Complementary and alternative medicine Friday Woo Medicine

Your Friday Dose of Woo: I need this like I need a hole in the head

This week sucked.

OK, it was the last two or three days that sucked, but they were bad enough to ruin the whole week. The only reason my blogging didn’t reflect this is because most of the posts over the last couple of days were actually written earlier this week, and the true magnitude of this week’s suckitude didn’t hit me until yesterday. Suffice it to say that my lab minions have caused me considerable aggravation and angst this week by doing something really, really dumb, a problem whose effect was amplified by the response of a colleague. (That’s all I’m going to say about it.) To top it off, I’m on call all weekend, which means I will have to be a tea-totaler at the faculty Christmas party on Saturday night; that is, if I even make it there.) Fortunately, last night arrived, and I knew just the thing that might get me out of my funk. And, of course, you know there’s only one thing that can do that when the funk is this deep, don’t you?

Only the highest quality, finest woo.

Yes, it’s time once again for Your Friday Dose of Woo. But what sort of woo would be powerful enough to relieve the pounding pressure in my head that all these annoyances have contributed to? Something to relieve this pressure? Something to let all those evil thoughts involving death and destruction out?

How about a hole in the head? Yep, I’m talking about trepanation.


Hard as it is to believe, there are actually people out there who think it’s a fine idea to drill holes in their skulls. True, I can think of quite a few people who might benefit from such a procedure, but not in the way these woos think. But what could possibly be the benefits of drilling a hole in your head? Let the trepanners tell you:

Trepanation, by a single act, restores the brainbloodvolume (“BBV”) to the level of childhood, the level at which the ego was originally installed. This benefits everyone, but most importantly the psychotic, whose de-conditioned ego can regain its original strength supported by a childhood-level cushion of blood. The word communication centers are re-floated in blood, and there is therefore less strain on the ego/constriction mechanism, which no longer needs to be permanently deployed in order to maintain self-control. Both the degree and extent of repression can therefore be reduced. The lifting of this burden is often felt as increased energy. The ego, now with more free time, can be used for the purposes of concentration, i.e. the channeling of blood into the capillaries of the brain required to be in action. This is a benefit to everyone, no matter however well adapted they may be, to their stasis of repression.

Trepanation is not necessarily to be considered a ‘cure-all’. Being trepanned does not mean that the neurotic will automatically lose all his or her symptoms, nor does it mean that the psychotic will immediately come back to full self-control. It means that their Brainbloodvolume (“BBV”) is restored to a level where the need for repression is lessened and where reconditioning can be deeper and therefore, bring more lasting reward. Other treatments may still be needed, however in conjunction with trepanation for more serious conditions and then they stand even a far better chance of success. To have more blood in the capillaries of the brain is a healthier foundation. Of course there are other ways of displacing the brain water (cerebrospinal fluid, or “CSF”), but trepanation seems to be the only permanent way.

In general terms, lightening the ego’s load removes a considerable weight from the shoulders of the psyche. The fact that a wider spectrum of centers are supplied with blood means that the inner world can be freed from the stresses of permanent ego tyranny: there is now enough blood in the capillaries of the brain for more brain centers to function independently of the ego. The effects, though somewhat varied by individual to individual, are evident and beneficial….. an overall improvement is experienced in an extremely high percentage of people who have been trepanned via ITAG under the ITAG Protocol Pilot Study, and under the direction of Peter Halvorson (ITAG’s Director of Services) and the ITAG Associate Surgeons at the Medical Clinic in Monterrey, Mexico.

