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Individually done by Jaelyn Mosher

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Definition: Humans tend to see patterns in objects as part of our instinct.

Connection: At the bottom of this shark toy one might see screws and a metal oval. But most would see a face. The screws as eyes and giant mouth with razor sharp teeth. There is no specific special reason as to why we see this or what it might be, it's simply just shows us that humans have the tendency to see faces in any object.

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Definition: When one can't find an explanation for something, they make up ideas to satisfy their minds.

Connection: It is unexplained as to where Amelia Earhart went. She mysteriously disappeared during one of her flights. Some suggested she went through he Bermuda Triangle, others suggest she crashed on an island and lived out her life there. It's the unexplained that creates curiosity and stories and that's what we did with Amelia Earhart.

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Table of Contents

This article was most recently revised and updated by

Amelia Earhart (born July 24, 1897, Atchison, Kansas, U.S.-disappeared July 2, 1937, near Howland Island, central Pacific Ocean) was an American aviator, one of the world's most celebrated, who was the first woman to fly solo across the Atlantic Ocean. Her disappearance during a flight around the world in 1937 became an enduring mystery, fueling much speculation.

Early life

Earhart's father was a railroad lawyer, and her mother came from an affluent family. While still a child, Earhart displayed an adventurous and independent nature for which she would later become known. After the death of her grandparents, the family struggled financially amid her father's alcoholism. The Earharts moved often, and she completed high school in Chicago in 1916. After her mother received her inheritance, Earhart was able to attend the Ogontz School in Rydal, Pennsylvania. However, during a visit to her sister in Canada, Amelia developed an interest in caring for soldiers wounded in World War I. In 1918 she left junior college to become a nurse's aide in Toronto.

Historic flights

After the war, Earhart entered the premed program at Columbia University in New York City but left in 1920 after her parents insisted that she live with them in California. There she went on her first airplane ride in 1920, an experience that prompted her to take flying lessons. In 1921 she bought her first plane, a Kinner Airster, and two years later she earned her pilot's license. In the mid-1920s Earhart moved to Massachusetts, where she became a social worker at the Denison House, a settlement home for immigrants in Boston. She also continued to pursue her interest in aviation.

During this time promoters sought to have a woman fly across the Atlantic Ocean, and in April 1928 Earhart was selected for the flight. Some speculated that the decision was partly based on her resemblance to Charles Lindbergh, who had become the first man to fly nonstop solo across the Atlantic the previous year. On June 17, 1928, Earhart departed Trepassey, Newfoundland, Canada, as a passenger aboard a seaplane piloted by Wilmer Stultz and Louis Gordon. After landing at Burry Port, Wales, on June 18, Earhart became an international celebrity. She wrote about the flight in 20 Hrs. 40 Min. (1928) and undertook a lecture tour across the United States. Much of the publicity was handled by publisher George Palmer Putnam, who had helped organize the historic flight. The couple married in 1931, but Earhart continued her career under her maiden name. That year she also piloted an autogiro to a record-setting altitude of 18,415 feet (5,613 metres).

Determined to justify the renown that her 1928 crossing had brought her, Earhart crossed the Atlantic alone on May 20-21, 1932. Her flight in her Lockheed Vega from Harbour Grace, Newfoundland, to Londonderry, Northern Ireland, was completed in a record time of 14 hours 56 minutes despite a number of problems. She notably experienced mechanical difficulties and inclement weather and was unable to land in her scheduled destination of Paris. Afterward she published The Fun of It (1932), in which she wrote about her life and interest in flying. Earhart then undertook a series of flights across the United States.

In addition to her piloting feats, Earhart was known for encouraging women to reject constrictive social norms and to pursue various opportunities, especially in the field of aviation. In 1929 she helped found an organization of female pilots that later became known as the Ninety-Nines. Earhart served as its first president. In addition, she debuted a functional clothing line in 1933, which was designed "for the woman who lives actively."

In 1935 Earhart made history with the first solo flight from Hawaii to California, a hazardous route 2,408 miles (3,875 km) long, a longer distance than that from the United States to Europe. She departed from Honolulu on January 11 and, after 17 hours and 7 minutes, landed in Oakland the following day. Later that year she became the first person to fly solo from Los Angeles to Mexico City.

Final flight and disappearance

In 1937 Earhart set out to fly around the world, with Fred Noonan as her navigator, in a twin-engine Lockheed Electra. On June 1 the duo began their 29,000-mile (47,000-km) journey, departing from Miami and heading east. Over the following weeks they made various refueling stops before reaching Lae, New Guinea, on June 29. At that point, Earhart and Noonan had traveled some 22,000 miles (35,000 km).

They departed on July 2, headed for Howland Island, approximately 2,600 miles (4,200 km) away. The flight was expected to be arduous, especially since the tiny coral atoll was difficult to locate. To help with navigation, two brightly lit U.S. ships were stationed to mark the route. Earhart was also in intermittent radio contact with the Itasca, a U.S. Coast Guard cutter near Howland. Late in the journey, Earhart radioed that the plane was running out of fuel. About an hour later she announced, "We are running north and south." That was the last transmission received by the Itasca. The plane was believed to have gone down some 100 miles (160 km) from the island, and an extensive search was undertaken to find Earhart and Noonan. However, on July 19, 1937, the operation was called off, and the pair was declared lost at sea. Throughout the trip, Earhart had sent her husband various materials, including letter and diary entries, and these were published in Last Flight (1937).

Earhart's mysterious disappearance captured the public's imagination and generated numerous theories and claims. Notably, some believed that she and Noonan had crashed on a different island after failing to locate Howland, and others posited that they were captured by the Japanese. However, no definitive evidence was found for such claims. Most experts believe that Earhart's plane crashed in the Pacific near Howland after running out of fuel. A fixture in popular culture, she was the subject of numerous books and movies.

The Editors of Encyclopaedia Britannica Encyclopaedia Britannica.

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Amelia Earhart | Biography, Childhood, Disappearance, & Facts

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Amelia Earhart, American aviator who was the first woman to fly alone across the Atlantic Ocean. Her disappearance during a flight around the world in 1937 became an enduring mystery, fueling much speculation. Learn about her life, career, and disappearance in this article.

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Definition: Poison Ivy is natural, snake venom is natural. When something is all natural it doesn't always mean its safe.

Connection: Although coconut oil is a safer product it still shouldn't be used on your face or body. Coconut oil actually clogs your pores causing your skin to suffocate. The molecules are too big to be absorbed causing more problems in the long run. So although it is all natural it's not the kind of natural you should put on you body.

