Episode 86
Ancient Neurosurgery and Modern Brain Scams
A Hole Lot of Nonsense: Surgery Before Science
People once drilled holes in skulls to cure madness
And in some cases… it actually helped. Well, if you consider madness what happens if you get a stroke from too much pressure in your brain from trauma
That’s the wild part.
While visiting the Surgeons’ Hall Museum in Edinburgh, I saw ancient skulls with round holes cut into them—evidence of trepanation, one of the world’s oldest surgeries. Even more shocking? Many of those patients survived. Some healed so well that they lived for years.
But let’s back up.
What is trepanation?
It’s the act of scraping or drilling a hole in your skull. Ancient people did it across continents—from South America to Europe.
We don’t know exactly why. Some may have used it to relieve pressure after a head injury. Others might have believed it released evil spirits.
Here’s the thing: it sometimes worked.
Today, we know that pressure in the brain—from a bleed, swelling, or injury—can be deadly. Modern medicine sometimes calls for drilling a hole or even removing part of the skull to save a patient’s life.
The ancients may have stumbled onto something real. Or they may have been guessing.
That’s the danger when we mix luck with ritual. If one patient improves, people assume the treatment works—even if there’s no science behind it.
Dr. Cotton and the colon cure
Jump ahead to the 1900s.
Dr. Henry Cotton believed mental illness came from hidden infections in the body. So what did he do? He had his surgeons remove teeth, tonsils, stomachs, and colons—even when patients showed no symptoms.
Many died. Most didn’t improve.
Still, Cotton was praised in journals and trusted by major institutions. His confidence overshadowed the lack of results.
It’s a painful reminder that being sure of yourself doesn’t make you right. Sounds like modern-day influencers - confidence beyond erudition.
Today’s brain hacks: same pattern, better packaging
Right now, people are terrified of dementia. That fear fuels a massive market for brain supplements. One of the biggest sellers? Lion’s Mane mushrooms.
They’re in powders, coffees, and pricey pills. Some lab research suggests benefits, but actual human studies? Weak at best.
Meanwhile, studies show that eating a Mediterranean or MIND-style diet can reduce your risk of dementia by up to 50%. But those diets don’t come in fancy bottles.
Instead of focusing on real food, we chase the next shiny pill.
And let’s talk about PRP…
PRP stands for platelet-rich plasma. Some orthopedic surgeons spin down your blood, pull out platelets, and inject it back into sore joints. They claim it speeds healing.
The truth? There’s little evidence that PRP works for most uses. But it’s expensive. And because it sounds high-tech, people trust it.
The orthopedic surgeon gets the thousands of dollars for it because insurance won't cover it. They won't cover it because it isn't a researched treatment. But if your surgeon says here take this and you will recover faster - what to do?
I should know—I co-authored one of the first papers on PRP for diabetic wounds, where it actually showed benefit.
But that’s a far cry from injecting it into tennis elbows for cash.
We’ve upgraded the tools. Not always the thinking.
What history teaches us
When I look around this museum, the lesson is clear:
We’ve always wanted to help. But good intentions without good science can hurt people.
Real medical progress comes from questioning our own assumptions. It comes from saying, “Let’s study this,” instead of, “Let’s just try it.” Whether it’s trepanning or turmeric, we need to ask:
Does this really work—or are we just hoping it does?
References:
- Barnes LL, Dhana K, Liu X, Carey VJ, Ventrelle J, Johnson K, Hollings CS, Bishop L, Laranjo N, Stubbs BJ, Reilly X, Agarwal P, Zhang S, Grodstein F, Tangney CC, Holland TM, Aggarwal NT, Arfanakis K, Morris MC, Sacks FM. Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons. N Engl J Med. 2023 Aug 17;389(7):602-611. doi: 10.1056/NEJMoa2302368. Epub 2023 Jul 18. PMID: 37466280; PMCID: PMC10513737. (click here for reference)
- Seitz, D. et al. (2022). “MIND Diet and Risk of Alzheimer’s Disease.” Nutritional Neuroscience.