Oh. My. God. This is industrial strength woo. Indeed, this is woo on the order of quantum homeopathy, DNA activation, or the Great Spirit Squid of Doom. I guess it’s at least nice to know that these woos have just enough of a tenuous toehold on reality that they recognize that drilling holes in people’s heads probably won’t cure schizophrenia. The rationale (if there can be a legitimate rationale for drilling holes in the heads of perfectly healthy people for no good medical indication–such as an epidural or subdural hematoma, for instance–is that babies’ brains can pulsate with the blood flow that comes through them with each beat of their hearts. This is possible because of the open fontanelle (the soft spot on top of a baby’s head). It also turns out, not surprisingly, that our cerebral blood flow and metabolism both decrease with age, and these guys show pretty graphs that suggest just that. From these two observations, the trepanners conclude that you can improve cerebral blood flow and metabolism by drilling a hole in an adult’s head in order to simulate the open fontanelle of the infant. I’m not making this up. Supposedly, this hole allows baby-like pulsations to resume, resulting in benefits in increased energy, clarity of mind, or whatever. Too bad they’ve confused correlation with causation. Yes, brain metabolism and cerebral bloodflow correlate, but that’s because brain metabolism drives blood flow, not the other way around. When the brain works harder, it sends signals that it needs more glucose (the primary fuel of neurons) and oxygen, and the blood vessels dilate to increase cerebral blood flow. Increasing cerebral blood flow will almost certainly not increase brain metabolism even if drilling a hole in your head actually did anything to increase blood flow, unless there is some sort of vascular problem that prevents adequate perfusion of the brain.

We call one such vascular problems an ischemic stroke.

Of course, these clowns claim it’s science, maaan! Check it out:

Pulsation is at the center of the trepanation discussion. Brain pulsation is clearly visible in the infant child. The soft tissue on the top of the head known as the fontanel rises and falls with the beating heart. This expansion and contraction on the heartbeat does not threaten the infant’s good health. However, within the first few months of life this tissue hardens into skull bone. The visual evidence that the heart beat still reaches into the brain vanishes before our eyes. Still the infant’s good health is unaffected. But does the heart pulsation (also known as cardiac rhythm) continue to exist inside the skull even if it can’t be seen? You may be thinking, “What’s the big deal here anyway? Why is brain pulsation such an important issue? How does brain pulsation relate to trepanation?”

Brain pulsation or intracranial pulse pressure has largely been ignored as a subject for investigation by the medical establishment in Western Europe and America. The primary investigators in modern times have been Russian. Most important amongst them is B.N. Klosovskii who is otherwise recognized internationally for his methods of studying blood circulation in the brain. In the mid 1950’s he developed methods of tissue staining that allowed the arteries and the veins of the brain to be clearly distinguishable. The vascular bed was then for the first time clearly mapped. His main work BLOOD CIRCULATION IN THE BRAIN was translated from the Russian in 1963 and published under an agreement with U.S. Public Health Service. In the closing chapter of this text Klosovskii takes up the subject of brain pulsation. Chapter 12, titled BRAIN PULSATIONS IN OPEN SKULLS AND THEIR ABSENCE IN THE HERMETICALLY-CLOSED SKULL CAVITY, is reprinted here in its entirety.

Klosovskii, however, is not without critics. And those critics too are not without theirs. Other Russian investigators dispute his findings. In their work HEMODYNAMICS OF CEREBRAL CIRCULATION, also published by the U.S. Public Health Service, Moskalenko and Naumenko take up the case against Klosovskii. Using impedance electroplethysmography, an entirely different method than Klosovskii’s direct observation through a “transparent window,” they find that there is a “pulse wave” in the hermetically sealed skull. Their measurements indicate that this pulse is in the order of 1-2mm of water. Cardiac rhythm, pulse pressure, or pulsation is normally measured in mm. of Mercury (mm.Hg) not mm. of water. The difference in order of magnitude here is one to thirteen. (Thirteen mm of water equals one mm of mercury). They conclude, “in the hermetical cavity of the cranium, the pulse wave is transmitted indirectly from the arterial system into the veins and in doing so bypasses the capillary bed.” The “pulse wave” that they have measure in the closed skull is in no way equivalent to the presence of “pulse pressure” that Klosovskii observes on the cerebral surface in the open skull.

In a 1960 review titled Soviet Investigations in the Field of the Vascular Supply of the Brain, the noted American brain physiologist, Ernst Simonson, disputes those investigators using impedance plethysmography. He says, “The viewpoints are in need of confirmation, as it is rather difficult to imagine that alterations of intracerebral pressure of only 1 to 2 mm. water column can lead to blood being expressed from the cerebral veins, no matter how thin-walled these may be.” Review of this information should provide researchers at the end of this century with the necessary focus to renew investigation of this topic using much improved bio-medical engineering. Using advanced methods now available the question of BRAIN PULSATIONS IN OPEN SKULLS AND THEIR ABSENCE IN THE HERMETICALLY-CLOSED SKULL CAVITY can be quickly resolved.