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Why you shouldn’t use coconut oil on your face

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Coconut oil has increased in popularity over the past several years due to its many benefits. It can be used as a cooking oil in the kitchen, to treat damaged hair, and even as a moisturizer for the skin on your body; however, I do not recommend using coconut oil on your face.

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Definition: Ancient Wisdom refers to alternative medical practices some believe that ancient wisdom is more accurate because they were around before us.

Connection: Trepanning is when one drills, burs, or scrapes holes into ones skull. A lot of the time only used on serve head trauma cases, the survival rates were low. It was also said to release evil spirits from the person. This is ancient Wisdom as it is no longer a surgery allowed to be preformed today, although people still do drill holes into there heads still believing the red flag of ancient wisdom.

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A survey of trepanation, or trephination, the oldest surgical procedure known to humanity.

A detail of a 17th-century naval surgeon's trephination kit. The trephines are very similar to both ancient Roman and modern ones.

In 1865, in the ancient Inca city of Cuzco, Ephraim George Squier, explorer, archeologist, ethnologist and U.S. charge d'affaires in Central America, received an unusual gift from his hostess, Señora Zentino, a woman known as the finest collector of art and antiquities in Peru. The gift was a skull from a vast nearby Inca burial ground. What was unusual about the skull was that a hole slightly larger than a half-inch square had been cut out of it. Squier's judgment was that the skull hole was not an injury but was the result of a deliberate surgical operation known as trepanning and furthermore, that the individual had survived the surgery.

When the skull was presented to a meeting of the New York Academy of Medicine, the audience refused to believe that anyone could have survived a trephining operation carried out by a Peruvian Indian. Aside from the racism characteristic of the time, the skepticism was fueled by the fact that in the very best hospitals of the day, the survival rate from trephining (and many other operations) rarely reached 10 percent, and thus the operation was viewed as one of the most perilous surgical procedures. The main reason for the low survival rate was the deadly infections then rampant in hospitals. Another was that the operation was only attempted in very severe cases of head injury.

Squier then brought his Peruvian skull to Europe's leading authority on the human skull, Paul Broca, professor of external pathology and of clinical surgery at the University of Paris and founder of the first anthropological society. Today, of course, Broca is best known for his localization of speech in the third frontal convolution, " Broca's area," the first example of cerebral localization of a psychological function, but at this time his fame seems to have been primarily for his craniometric and anthropological studies.

The trephined Inca skull given to Ephraim George Squier. It now resides in the American Museum of Natural History.

Broca and More Skulls

After examining the skull and consulting some of his surgical colleagues, Broca was certain that the hole in the skull was due to trephination and the patient had survived for a while. But when, in 1876, Broca reported these conclusions to the Anthropological Society of Paris, the audience, as in the United States, was dubious that Indians could have carried out this difficult surgery successfully.

Seven years later a discovery was made in central France that confirmed Broca's interpretation of Squier's skull, or at least demonstrated that "primitives," indeed Neolithic ones, could trephine successfully. A number of skulls in a Neolithic gravesite were found with roundish holes two or three inches wide. The skulls had scalloped edges as if they had been scraped with a sharp stone. Even more remarkable, discs of skull of the same size as the holes were found in these sites. Some of the discs had small holes bored in them, perhaps for stringing as amulets. Although a few of the discs had been chiseled out after death, in most cases it was clear from the scar formation at the wound's edge that the interval between surgery and death must have been years. Trephined skulls were found of both genders and of all ages. Virtually none of the skull holes in this sample were accidental, pathological, or traumatic. Furthermore very few of the skulls showed any sign of depressed fractures, a common indication for trephining in modern times.

Trephined skulls have been discovered in widespread locations in every part of the world, in sites dating from the late Paleolithic to this century.

These findings finally established that Neolithic man could carry out survival trephination but left unresolved the motivation for this operation. At first, Broca thought that the practice must have been some kind of religious ritual, but later he concluded that, at least in some cases, it must have had therapeutic significance. Broca actually wrote more papers on prehistoric trephination and its possible motivation than he did on the cortical localization of language. Since Broca's time thousands of trephined skulls have been found and almost as many papers written about them. They have been discovered in widespread locations in every part of the world in sites dating from the late Paleolithic to this century. The usual estimates for survival of different samples of trephined skulls range from 50 percent to 90 percent with most estimates on the higher side.

Methods of Trephining

Across time and space five main methods of trephination were used. The first was rectangular intersecting cuts as in Squier's skull. These were first made with obsidian, flint, or other hard stone knives and later with metal ones. Peruvian burial sites often contain a curved metal knife called a tumi, which would seem to be well suited for the job. (The tumi has been adopted by the Peruvian Academy of Surgery as its emblem.) In addition to Peru, skulls trephined with this procedure have been found in France, Israel, and Africa.

The second method was scraping with a flint as in skulls found in France and studied by Broca. Broca demonstrated that he could reproduce these openings by scraping with a piece of glass, although a very thick adult skull took him 50 minutes "counting the periods of rest due to fatigue of the hand." This was a particularly common method and persisted into the Renaissance in Italy.

Different methods of trephining: (1) scraping; (2) grooving; (3) boring and cutting; (4) rectangular intersecting cuts.

The third method was cutting a circular groove and then lifting off the disc of bone. This is another common and widespread method and was still in use, at least until recently, in Kenya.

The fourth method, the use of a circular trephine or crown saw, may have developed out of the third. The trephine is a hollow cylinder with a toothed lower edge. Its use was described in detail by Hippocrates. By the time of Celsus, a first-century Roman medical writer, it had a retractable central pin and a transverse handle. It looked almost identical to modern trephines including the one I used as a graduate student on monkeys.

The fifth method was to drill a circle of closely-spaced holes and then cut or chisel the bone between the holes. A bow may have been used for drilling or the drill simply rotated by hand. This method was recommended by Celsus, was adopted by the Arabs, and became a standard method in the Middle Ages. It is also reported to have been used in Peru and, until recently, in North Africa. It is essentially the same as the modern method for turning a large osteoplastic flap in which a Gigli saw (a sharp-edged wire) is used to saw between a set of small trephined or drilled holes. (I used this method as a graduate student, too.)

