diagnostic system against physicians using simulated medical cases.

On complicated cases, AI achieved 83% diagnostic accuracy.

Generalist physicians using reference materials?

36%.

On emergency-department case simulations, AI scored 80%, compared with 47% for doctors.

Well, that's an uncomfortable PowerPoint presentation.

The system doesn't simply guess a diagnosis. It asks questions, recommends tests, and works through possibilities step by step.

But before anyone fires their physician and hires a chatbot, here's the enormous catch.

These were historical, text-based simulations, not real patients. The AI wasn't compared with specialist teams, and better test performance doesn't automatically mean better clinical outcomes.

The takeaway: AI could become an extremely useful diagnostic assistant. But don't confuse winning a benchmark with safely managing a patient.

Now, enough about futuristic medicine.

Let's talk about something painfully ordinary.

Your back.

Back pain is miserable.

But how you initially treat it may matter long after the pain disappears.

Researchers followed nearly 400,000 adults receiving treatment for new-onset lower back pain.

Higher-dose opioid treatment was associated with a 147% higher relative risk of opioid use disorder or overdose.

Meanwhile, physical therapy and chiropractic care were associated with approximately 31% and 33% lower risks.

Now, before anyone declares spinal manipulation a miracle cure, remember this was observational research.

Patients receiving different treatments may have differed in important ways.

Still, the message is worth hearing.

For uncomplicated acute back pain, opioids usually shouldn't be your automatic first option.

The takeaway: Discuss appropriate non-opioid options, including staying active and physical therapy. Seek urgent assessment for major weakness, saddle numbness, or new bladder or bowel dysfunction.

And since we're already talking about movement, your walking habits have apparently been collecting health information about you.

Some people walk like they're competing for an Olympic medal.

Others move like the supermarket aisle is a historical museum.

Turns out, walking speed may actually reveal something about long-term health.

Researchers studied more than 4,000 older adults over approximately 12 years.

People who walked faster generally had lower mortality risk.

Even the rhythm of their everyday steps provided useful health information.

But here's the distinction.

Walking faster didn't necessarily cause people to live longer.

People who are healthier, stronger, and more physically capable may simply walk faster.

The takeaway: Maintain your mobility. Walk regularly, incorporate strength training, and pay attention if your usual walking speed suddenly declines.

You don't need to turn every trip to the grocery store into a qualifying race.

And maintaining physical health isn't always about exercise or food.

Sometimes your emotions get involved.

We love simplifying weight management.

Eat less. Move more. Problem solved.

Except human beings aren't calculators with legs.

Researchers studied 166 teenagers and their parents, comparing standard family-based weight treatment with the same program plus emotional regulation training.

Both groups initially lost weight.

But the teenagers who learned additional emotional coping skills experienced less weight regain afterward.

Turns out, understanding stress and emotions might help people maintain behavioral changes.

Who would've thought that treating human beings like human beings could be useful?

This doesn't mean weight loss is purely psychological, and the results don't automatically apply to adults.

The takeaway: For teenagers receiving weight-management care, emotional support and coping strategies deserve a place alongside nutrition, activity, and medical guidance.

Speaking of long-term treatment, another approval this week could change how some patients manage a serious chronic infection.

Chronic hepatitis B can mean years of antiviral treatment to keep the infection controlled.

But the FDA has approved a new medication called bepirovirsen, marketed as Hibsago.

It works by interfering with the genetic instructions hepatitis B uses to produce viral proteins.

In two placebo-controlled trials, 24% of treated patients qualified to stop their existing antiviral medication.

And 19% maintained viral control with undetectable hepatitis B surface antigen 24 weeks after stopping all treatment.

That's meaningful progress.

But let's not start using the word "cure" irresponsibly.

The treatment is only for selected patients, and serious liver reactions and low platelet counts are possible.

The takeaway: If you have chronic hepatitis B, discuss eligibility with your liver specialist. Never stop antiviral medication without medical supervision.

And our final major story involves another situation where aggressively following health advice might backfire.

People with chronic kidney disease are sometimes advised to limit protein.

Reasonable.

But a new study suggests excessive restriction may come with a serious downside.

Researchers followed 1,861 people with chronic kidney disease for roughly nine years.

Compared with those eating at least 1.2 grams of protein per kilogram of body weight daily, people consuming less than 0.6 grams had:

Now comes the part nutrition extremists never enjoy.

This does NOT mean people with kidney disease should suddenly double their protein intake.

It's observational research. Poor nutritional status, muscle loss, and underlying illness may partly explain the results.

The takeaway: If you have kidney disease, your protein target should be individualized with your nephrologist or renal dietitian.

Your kidneys need protection.

Your muscles need nutrition.

Both can be true.

Before we wrap up, four developments worth keeping an eye on.

Premature birth: Researchers identified immune antibodies that might contribute to some premature births. Interesting biology, but no proven preventive treatment yet.

Sjögren's disease: Two randomized trials of a new immune-targeting treatment, ianalumab, offer potential progress for this autoimmune condition. And no, it's not a treatment for everyone who occasionally has dry eyes.

AI-guided lung biopsies: Researchers are testing whether AI can improve navigation during lung biopsies. Promising, but real-world benefits still need establishing.

Measles: A global analysis estimated 15.6 million measles cases in 2023 and 118,000 deaths among children under five. A grim reminder that preventable infectious diseases don't disappear just because people get bored of hearing about vaccines.

Medical progress doesn't always mean adding another treatment.

Sometimes it means knowing which treatments you can safely avoid.

That's all for this week's Scalpel.

Stay curious, stay skeptical, and see you next Saturday.

Dr. Kevin Cutthebull, MD

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