Health

BECAUSE IT INDICTS THE PATIENT:

Exercise works for depression. So why isn’t it treated like real medicine? (Nicholas Fabiano, July 21, 2026, Big Think)

Hundreds of clinical trials now show that exercise can significantly reduce symptoms of depression. For mild to moderate cases, its effects are generally comparable to medication or therapy. When exercise is combined with medications or therapy, the effects may even be additive. On a population level, even achieving just half the recommended amount of physical activity is linked to an 18% lower risk of developing depression.

FIRST, DO NO HARM:

Common knee surgery may do more harm than good (Dr. Elisabeth Rosenthal, July 13, 2026, CBS News)

Researchers who followed patients for 10 years after they received either the actual procedure, arthroscopic knee surgery to trim degenerative cartilage tears, or merely “sham surgery” — a skin incision — for knee pain, found that the surgery provided little or no benefit and was, in fact, associated with accelerated osteoarthritis and higher rates of reoperation. That generally meant a total knee replacement.

“I don’t know how I would defend this procedure at all,” said one of the study’s authors, Teppo Järvinen, an orthopedist and head of the Finnish Centre for Evidence-Based Orthopaedics.

TOUGH BEAT FOR EMPATHISTAS:

There are no psychopaths: Virtually everything you think you know about psychopathy has been thoroughly debunked. Why does this zombie idea live on? (Rasmus Rosenberg Larsen, 2/27/26, Aeon)

Consider one of the most repeated tropes about psychopaths, that they are incapable of mirroring or reading other peoples’ emotions: they lack empathy. The problem with this view is that science tells a radically different story. When people diagnosed with psychopathy participate in empathy experiments, their performance is entirely indistinguishable from normal controls.

The most compelling evidence comes from a recent systematic review of empathy research my team conducted, which included a total of 66 studies involving 5,711 persons clinically assessed for psychopathy. We found that the results were ‘overwhelmingly null findings’ (89.11 per cent of all tests). That is, statistical analyses cannot tell the difference in performance between psychopathic vs non-psychopathic persons. We also found that high-quality studies – those using more rigid statistical methods – had an even higher null-ratio of a whopping 94.77 per cent. In behavioural scientific experiments, where datasets are presumed to be rife with false positives, this is arguably as close as you get to proving a negative: people diagnosed with psychopathy do not have empathy deficits.

Consider another well-trodden claim that psychopaths lack emotions. This claim is as old as the idea of psychopathy itself, however it was the psychiatrist Hervey Cleckley who popularised it through his book The Mask of Sanity (1941). Cleckley hypothesised that psychopathy was essentially a neurological disorder of the affective system, causing abnormally shallow emotions. What made psychopathy peculiar was that those who were affected by the disorder could hide or mask their disability, coming across as if they were normal. But, to Cleckley, this is just a façade covering up a barren inner emotional life. In many ways, the Chigurh character effectively captures this aspect of Cleckley’s conception of psychopathy.

However, most researchers have long given up on this idea too, rendering it little more than a myth. There has never been any clear evidence to support it. A person clinically diagnosed with psychopathy might appear as if they are lacking emotions, but once these patients are subjected to careful analysis using technology capable of measuring physiological markers correlated with emotional reactions – like skin conductance, heart rate, brain activity, etc – the data tell a different story.

ALL IN YOUR HEAD:

When It Comes to Back Pain, Maybe You Should be Your Own Doctor (Jake Currie, July 1, 2026, Nautilus)

But even more interesting was why the self-guided therapy seemed to work. According to the researchers, a trio of psychological factors contributed to the self-guided group’s success. Improved self-efficacy, reduced fear of movement, and avoiding negative thinking patterns about pain explained as much as 76 percent of their pain reduction.

FUNNY HOW THAT WORKS…:

Rogue Wounds: Playing ill or feigning madness has been a con for hundreds of years. But can a fake sickness become a real sickness? (Daniel Mason, Lapham’s Quarterly)

It is a wonderful turn of fate,” wrote the British psychiatrist W.H.R. Rivers in 1922, “that just as Freud’s theory of the unconscious and the method of psychoanalysis founded upon it should be so hotly discussed, there should have occurred events which have produced on an enormous scale just those conditions of paralysis and contracture, phobia and obsession, which the theory was especially designed to explain.”