"Trepan" Versus "Trephine"

The relationship between the terms trepan and trephine is a curious one. The terms are now synonyms but have different origins and once had different meanings. In Hippocrates' time the terms terebra and trepanon (from the Greek trupanon, a borer) were used for the instrument that is very similar to the modern trephine. In the 16th century, Fabricius ab Aquapendente invented a triangular instrument for boring holes in the skull. (He was Harvey's teacher and the discoverer of venous valves.) It had three arms with different-shaped points. Each of the ends could be applied to the skull using the other two as handles. He called it a "tre fines" from the Latin for three ends, which became trafine and then trephine, and by 1656 it was used as a synonym for trepan, as a term for the older instrument. In another version of the etymology, a quite different triangular instrument for boring a hole in the skull was invented in 1639 by John Woodall, a London surgeon, who also called his instrument a tres fines, which became trefina and then trephine and, eventually, a synonym for trepan. More generally, in Renaissance times and later, trephination was a popular operation and a great variety of instruments for carrying it out were invented.

Why did so many cultures in different periods cut or drill holes in the skull? Since most trephined skulls come from vanished nonliterate cultures, the problem of reconstructing the motivations for trephining in these cultures is a difficult one. However, there is information about trephining in Western medicine from the fifth century BCE onward as well as about trephining in recent and contemporary non-Western medical systems. Both of these sources may throw light on the reasons for the practice in earlier times. In the following sections we consider trephination in Hippocratic medicine, in ancient Chinese medicine, in European medicine from the Renaissance onward, in contemporary non-Western medicine, and on the Internet today.

Greek Medicine

The earliest detailed account of trephining is in the Hippocratic corpus, the first large body of Western scientific or medical writing that has survived. Although there is no question that there was a famous physician called Hippocrates in the fifth century BCE, it is not clear which of the Hippocratic works were written by him. The most extensive discussion of head injuries and the use of trephining in their treatment is in the Hippocratic work On Wounds in the Head.

A 17th-century naval surgeon's trephination kit.

This treatise describes five types of head wounds. Interestingly, however, the only type for which trephination is not advocated is in cases of depressed fractures. Even when there is not much sign of bruising, drilling a hole in the head is recommended. The trephining instrument was very similar to the modern trephine, except that it was turned between the hands or by a bow and string rather than by using a crosspiece. The Hippocratic writer stressed the importance of proceeding slowly and carefully in order to avoid injuring the [dural] membrane. Additional advice was to "plunge [the trephine] into cold water to avoid heating the bone . . . often examine the circular track of the saw with the probe. . . . [and] aim at to and fro movements." Trephining over a suture was to be studiously avoided.

The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled.

Apparently the Hippocratic doctors expected bleeding from a head wound and the reason for drilling the hole in the skull was to allow the blood to escape ("let blood by perforating with a small trepan, keeping a look out [for the dura] at short intervals"). Since they presumably had no notion of intracerebral pressure, why did they want the blood to run out? Although the reasons for trephining are not discussed in "On Wounds in the Head," they seem clear from other Hippocratic treatises such as "On Wounds and On Diseases." The Hippocratic doctors believed that stagnant blood (like stagnant water) was bad. It could decay and turn into pus. Thus, the reason for trephining, or at least one reason, was to allow the blood to flow out before it spoiled. In cases of depressed fractures, there was no need to trephine since there were already passages in the fractured skull for the blood to escape.

By Galen's time (129-199) trephining was in standard use in treating skull fracture for relieving pressure, for gaining access to remove skull fragments that threatened the dura, and, as in Hippocratic medicine, for drainage. Galen discussed the techniques and instruments in detail and advocated practicing on animals, especially the Barbary "ape" (Macaca sylvana). He was well aware of avoiding damage or pressure on the dura and indeed carried out experiments on the effect of pressing on the dura in animals.

Trepanation in Ancient China

The possibility that trepanation was practiced in ancient China is suggested by the following story about Cao Cao and Hua Tua, from a historical novel attributed to Luo Guanzhong, written in the Ming dynasty (1368-1644) and set in 168-280 at the end of the Later Han dynasty. Cao Cao was commander of the Han forces and posthumously Emperor of the Wei dynasty, and Hua Tuo was (and still is) a famous physician of the time.

Cao Cao screamed and awoke, his head throbbing unbearably. Physicians were sought, but none could bring relief. The court officials were depressed. Hua Xin submitted a proposal: "Your highness knows of the marvelous physician Hua Tuo? . . . Your highness should call for him."

Hua Tuo was speedily summoned and ordered to examine the ailing king. "Your Highness's severe headaches are due to a humor that is active. The root cause is in the skull, where trapped air and fluids are building up. Medicine won't do any good. The method I would advise is this: after general anesthesia I will open your skull with a cleaver and remove the excess matter, only then can the root cause be removed." "Are you trying to kill me?" Cao Cao protested angrily . . . [and] . . . ordered Hua Tuo imprisoned and interrogated.

Ten days later Hua Tuo died. His medical text was lost upon his death.

Western Medicine

From the Renaissance until the beginning of the 19th century trephining was widely advocated and practiced for the treatment of head wounds. The most common use was in the treatment of depressed fractures and penetrating head wounds. However, because of the high incidence of mortality particularly when the dura was penetrated, there was considerable debate in the medical literature throughout this long span about if and when to trephine. Besides trephining in cases of skull fracture, the Hippocratic practice of "prophylactic trephination" in the absence of fracture after head injury continued to persist. For example, in the 1800s Cornish miners "insisted on having their skulls bored" after head injuries, even when there was no sign of fracture.

The practice of trephination was so dangerous that the first requirement for the operation was said to be "that the wound surgeon himself must have fallen on his head."

Until the early 19th century trephination was done in the home. However, when the operation was moved to hospitals, the mortality was so high that trephination for any reason including treatment of fractures and other head injury declined precipitously. The practice was so dangerous that the first requirement for the operation was said to be "that the wound surgeon himself must have fallen on his head." Or as Sir Astley Cooper put it in 1839, "If you were to trephine you ought to be trephined in turn." It was against this background that the discovery of Neolithic trephining was so unbelievable to the American and French medical communities in the middle of the 19th century. Eventually, the introduction of modern antisepsis and prophylaxis of infection at the end of the 19th century, as well as an increased understanding of the importance of intracerebral pressure in head injury, allowed trephination to return as a common procedure in the management of head trauma.

In modern neurosurgical practice, trephining is still an important procedure but it is no longer viewed as therapeutic in itself. It may be used for exploratory diagnosis, for relieving intracerebral pressure (as from an epidural or subdural hematoma), for debridement of a penetrating wound, and to gain access to the dura and thence the brain itself (for example, to provide a port through which a stereotactic probe can be introduced into the brain.)