- Simpson, T. (1991). “Platelet-derived Growth Factor and Wound Healing.” Journal of Diabetic Complications.
Want to avoid brain fads? Start with whole foods, good sleep, and honest science. The hole in your head should stay in your museum tour, not in your health plan.
Transcript
>> Dr. Terry Simpson: Right now, I am standing in the Surgeons Hall Museum
Speaker:in Edinburgh. It's one of the oldest
Speaker:surgical museums in the world, filled with
Speaker:skulls, saws and surgical tools that tell
Speaker:the stories of medicine's slow,
Speaker:stumbling progress. And today, we're going to talk about
Speaker:one of the oldest and sometimes the most horrifying
Speaker:ideas in medicine and surgery. That the best way to
Speaker:treat mental illness was to drill a hole in
Speaker:your head.
Speaker:I'm Dr. Terry Simpson, your chief medical
Speaker:explanationist, on site at the
Speaker:Surgeons Hall Museum in Edinburgh.
Speaker:And this is Fork U Fork
Speaker:University, where we unpack the weird,
Speaker:wild and too often wrong history
Speaker:of food, medicine and surgery. And we look at
Speaker:how bad ideas never really die.
Speaker:They just rebrand.
Speaker:Let's start today with trepanation, the
Speaker:practice of drilling or scraping a hole in the
Speaker:skull. It's one of the oldest known
Speaker:surgeries in human history. And here at the
Speaker:Surgeons Hall Museum in Edinburgh, you can
Speaker:see the actual ancient skulls with neat
Speaker:round holes carved into them. Some of these
Speaker:skulls show clear signs of healing,
Speaker:meaning the patients survived, some of them
Speaker:for a long time. But why did they do it?
Speaker:That's the part we don't know.
Speaker:Maybe they did it to relieve pressure from a head injury.
Speaker:Maybe they thought they were letting out evil spirits.
Speaker:Maybe, just maybe, they figured out by
Speaker:observation that people sometimes got better
Speaker:when they drilled. Were they scientists
Speaker:or shamans, healers or hopeful butchers?
Speaker:Sadly, that data is lost. But we
Speaker:do have some disturbing data today. We
Speaker:do drill holes in the skull, but we do it for some really
Speaker:good reasons. If someone has increased
Speaker:intracranial pressure after trauma, meaning high
Speaker:pressure in their brain, we drill a hole. Or
Speaker:sometimes if they have a subdural hematoma or a brain
Speaker:bleed, we drill a hole to remove the clot, to relieve
Speaker:the pressure on the brain. So you don't have stroke like symptoms or
Speaker:lose second grade. And in some severe
Speaker:brain injuries, we even remove a portion of the
Speaker:skull to let the brain swell without
Speaker:compression. So trepanation as a
Speaker:technique isn't the problem. The problem
Speaker:was a lack of understanding about why it works sometimes
Speaker:and not others. And before we did the
Speaker:research, we made things up,
Speaker:meaning we saw it work once and assumed it was always
Speaker:the answer. We saw a survivor and declared it
Speaker:a cure. It's the oldest mistake in
Speaker:medicine and one we and the
Speaker:public keep repeating. Fast
Speaker:forward to the 20th century. Take Dr.
Speaker:Henry Cotton, a psychiatrist who believed that mental
Speaker:illness came from hidden infections in the body. So what
Speaker:did he do? He had his surgeons remove teeth,
Speaker:tonsils, gallbladders and pieces of colon to
Speaker:cure psychosis. Many of his patients
Speaker:died and the rest didn't improve. But he
Speaker:was celebrated in medical journals. He ran a major
Speaker:institution, he lectured. He wasn't a
Speaker:fringe player. He was medicine's main stage.