Maybe these guys should use all these advanced methods to investigate instead how much pseudoscience one can swallow before one becomes a woo. It’s also utter B.S. to claim that intracranial pressure hasn’t been studied in the West. It’s a huge topic of study in the trauma and neurosurgery literature, because increased intracranial pressure due to brain swelling secondary to head injury is the main mechanism by which such injuries result in death or serious brain damage. In any case, another part of the rationale seems to be that drilling a hole in the head, and thus allowing these “pulsations” to occur improves cerebral blood flow and somehow allows the brain to reach its maximal metabolism. As Bart Huges, one of the “pioneers” of modern trepanation (an appellation I certainly would never want) put it:

Modern practitioners, preferring the use of electric drills with special cranial perforator’s that know when to shut off and stop the drilling ‘automatically’ before damaging the brain covering (dura matter), contend that this simple and fast operation improves blood flow to the capillaries of the brain on a permanent basis. The many benefits to this procedure include relief from the following: anxiety, stress, headaches and depression, as well as a higher level of consciousness and awareness with improved mental activity.

The modern trepanation movement began in 1962, when a Dutch doctor named Bart Huges developed the hypothesis (“The Mechanism of Brainbloodvolume (“BBV”) – Published in 1962) that as we mature and age our skulls harden, restricting blood flow to the capillaries of the brain. He reasoned that children, especially babies with their “soft spot”, had a clearer outlook on the world because their brains were free to receive more cerebral blood volume than in our adult brains with hermetically-sealed skulls.

“Hermetically sealed skulls”? That describes these guys amazingly well. Actually, there’s a pretty sound evolutionary reason that adult brains are “hermetically sealed.” The brain is a delicate organ. It’s easily damaged. It’s not surprising that evolution would have provided us with a nice, hard protective casing for such a critical organ that is so easily damaged and damage to which causes such catastrophic results. It wouldn’t be cool if any time you bumped your head hard (and every one of us has bumped his or her heads hard at some point in our lives) you suddenly couldn’t move one side of your body. Of course, as Robert Carroll over at Skepdic describes it, the “flash of insight” that led Bart Huges to his great idea was rather less than impressive:

Bart Huges (b. 1934), a medical school graduate who has never practiced medicine except for a bit of self-surgery, believes that trepanation is the way to higher consciousness. He says that he wanted to be a psychiatrist but failed the obstetrics exam and so never went into practice. In 1965, after years of experimentation with LSD, cannabis, and other drugs, Dr. Huges realized that the way to enlightenment was by boring a hole in his skull. He used an electric drill, a scalpel, and a hypodermic needle (to administer a local anesthetic). The operation took him 45 minutes. How does it feel to be enlightened? “I feel like I did when I was 14,” says Huges.

What led Dr. Huges to believe that trepanation would lead to enlightenment? His first insight came when he was taught that he could get high by standing on his head. He came to believe that by permanently relieving pressure he could increase the flow of blood to the brain and achieve his goal. After he took a little mescaline he soon understood what was going on. “I recognized that the expanded consciousness was attributed to an increase in the volume of blood to the brain.” How has such a simple fact eluded scientists and mystics alike for so many millennia?

Maybe because it’s not true, because there’s no scientific evidence for it? Just a thought. I mean, just because standing on your head makes you feel a bit dizzy because the impaired venous return leads to a slight increase in intracranial pressure does not mean that drilling a hole in your head will allow you to achieve enlightenment and figure out the answer to the Great Question of Life, The Universe, And Everything. Maybe it’s just all the years of LSD talking to you, perhaps in the form of a giant panda bear. I’m just sayin’.