Epilepsy and Mental Disease

In the European medical tradition, in addition to its use in treating head injury, trephining has been an important therapy for two other conditions, epilepsy and mental illness.

A 16th-century woodcut of a trephination in the home. Note the man warming a cloth dressing, the woman praying, and the cat catching a rat.

The tradition of trephining as a treatment for epilepsy begins as early as Aretaeus the Cappadocian (ca. 150), one of the most famous Greek clinicians, and lasted into the 18th century. The 13th-century surgical text "Quattuor magistri" recommended opening the skulls of epileptics so "that the humors and air may go out and evaporate." However, by the 17th century trephination for epilepsy was beginning to be viewed as an extreme measure, as in Riverius, "The Practice of Physick" (1655):

If all means fail the last remedy is to open the fore part of the Skul with a Trepan, at distance from the sutures, that the evil air may breath out. By this means many desperate Epilepsies have been cured, and it may be safely done if the Chyrurgeon be skilful.

One 13th-century text recommended opening the skulls of epileptics so "that the humors and air may go out and evaporate."

By the 18th century the incidence of trephining for epilepsy had declined and its rationale changed. Now rather than the idea of allowing an exit for evil vapors and humors, the purpose was to remove some localized pathology. By the 19th century trephining for epilepsy was confined to the treatment of traumatic epilepsy, that is, cases associated with known head injury.

Another use of trephining was as a treatment for mental disease. In his "Practica Chirurgiae," Roger of Parma (ca. 1170) wrote:

For mania or melancholy a cruciate incision is made in the top of the head and the cranium is penetrated, to permit the noxious material to exhale to the outside. The patient is held in chains and the wound is treated, as above, under treatment of wounds.

Robert Burton, in "Anatomy of Melancholy" (1652), also advocated boring a cranial hole for madness, as did the great Oxford neuroanatomist and physician Thomas Willis (1621-1675).

Hieronymus Bosch's The Cure for Madness (or Folly), also known as The Stone Operation shows a surgical incision being made in the scalp.

Probably the most famous depictions of apparent trephining for mental disease are in early Flemish Renaissance painting. Thus, Hieronymus Bosch's The Cure for Madness (or Folly), also known as The Stone Operation, shows a surgical incision being made in the scalp. The inscription has been translated in part "Master, dig out the stones of folly." There are similar depictions of the removal of stones from the head by Peter Bruegel, Jan Steen, Pieter Huys, and other artists of the time.

By the 18th century, "most reputable and enlightened surgeons gave up the practice of . . . [trephination] . . . for psychiatric aberrations or headache without evidence of trauma. Thus, . . . the skull was never to be trephined for 'internal disorders of the head."'

Trephining in Africa

Herodotus describes the Libyans as cauterizing the heads of their children to "prevent them being plagued in their afterlives by a flow of rheum from the head." And indeed, trephined skulls have been found among the people he was probably writing about, the Tuareg nomads.

An important source of information on the motivations for trephination is contemporary traditional practitioners and their patients. There are literally hundreds of 20th-century accounts of trephination, particularly in Oceanic and African cultures. Especially detailed and recent ones concern the Kisii of South Nyanza in Kenya and include photographs of the surgical instruments, practitioners, and patients; X-rays of the skulls of surviving patients; detailed interviews; and even a documentary film.

The ancient Greek historian Herodotus describes the Libyans as cauterizing the heads of their children to "prevent them being plagued in their afterlives by a flow of rheum from the head."

Trephining among the Kisii is carried out primarily for the relief of headache after some kind of head injury. According to Margetts, it is not done for "psychosis, epilepsy, dizziness or spirit possession." The operation is carried out by general practitioners of medicine and takes a few hours. Restraint rather than anesthesia is used. The hole in the skull is usually made by scraping with a sharp knife with a curved tip to avoid injuring the dura. Various medicines are administered before, during, and after surgery but their nature does not seem to have been studied. Mortality, by one authority, is described as "low, perhaps 5 per cent." The practitioners and patients seem to be quite satisfied with the results of the operation.

Although headache after head injury is the most prevalent reason given for trephining by contemporary practitioners of traditional medicine in Africa and elsewhere, other reasons are cited in the literature such as "to let out the evil spirits which were causing an intractable headache."

Trephining on the Internet

Today, the practice of trephining is not confined to surgical suites or traditional medicine men. It is advocated by the International Trepanation Advocacy Group as a means of enlightenment and enhanced consciousness. Their general idea is that when the skull sutures close in childhood it "inhibits brain pulsations causing a loss of dreams, imagination and intense perceptions." Trephining a small hole, they say, "restores the intracranial pulse pressure which leads to a permanent increase of the brain-blood volume which leads to accelerated brain metabolism and more areas of the brain functioning simultaneously" and "increased originality, creativity and...testosterone level." Beyond such "physiological" arguments, the group supports the practice by pointing out its ancient, widespread, and continuing presence in other cultures. This particular form of alternative medicine recently gained considerable if not entirely positive publicity: In November 1998 it was featured on ER, the television soap opera set in an emergency ward.

Much of the defense for alternative medicine treatments is that they must work because they have been around for such a long time, an apparently attractive argument for the increasing popularity of five-thousand-plus-year-old Chinese traditional medical practices. However, the case of trephining suggests that just because a procedure is very old does not mean it is necessarily an effective one, at least for enhanced enlightenment and creativity.

Trepanation as an Empirical If Not a Rational Procedure

The most common view of the prehistoric and the non-Western practice of trephining, especially in the absence of a depressed fracture, was that it represented some kind of "superstition," "primitive thinking," "magic," or "exorcism." Yet an examination of the reasons for the practice among the Hippocratic and early European doctors as well as among contemporary Kenyan practitioners suggests a different view. Trephining may have appeared, in these contexts and cultures, to have been an effective empirical approach to head injury and the headaches that often accompany them. Headaches after head injury often do feel like "a pounding" and "pressure" inside the head and thus the idea that a hole in the skull would relieve them is not necessarily magical or bizarre. Furthermore, epidural bleeding does sometimes accompany head injury, and in these cases trephining might have actually reduced intracranial pressure. Finally, the apparently excellent survival rate meant that the procedure, at least until it moved into a hospital setting, may have met the prime requirement of medicine, "do no harm."

