A Hole Lot of Nonsense: Surgery Before SciencePeople 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.