Speaker:And that's the real horror. Even
Speaker:when evidence showed that his surgeries caused harm, his
Speaker:reputation protected him. Because confidence
Speaker:often beats data. Hello,
Speaker:Gary Brecke and Paul Saladino.
Speaker:Today we don't drill holes in the skull to release
Speaker:spirits. But we still try to hack the brain
Speaker:with products that offer less harm but just
Speaker:as little proof. One of the biggest fears in
Speaker:America today is dementia. So why do people
Speaker:turn to things like lion mane's mushroom? Because
Speaker:it promises to regrow brain cells, boost memory and
Speaker:prevent Alzheimer's. Some lab studies are
Speaker:promising, but real clinic evidence, almost
Speaker:none and has never been repleted.
Speaker:Still, it is a booming industry.
Speaker:A $50 a bottle, memory gummies, mushroom
Speaker:coffee, neurotropics. Meanwhile, two real
Speaker:diets, the mind and Mediterranean diets, can
Speaker:reduce dementia risk by almost half.
Speaker:But eating well doesn't make anybody rich.
Speaker:We chase the shiny pill and ignore the
Speaker:olive oil. Let's look at orthopedic
Speaker:surgery. Some surgeons offer
Speaker:platelet derived growth factor for injections. They
Speaker:spin your blood, pull out the platelets and inject them
Speaker:back. The idea, boost healing,
Speaker:help your recovery. The evidence,
Speaker:weak or absent from most uses. And I should know because
Speaker:I helped publish one of the first studies showing
Speaker:platelet derived factor helped with
Speaker:patients with diabetic wounds. That was valid,
Speaker:but now it's used from everything from tennis elbow to torn
Speaker:knees to post op shoulders with no proof
Speaker:but high building codes because that is not
Speaker:covered by insurance. So it is
Speaker:a tax on your health care from the
Speaker:orthopedic surgeon to you that
Speaker:you pay for. Because the orthopedic surgeon, the
Speaker:person that you have your confidence in, says this
Speaker:will help you heal better and recover faster. And
Speaker:you're just giving your orthopedic surgeon an extra 2000 bucks
Speaker:to feel good and get a band aid. It's
Speaker:trepanation with better lighting and
Speaker:sterile gloves. As I walk through this
Speaker:museum, one thing is clear. We've always
Speaker:meant well. But meaning well isn't
Speaker:enough. Progress in medicine and surgery
Speaker:means being willing to say we're wrong.
Speaker:It means asking, does this actually help people?
Speaker:Science moves forward when we replace story with
Speaker:evidence. That goes for trepening and
Speaker:lion's mane mushroom.
Speaker:This episode was written and recorded by me, Dr. Terri
Speaker:Simpson, standing right here in the halls of the Royal College of
Speaker:Surgeons in Edinburgh. You can find references and
Speaker:more@yourdoctorsorders.com and
Speaker:forku.com and while I am a board
Speaker:certified surgeon, I am not your
Speaker:physician. If you're tempted by PRP Brain
Speaker:Mushrooms or the next TikTok Brain Booster,
Speaker:talk to a real doctor and a registered
Speaker:dietitian. Not to your chiropractor, not
Speaker:the shaman in Luaman, and not the guy who
Speaker:drilled a hole in your head for clarity.
Speaker:This episode was produced by Simpler Media and the man with
Speaker:more wisdom than any mushroom Evotera.
Speaker:Have a good week.
Speaker:Hey Evo, if a wellness influencer told you
Speaker:mental clarity comes from drilling a hole in your skull,
Speaker:would you try that? Or do you think a good
Speaker:IPA would serve just as well?
Speaker:>> Speaker B: Aye, right. Craft beer might be just the thing
Speaker:for you, but you're up there in the Scottish
Speaker:Highlands, so I'd be thinking there, Dr.
Speaker:Simpson, that a nice single malt might be more what
Speaker:you're looking for. I can't tell if that's Scottish
Speaker:or pirate. Anyhow.