POSTSCRIPT

The first International Colloquium on Cranial Trepanation in Human History was held at the University of Birmingham in April 2000. Papers from this unique three-day meeting were published as Trepanation: History, Discovery, Theory, which provides the most complete review of the subject to date. A major achievement of the meeting was the demonstration that trepanation was widespread in many regions of Europe, Asia, Africa, Oceania, and the Americas in both preliterate and literate periods. The volume also contains illustrations of trephined skulls from many cultures and of the great variety of instruments used.

Another interesting development was the return of E. L. Margetts to the Kisii of Kenya, whose trepanning practices he had studied 25 years earlier. He estimates that there may now be more than 100 surgeons carrying out the operation. Unlike in the past, they now use modern Western local anesthetics injected into the scalp prior to surgery. However, the reasons for the very low rate of infections still have not been studied systematically.

Since my original article, there seems to have been an increase in Internet sites advocating trepanning and often self-trepanning for the treatment of, among other disorders, depression, chronic fatigue syndrome, and stress and to improve mental "energy and vigor."

The British Medical Journal took these developments seriously enough to issue a warning of their dangers:

Doctors have warned about the dangers of trepanning after the launch of several websites promoting the "do it yourself " surgery and the case of a Gloucestershire woman who drilled a 2 cm diameter hole in her skull. Concern has been expressed about the growing interest in trepanning for several conditions, including depression and chronic fatigue syndrome. Concern is also growing about the increasing promotion of trepanning, including videos, T-shirts, and a virtual trepanning shopping mall on the internet.

Trepanning received widespread publicity when the surgeon Stephen Maturin carried out the procedure on a sailor in view of the assembled crew in the film Master and Commander: The Far Side of the World, based on the Patrick O'Brian naval novels about the Napoleonic Wars.
Charles G. Gross was a pioneering neuroscientist who specialized in vision and the functions of the cerebral cortex. This essay is excerpted from his book "A Hole in the Head: More Tales in the History of Neuroscience."

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A Hole in the Head: A Complete History of Trepanation

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A survey of trepanation, or trephination, the oldest surgical procedure known to humanity.

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I decided to critically think over the Amelia Earhart disappearance.

Define the problem: Where did Amelia Earhart go?

Gather information: It was 1937 when she set out to fly around the world with her navigator. On June 1st they began their 29,000 mile flight. By June 29th they had traveled 22,000 miles. July 2nd they were headed for Howland Island. the flight was hard to achieve and to locate. two U.S ships were stationed to mark the route but the plane was running out of fuel. The last she announced she said "we are running north and south." They had a search party but later called it off and declared them lost at sea.

Evaluate Evidence: From the looks of it Amelia and her navigator did disappear, whether they called the search party off too early or they really were unable to be found she was missing and to this day was never found. Now the mystery is where did she go. From the evidence above the plane was running out of fuel, it sounded like the plane was going down.

Recognize, assumptions, emotions, and biases: I think the biggest decision and impact that was made was calling off the search party. If there was any chance they were alive they definitely aren't anymore. Calling it off was a life or death decision and impacted the outcome today. It was a personal belief that the search party believed they had been lost at sea.

Synthesize evidence, identify alternatives:
Alternative 1: One alternative would be that she flew over the Bermuda Triangle and her compass stopped working, then eventually ran out of fuel.
Alternative 2: A second alternative was that she was a spy collecting information from the U.S. government and wasn't just a pilot.

Select the best alternative: I believe of all alternatives the best is that they were lost at sea especially from my concluding evidence.

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Definition: Conspiracy. Often believing that higher power is hiding something so one believes there is a higher truth.

Connection: A big conspiracy was that when people were getting the covid vaccine, they were actually being microchipped. Although this is not true people believed the government was lying about multiple things to do with covid, starting with biological warfare. So when the vaccine became mandatory people were suspicious including the president of the U.S. which led to some appeal to authority. Others blew this conspiracy out of proportion but all in all it's the red flag of suppression by authority.

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On Oct. 2, 2020, President Donald Trump and the first lady tested positive for the coronavirus. As we were all waking up to the news, I got into my car and tuned in to "The Breakfast Club" on Power 105.1 FM in New York, where Charlamagne Tha God, its most outspoken host, wasn't having it. "I got a few thoughts, and one of those thoughts is the reason I'm saying 'allegedly,' " he said.

At the time, the country was accelerating into the third wave of the pandemic, and the president had been appearing at large maskless rallies. But the news didn't sit right with Charlamagne. "The conspiracy theorist in me simply doesn't believe it," he said.

As I listened, he seemed to build a conspiracy theory on the fly. According to Charlamagne, the president was pretending to get the coronavirus so he could be the first to take the vaccine and become a hero to the world just in time for the election. Which is the provocative, Sasquatch-exists brand of conspiracy theory you might expect to hear on the show. But then Charlamagne took the conversation in a direction I didn't see coming: "Millions will line up to take the vaccine, and boom, microchips for all of y'all,right in time for goddamn Thanksgiving."

Microchips? In the vaccine? I looked around to see if I could make eye contact with any neighbors. Did anyone else hear that? I thought. But no one else was shaking their head at their radios. Hopefully, the millions who tune in to this nationally syndicated show knew he was just joking. Right? But after the fourth time Charlamagne repeated his wild claim that the government is putting microchips in the COVID-19 vaccine, I couldn't help but wonder: Is this going to be a problem?

To be clear: There are no microchips in any vaccine. There's no evidence that even one of the nearly 170 million Americans who have received a shot so far have been implanted with a tiny piece of tracking hardware.

But this conspiracy, along with other false claims about the vaccine, has gained traction. These dangerous myths have built on a distrust of vaccines sown for years by well-organized groups that launched targeted, effective disinformation campaigns. Through glossy magazines distributed to Orthodox Jews in New York, intimate seminars led by Robert F. Kennedy Jr. on the California coast and deceptive websites like the National Vaccine Information Center, these messages found receptive audiences among Americans who have grown more distrustful of its elites and institutions.

Even before COVID-19, anti-vaccine disinformation has had real consequences for our health. Measles, which was controlled in the 20th century, is back in the 21st. One of the key reasons, according to Dr. Seth Berkley, CEO of the nonprofit Gavi, the Vaccine Alliance: "the spread of falsehoods about the vaccine." The World Health Organization now ranks vaccine hesitancy as one of the top 10 threats to global health.