I’ll give these trepanation guys credit for one thing: They have to be the only people I’ve ever heard of who are running a clinical trial to determine if drilling holes in people’s heads can actually improve their outlook on life (or anything else. (I’m not sure who’s the bigger idiot, the doctor or the person asking the doctor to drill a hole in his skull.And it’s science, too! Really. How do I know? They tell us so, show pretty colored graphs that are too small to read and even present before and after MRIs of a guy who actually let one of these clowns drill him. I was going to post the pictures here, but there are so many notices and threats about how everything on that site is copyrighted and you will suffer horrendous death and damnation if you even do fair use with them. I realize it’s probably an utterly vacuous threat, because fair use is part of copyright law, particularly for text–which is why I feel justified cribbing excerpts from the website–but using pictures seems to annoy people more, and why take the chance with crazies? Just scroll down about halfway to the MRI images of Randall W. Hawes.

That big red circle on the “after” image conveniently shows you where the hole is. I would also note that whoever drilled Mr. Randall W. Haws’ head open appears to have left a small epidural hematoma that, as you can see, is slightly compressing the brain right at the site of the hole. This is, of course, not unexpected whenever you drill a hole in the skull. It bleeds. You can hit blood vessels running in the dura mater just under the skull, even if you don’t actually violate the dura mater itself. It’s not surprising that there would be a small epidural hematoma there. I just hope the “improved blood flow” makes up for the bruise to Mr. Haws’ brain that likely occurred when he was trepanned. Given that he volunteered for the procedure and now is one of the forces behind the site, he clearly needs to protect every last remaining neuron that he has.

I’ll also note that these guys have got to be about as ballsy as you can imagine. No, not because they drill holes in their heads for no reasons. That’s just stupid. Rather, the provide a link to a page that contains the Belmont Report. Yes, the Belmont Report, the very basis of human subject protections for research in the United States. And not only that. The World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects is on the same page. I kid you not. Pretty amazing, eh? They publish a copy of the two most important documents that serve as the basis of the moral and ethical guidelines used by nearly every civilized nation for human subjects protection in research while at the same time violating nearly every single one of the guidelines contained in them.

Finally, one of my favorite justifications for trepanation is this appeal to ancient knowledge:

Trepanation was practiced on every continent through every time period and by every race of mankind until the advent of brain surgery in this century. Doctors, today, have been taught that trepanation was done in past centuries for superstitious, magical or religious reasons. They generally look on trepanation as a practice akin to blood letting. They scoff at it. They deny that trepanation could have a reasonable basis. They fear that to practice trepanation would demean their professional status. They have stated that they wouldn’t undertake it if their lives depended on it. And further, trepanation can’t be investigated by any individual doctor because a board must be set up to approve all research projects connected to universities and hospitals.

Damn those pesky Institutional Review Boards and their annoying questions about whether this sort of thing is ethical, whether there’s any evidence that the potential benefits outweigh the risks, and demanding that researchers justify performing invasive surgery on perfectly healthy individuals to “increase their cerebral bloodflow.” They just don’t get it. But they can’t stop stupid people needing holes in their heads, as the trepanners tell us:

However trepanation doesn’t go away. It is ingrained in our history on planet earth. The ancestors of modern Europeans, the Battle-Ax people, were prodigious trepanners as well as were all other ancient peoples. There is an extensive scientific literature on trepanation both in medicine and anthropology (also see Ethne Barnes – Paleopathology discussion). The risk to benefit ratio would have to have been very favorable for the practice to have been so widely practiced but official investigators haven’t been able to see that there is a both a rationale and a benefit to this procedure. There seems to be a deliberate intent amongst them not to see, maybe even a conspiracy, that there is a benefit to making a hole in the skull bone. This is understandable though because if doctors and scientists recognized the benefit they would be obliged to announce to the world that upright walking humans need a hole in the head! It’s unlikely that doctors will be stepping forward with this announcement anytime soon so in the meantime the public will have to educate itself, do the research and investigating themselves and communicate with those who have had the procedure performed on them…and then…they must educate the doctors and the medical community!

Naughty skeptics! Bad doctors! Insisting on scientific evidence before recommending a procedure to drill a hole in peoples’ heads. That means you–yes, you!–have to think for yourself because the evil conventional medical cartel is hiding the benefits of this wondrous procedure from you to protect their ill-gotten profits. Really. They only got one thing right here: It is indeed very unlikely that doctors will be stepping forward soon to announce that normal healthy people would benefit from having a hole drilled in their head. Of course it’s all a conspiracy, as this answer to a question about whether trepanning is beneficial:

The jury is still out on this. Many who are trepanned experienced a richer life as a result. The professionals think it’s all a placebo. However they haven’t collected any data on patients who have been electively trepanned. They couldn’t have. They refuse to do it. Everyone has opinions. ITAG has the data. Let’s get it analyzed properly.