Social contagion is an old phenomenon.

ENTIRELY UNSURPRISING:

When It Comes to Back Pain, Maybe You Should be Your Own Doctor (Jake Currie, July 1, 2026, Nautilus)

Researchers at the University of Pittsburgh and University of Minnesota recruited more than 1,000 adults already suffering from acute or subacute lower back pain that had a moderate to high risk of turning into chronic back pain. They separated the participants into four groups. The first received supported self-management, featuring pain education, exercises, relaxation techniques, and strategies for reframing negative thought patterns (supervised by a physical therapist or chiropractor). The second group got a more hands-on treatment—spinal manipulation therapy from a physical therapist or chiropractor. The third group received both programs, and the fourth received treatments from physicians, which included pain relievers and muscle relaxants.

Interestingly, the supported self-management group reported the most improvement.

IT’S ALL IN YOUR HEAD:

Chronic pain eased by a common sleep supplement (Bronwyn Thompson, July 01, 2026, Refractor)

Essentially, the results were on par with how opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol scored in trials. […]

“For many patients, pain doesn’t exist in isolation and is closely tied to poor sleep,” Wu says.

Simple sleep hygiene will render the same results.

ALL IN YOUR HEAD:

Bravery (and Humility) is Needed to do Proper Medical Science: Hundreds of thousands of knee arthroscopic meniscus repairs are done. At a cost of $10,000 per surgery. Now let me tell you about the FIDELITY trial follow-up at 10 years. (John Mandrola, May 04, 2026, Sensible Medicine)

First was a diagnostic arthroscopy. Then randomization. Active arm surgery included removal of all loose, weak fragments as well as unstable meniscus with preservation of as much of the meniscus as possible.

For the sham surgery, a standard arthroscopic partial meniscectomy was simulated. To mimic the sensations and sounds of a true arthroscopic partial meniscectomy, the surgeon asked for all instruments, manipulated the knee as if an arthroscopic partial meniscectomy was being performed, pushed a mechanized shaver (without the blade) firmly against the patella (outside the knee), and used suction. The patient was also kept in the operating room for the amount of time required to perform an actual arthroscopic partial meniscectomy.

Outcomes were three pain scores. Their names aren’t critical. But all three were not statistically different. Critically, patients could not identify their treatment arm; blinding had worked.

In the 10-year radiological assessment. 81% of the patients in the operative arm had progressed to have arthritis vs 70% in the placebo arm. This barely missed statistical significance. More patients in the placebo arm reported satisfaction (84% vs 75%). More patients in the surgery arm progressed to high tibial osteotomy or total knee replacement (12% vs 4%).

The first thing that pops in my head is: what if these researchers (and patients) were not so bold. An ineffective procedure would have remained popular, with costs into the billions, and if the trends in this study are true, increasing numbers of people would progress to knee replacement. AKA: harm.

INCENTIVIZE CAUTION INSTEAD OF HEROICS:

Do Less, Heal More: The Case for Medical Conservatism: Dr. John Mandrola joins Russ Roberts to explore the surprising evidence behind sham knee surgery, the hidden power of expectation, and why medical humility may sometimes be the best medicine. (Russ Roberts, John Mandrola, 6/29/26, Econ Talk)

What if the surgery that fixed your knee did no better than fake surgery? EconTalk host Russ Roberts speaks with Dr. John Mandrola about a striking clinical trial in which patients who received sham knee surgery (a real incision, but no actual repair) did as well or better than those who had the actual procedure — one performed 700,000 times annually in the US. The conversation ranges from the power of placebo and nocebo effects (how expectation of harm can cause real suffering) to the broader philosophy of “medical conservatism” — the idea that humility, watchful waiting, and honest counsel often serve patients better than the knife. Mandrola argues that financial incentives, professional identity, and language itself (“bone-on-bone,” “the widowmaker”) conspire to push patients toward interventions that can do more harm than good.