In the U.S., polling from March found that 42% of respondents believed at least one COVID-19 conspiracy theory. That survey, commissioned by the nonprofit Surgo Ventures, found that 16% of eligible Americans are a hardened group of COVID-19 skeptics steeped in conspiracy theories, while another 7% are system distrusters. The skeptics are disproportionately White and conservative, while the system distrusters are heavily Black and Latinx. This mixture of ideological strains means vaccine hesitancy has taken hold in rural communities and religious enclaves, in dense coastal cities and in wine country. As the nation moves into a phase when most vaccine enthusiasts have gotten their shots, this broad coalition of the skeptical poses a massive challenge for public health officials. The next phase of vaccination will likely depend on reaching members of this population and understanding their specific concerns.

Dr. Jordan Dow works at Kings County, a large public hospital in Brooklyn, about a mile from where I heard the microchip rumor. He said he was hearing a variant on the microchip conspiracy in his ER. Dow said that of the hundreds of patients he was giving COVID-19 nasal tests to every day, 1 in 5 would ask about a tracking microchip on the end of the swab. "I would just look at them like, 'This is not the time to play,' " he told me.

Most would laugh and go on with the test; others would refuse. The Surgo survey found that 1 in 14 people believe a tracking chip might be planted with the vaccine. A poll from Axios/Ipsos, also from March, asked 1,000 American adults if the COVID-19 vaccines contained a tracking microchip. More than 1 in 4 said they didn't know. That's the equivalent of nearly 69 million people.

Joan Donovan, research director of the Shorenstein Center on Media, Politics and Public Policy at Harvard, is the kind of disinformation researcher who listens to White supremacist podcasts at 2 a.m. That's actually how she first learned about a mysterious illness in China before she had seen news of the outbreak published anywhere else.

"I don't think anybody's written a definitive case on the microchips," she said, "but I have one kind of half-done that might be useful for you."

Donovan's analysis led me to some web chatter at the dawn of the U.S. pandemic, on March 18, 2020 - after the NBA had suspended its season but when reported American deaths were still around 150. That's when Bill Gates, whose foundation has pledged $1.75 billion toward international pandemic aid, logged onto a Reddit AMA to answer questions about the pandemic. In the chat, he predicted that one day, we would all carry a digital passport for our health records. He suggested not a microchip, but some kind of e-vaccine card that people could flash before going into a business.

The next day, a Swedish website that reads like a tabloid full of memes about biohacking wrote about Gates' comment. The site's administrator, who goes by the name CyphR, belongs to a community of biohackers who advocate for human implantable microchips. They also have them - and hope that one day we all will be using them to monitor our biometrics and verify our identity. But they believed that future was a decade away.

That is until they saw Gates' comment about digital certificates on Reddit. "We're like, WTF! This is it! Suddenly, chip implants don't only have an actual, scalable mainstream application, but one that is an urgent medical need," CyphR said in an email. The bloggers connected Gates' remark with various research projects supported by the Bill & Melinda Gates Foundation, including one December 2019 study exploring invisible "quantum dot" tattoos that could reveal your vaccine history when held close to a special smartphone light.

Then, CyphR acknowledged, they made a fateful "jump" - by suggesting the best way to implement Gates' idea was through an implantable microchip. "(W)e did what do best and tried to meme this biohack into the mainstream," CyphR wrote. "(A)s advocates of biohacking, that's what we do. We advocate for the adoption of biohacking wherever possible, even if it means memeing the desired outcome."

Their headline read: "Bill Gates will use microchip implants to fight coronavirus."

Two days later, Adam Fannin, a polemical Baptist pastor from Jacksonville, Florida, stumbled upon the blog post online. It resonated with his deep distrust of Gates and he ran with it. Fannin, who started his own church with its own YouTube channel in 2017, transformed the biohackers' fantasy into a biblical prophecy, one that was warned about in the Book of Revelation: "It's not just an implantable ID system," Fannin says on a YouTube video. "It's literally worshipping this beast."

The pastor's 9-minute sermon tapped into a long-standing, wide-ranging conspiracy theory that Gates, through his business and philanthropy, is trying to "depopulate" the planet. The pastor titled the post, "Bill Gates - Microchip Vaccine Implants to fight Coronavirus," adding one pivotal word to the biohackers' title: vaccine.

The video quickly got 1.6 million views - an order of magnitude more than the pastor's account had ever received.

Then the conspiracy theory spread. Posts like this were suddenly getting shared by shock-jock comedians and doomsday preppers on YouTube; by the far-right news site Newsmax; by pop culture icons such as M.I.A. and Kanye West; and by defiant, conspiracy-minded members of Gen Z on TikTok. In one minute-long video, a young woman points at spurious microchip-related screengrabs and over an "X-Files" - style score says, "It's already being activated across the globe, including New York."

Each time I saw a new host repeat the lie, it seemed to mutate, tapping into a new strain of American mistrust: mistrust of the medical system, mistrust of the government, mistrust of powerful elites. And then there's Roger Stone.

On April 13, 2020, in Stone, the lie found the superspreader it had been waiting for. That's when the former political adviser to Trump, who was convicted of repeatedly lying to Congress, made a guest appearance on "The Joe Piscopo Show" on AM 970 in New York.

The early "SNL" star didn't even need to prompt Stone before he launched in. "Whether Bill Gates played some role in the creation and spread of this virus is open for vigorous debate," Stone said. "He and other globalists are definitely using it in a drive for mandatory vaccinations and microchipping people."

Later that afternoon, the New York Post gave the story legitimacy, running the headline, "Roger Stone: Bill Gates may have created coronavirus to microchip people."

Soon, the Post story and the pastor's video each had over a million interactions on Facebook. Since then, the lie has continued spreading and mutating across the world. By January, according to the Surgo survey, 1 in 10 U.S. adults - and 1 in 7 Republicans - said they believed a tracking chip would be implanted with the vaccine.

Charlamagne and the Post did not respond to queries about their role in spreading the conspiracy, and spokesperson for Redditclaimed the conspiracy had existed in the bowels of the web - on 4plebs - before it surfaced on Reddit.

But Fannin and Stone defended their remarks. "The idea of a microchip in order to track who has been vaccinated is no crazier than the idea of a vaccine passport," Stone said. "The first amendment of the U.S. Constitution gives every American the right to question the safety of any vaccination." Fannin, the YouTube preacher, confirmed his view that "Bill Gates is an evil person" - and that he has continued to avoid the vaccine himself.