How seemingly reasonable sounding. Too bad it would be almost pointless to collect data on trepanned patients without the baseline data before they were trepanned. And if a physician participated in a “study” that subjected patients to unnecessary surgery, that would also be unethical, particularly when there is no good physiological reason to think that the surgery will do any good. This is more than just an “opinion.” It’s also ludicrous that the “risk-to-benefit” ratio would have to be favorable for the practice to persist. Bloodletting, for example, persisted for centuries, if not millennia, even though, except in rare cases, it is harmful to induce anemia in ill patients and, indeed, many patients probably died faster because of the bloodletting–or because of the bloodletting itself. (Remember Theodoric of York, Medieval Barber.) If a people believed that there were evil spirits in their heads that needed to be let out, risk suddenly becomes less of a factor. And, in fact, if this procedure were so safe, even in primitive hands, why do the trepanners themselves post an article in which the mortality from the procedure is quoted as 5%? Here’s the story of trepanation among a tribe that still exists today in Kenya:

Trephining in the Kisii highlands is done primarily for the complaint of headache, ache or pain after an injury to the head, with or without fracture of the skull. The practitioners have day jobs as farmers, observing the village specialists as they acquire their skill. They are usually apprenticed until they are sufficiently skillful and responsible to do the operation on their own. It is not uncommon for a patient to have multiple operations, involving any part of the skull.

Surprisingly, the mortality is low, perhaps 5%. Nevertheless, many other Kisii take cultural pride in the knowledge that only the Kisii among the many tribes have the traditional skills and knowledge to carry out such a demanding procedure with so few complications and the prestige of the omobari as the one who possesses the key to alleviation of these symptoms is still at a high level in many rural circles.

A 5% mortality for the treatment of a headache or a minor head injury is something to be proud of? Jumpin’ Jesus on a pogo stick! If I reported a mortality like that for the treatment of such maladies, the state would be hunting me down to take my license away. Yet the trepanners use such a story as an example of how safe the procedure is, even in non-medical hands in tribes that live without modern amenities?

So how much does all this woo cost? Well, a fair amount:

  • The complete medical expenses of trepanation for volunteers who participated in the film interviews was $2,400.00.
  • The complete medical expenses for trepanation for volunteers who wished to remain anonymous was $3,600.00.
  • To continue into the long-term study phase the cost will definitely increase.
  • The increase will include a limited three day insurance policy to provide for any medical emergency that could result from the surgery.
  • This is for the protection of the volunteer and is in keeping with the spirit and the letter of the Helsinki and Belmont Accords. The cost of the limited policy has not yet been determined.

Mighty generous of them, isn’t it? You have only a three day insurance contract. What if you suffer complications after three days, which is entirely possible? What if you have a slow bleed or develop osteomyelitis of the skull? Sorry, buddy, but you’re out of luck. You’ll have to pay for any treatment of those complications yourself. Of course, what would really happen is that the sucker’s–I mean, patient’s–health insurance would pay, because the patient would only be in Monterrey, Mexico for three days to have the procedure. And another unethical thing: In clinical trials, it is considered a really, really big no-no to require patients to have to bear any of the financial costs of experimental treatments or any of the tests necessitated by those treatments. I realize that it’s a stretch to call any of this “experimental,” given the amazing level of woo there, but the clinic is calling it a “pilot study,” which is a form of clinical trial (even if it sounds like a breathtakingly badly designed one, with no real controls); so I’m taking the “investigators” at their word. No wonder they set up shop in Mexico. Of course, this makes me wonder what Mexican doctors can get away with in biomedical research; the laws must be really lax there (or the “International Trepanation Advocacy Group” greased the right palms).

There, that’s better. I now realize that, no matter how bad this week was, it could have been worse. I could have, for instance, gotten a hole in my head, which is what I need like the world needs another folk singer. Or is it the other way around?

Excuse me, I need to go enhance my cerebral blood flow and metabolism. Or maybe I need a new Frank Sinatra.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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