It's easy to write off these beliefs as far-fetched. But since I started looking closely at this conspiracy theory, I started seeing microchips everywhere. One night, I turned on "60 Minutes" and saw a segment about how the U.S. military is developing a subdermal implantable sensor to detect viruses. But it's not a tracking microchip, right? Then a couple of weeks later, the show was reporting on an international microchip shortage. Where'd they all go? Then IBM announced that the company had designed the smallest, most powerful microchip ever. It felt like I was consuming the raw material that would shape the next microchip conspiracy theory.

Social media is the place where so much information gets repackaged and shared as misinformation. So I went to the major platforms to ask what they are doing to contain this high-stakes infodemic. Facebook, which also owns Instagram, said that by May, the platform had removed 16 million pieces of content for violating its COVID-19 and vaccine misinformation policy and slapped warning labels on 167 million pieces of content rated false by its fact-checking partners.

YouTube offered a statement saying the platform had removed 900,000 misleading videos about the coronavirus, including 30,000 just about the vaccines. The video platform even has an explicit policy banning videos that claim there are microchips in the vaccine.

TikTok pointed to a policy that prohibits medical misinformation, including vaccine misinformation. But according to research by the nonprofit Center for Countering Digital Hate, based in London and Washington, platforms fail to act on 95% of COVID-19 and vaccine misinformation reported to them. That means that when people go looking for accurate information about the vaccine, there's a decent chance they will run into a falsehood first.

In April, the video by the Baptist pastor that helped spark this conspiracy was still up, with nearly 2 million views. I asked YouTube why, but officials declined to answer. Instead, two days later - more than a year after the pastor shared it, spawning a wave of social media disinformation - YouTube decided to take the video down for violating its medical misinformation guidelines.

In total, the platform removed six out of seven YouTube videos I asked about. The comedian Andrew Schulz - who said, "So if you think that there's not going to be more shit in that chip that they're going to put in our arm besides proof that we've been vaccinated, you're outta your goddamn mind" - got to stay.

TikTok likewise removed five of the six videos I asked about and quarantined the other one to limit its spread.

Given the scale of this problem and the severity of the public health risks it poses, I figured there'd be a war room of epidemiologists and disinformation specialists somewhere in the federal government poring over posts, monitoring conspiracies and coordinating with social media platforms and media outlets to halt their spread. Instead, Facebook, for instance, said the platform uses machine learning and human fact checkers to moderate posts to flag misinformation after it lives on the site.

In January, a year after the first U.S. case was reported, the White House released a national COVID-19 response plan that included building the "capacity to quickly identify disinformation."But when I repeatedly asked the Centers for Disease Control and Prevention what resources it has deployed to tracking and responding to that misinformation, I couldn't get an answer. I spoke with a member of the White House's COVID-19 Health Equity Task Force, Bobby Watts, who is also CEO of the National Health Care for the Homeless Council. He told me about the federal government's strategy to tackle vaccine hesitancy "with a mass education campaign to let people know about the importance of vaccinations," including messages tailored to various Asian American and Pacific Islander cultures, Spanish speakers, people experiencing homelessness and rural Republicans. But he didn't know whether the federal government has a way of monitoring and interrupting misinformation influencing those communities.

After weeks of asking the CDC and the White House to provide details on how they are monitoring COVID-19 misinformation, I finally turned to Joe Smyser, a public health expert whose nonprofit helped create the nation's largest vaccine misinformation tracking system. Project VCTR (pronounced "vector") is now used by 450 organizations, including the health department for New York City, the city whose radio and print outlets were so decisive in the early spread of the microchip conspiracy theory. Smyser said he has been talking with a team of data scientists at the CDC who just last year started to build their own misinformation monitoring system. But he said they had to proceed with caution - and were constrained from communicating with state health departments - because misinformation was so politicized in the last administration. The CDC did not respond to queries.

Tracking medical misinformation is a relatively new and underfunded field of public health. Of the flood of money dedicated to coronavirus vaccine research, production and distribution since the pandemic began, Smyser said, "less than one-half of 1% of global funding has gone to any research or any programs addressing misinformation." The nonprofit CDC Foundation, he pointed out, recently put out a request for proposals for combating misinformation through social media; three to four projects will receive around $2 million each.

Meanwhile, the disinvestment has left county and state health departments mostly on their own, fighting the tide of COVID-19 misinformation while trying to get enough vaccines in enough arms to finally bring an end to the pandemic. With the nation's current anemic response to misinformation, a new projection from the Surgo survey estimates that only 58% of the U.S. population, including 74% of adults, will be vaccinated by next April.

In New York, where the microchip theory first went mainstream, the city has a team that tracks vaccine rumors in order to inform its educational messaging. I recently found my way to the State Department of Health webpage dedicated to combating vaccine misinformation. It was last updated in January 2012.
This story was edited by Esther Kaplan at Reveal and Kevin Nguyen at The Verge. It was copy edited by Nikki Frick at Reveal.
Ike Sriskandarajah can be reached at ike@revealnews.org. Follow him on Twitter: .
Taking on powerful interests demands lots of time, a strong backbone and your support.

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Where did the microchip vaccine conspiracy theory come from anyway?

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On Oct. 2, 2020, President Donald Trump and the first lady tested positive for the coronavirus. As we were all waking up to the news, I got into my car and tuned in to "The Breakfast Club" on Power 105.1 FM in New York, where Charlamagne Tha God, its most outspoken host, wasn't having it.

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Definition: Humans tend to infuse meaning too patterns, intentions, and agency. Giving invisible forces meaning.

Connection: This article specifically talks about UFOs. In this article it mentions how some believe there is going to be a connection between aliens and humans, though no one knows the time, date, or place just that it's going to happen. This is a force that people gave meaning too. Something they looked into a little too much resulting in agenticity.

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They Are Among Us. Photographing the UFO Believers

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Photographer Manfredi Pantanella's cinematic images reveal the stories behind UFO believers.

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Definition: Mystical energy believes in stronger forces and energies like "chi" or "positive energy."

Connection: This article talks about different ways changing your energy can save your life. In different forms how being positive, energy healing and higher power can change your life. All relating back to the red flag mystical energy the power of energy.

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If you were ever inspired by The Secret or stumbled upon an Abraham Hicks video, you know that your thoughts create your reality. What you think, leads to your feelings, habits, and reality. You may also realize that reframing your thoughts, and simply thinking positive is incredibly challenging. It is also an ineffective way of manifesting when done by itself. True reconditioning comes from shifting your energy.

What Is Energy Healing?

The human body is a complete energy system, and any imbalance in the body would create an obstruction in the flow of energy, which can result in illness or negative thoughts and feelings. Energy healing is a method to ensure that the energy flow within your body moves unobstructed. Energy healing modalities also take you to the root of your thought pattern, help you safely and gently release it, and imprint positivity. This process creates healing on the physical and spiritual layers as well as the mental and emotional ones.

Here are five reasons why the key to changing your thoughts is shifting your energy field.

1. The Building Block for Your Thoughts Is Energy

Every notion and belief that you've ever held onto is stored as energy in your chakras. Everything that you have experienced, whether you processed it or not, is recorded in the auric field.

By balancing the chakras, releasing stagnant energy, and integrating life-force back into the subtle body, you give yourself new information to base new perspectives with. While repeating affirmations is a part of that new conditioning, energy healing modalities such as Reiki, Integrated Energy Therapy, or Psych-K can support manifestation by connecting to your chakras, subconscious, and cellular memory.

2. Thinking Positively About Someone Won't Heal the Karmic Tie

People can unconsciously create energetic cords of attachment that drain your energy. As long as the cord is attached to you, you aren't fully in your power.

If you can't stop thinking about someone, feeling depleted, or simply feeling easily triggered in the presence of someone, consider practicing a cord-cutting meditation for at least 21 days. Cord-cutting is a practice in which you call back all of your power through time and space, and release any energy that isn't yours.

Once you try it, notice if your energy field strengthens. Observe how the people who once triggered you cannot penetrate your peace. While reframing your perspective about this person can help you develop emotional intelligence, energy healing compliments this transformation by tending to the physical, emotional, and spiritual bodies.

3. Energy Healing Takes the Pressure Off of You and Calls in a Higher Power

Energy healing is based on the idea that there is Divinity within you that brings everyone together. Divinity supports you in your path and guides you to exactly what you need.

In crystal healing, you call in the energy of Mother Earth. In Reiki, you call upon your guides, teachers, and ancestors. Let go of the need to rely on your own strength. Take the pressure off of yourself to manifest your dreams and desires and tap into a higher power.

4. Energy Healing Takes You to the Root of the Issue

Perhaps you're trying to feel more supported by your loved ones, but you're ruminating beliefs such as "I'm not lovable" or "I'm not worthy of their time and money." Some reflection can surface whether the idea stemmed from an experience such as the time your loved ones accidentally lost you at the mall or the time they chose their job over your soccer game.

Energy healing transports you to the time when you first picked up on a limiting idea and uncovers societal and cultural programming, ancestral trauma, or past life trauma. From there, you acknowledge how that mindset no longer fits your needs. Awareness of the experiences and memories that snowballed your limiting ideas is essential to transforming your thoughts. If you're working through challenging thoughts, energy healing techniques such as hypnosis or Reiki can reveal the true source of suffering. While affirmations and journaling exercises help you to witness your shadow and reprogram the conscious mind, they can be coupled with energy healing modalities to connect you with deeper layers of your consciousness.

5. Elevated Frequencies Keep You Aligned

When you are operating on a lower frequency due to old perspectives or disturbing experiences, it's difficult for you to think positively, release the past, and feel empowered. You then manifest more people and situations from that lower frequency.

Through energy healing modalities, you can break the energetic patterns that have been holding you back. Energy healers repair tears, seal leaks in the aura, and fill the aura with life-force. As your frequency is raised, reaching for more positive thoughts and belief systems becomes easier. You can become centered in your own energy field, rather than other people, places, and events. With that, you feel more creative, inspired, and aware.

If you've been battling self-sabotaging thoughts, you may have started an affirmation journal, talk therapy, or simply committed to thinking positive thoughts. While these are incredibly commendable efforts that do work, consider supplementing your practice with an energy healing modality such as Reiki, Chakra Balancing, hypnosis, or Psych-K. Take the pressure off of yourself to cure your thought patterns and welcome in support.
Energize your spirit with the ultimate well-being experience at the Chopra Whole Health Retreat.

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How Shifting Your Energy Can Transform Your Life

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If you were ever inspired by The Secret or stumbled upon an Abraham Hicks video, you know that your thoughts create your reality. What you think, leads to your feelings, habits, and reality. You may also realize that reframing your thoughts, and simply thinking positive is incredibly challenging.

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Definition: Appeal to authority is when we intrust people such as doctors, and celebrities to tell us or sell us something ignoring the true facts.

Connection: Kim Kardashian was caught endorsing a dangerous morning sickness pill. A lot of women deal with morning sickness while pregnant, a lot would also do anything to take it away. A celebrity like Kim Kardashian promoting this product encouraged some people to actually take it. Others asked their doctors which is still appealing to authority rather they were told it was unsafe. Many believed their doctors others tried the product because of Kim, both connecting to this red flag.

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Last week, all was abuzz with the personal endorsement by television personality Kim Kardashian West of a drug used to relieve the nausea and vomiting of pregnancy (NVP), incompletely known as morning sickness. Kardashian took to Instagram to tell her followers that after exhausting all other approaches, her doctor was able to manage her suffering with Diclegis, an delayed-release preparation comprised of doxylamine and pyridoxine (vitamin B6).

Unlike some of the diet pills the reality show star had hawked in the past, Diclegis is specifically approved for this indication. Moreover, it's one of the few drugs that has been tested for safety in pregnant women. As a result of its modest side effect profile and limited duration of use, Diclegis has earned the rare classification of pregnancy category A.

Incidentally, such pregnancy classifications were eliminated by FDA last month and companies are now required to give prescribers more precise safety details on a drug's fetal and maternal risk profile because the old classification was "often misinterpreted and misused in that prescribing decisions were being made based on the pregnancy category, rather than an understanding of the underlying information that informed the assignment of the pregnancy category." Approved in April, 2013, Diclegis is the most extensively studied drug in pregnancy to date, according to an FDA staff-authored 2014 publication in the New England Journal of Medicine.
The Kardashian phenomenon
However, former journalist and public relations expert Brian Reid tweeted that the manufacturer of Diclegis, Duchesnay USA, had been cited in 2013 by the FDA's Office of Prescription Drug Promotion for advertising literature that lacked drug safety information required in any medium that speaks of the drug's efficacy. (For Canadian readers, the same formulation is sold in the Great White North as Diclectin.)

But the Instagram post from Kardashian West had none of those problems. She accurately represented the drug's approved indication, specifically noting that she was given the Diclegis after exhausting lifestyle and dietary recommendations. She explicitly stated that she was partnering with the manufacturer, "to raise awareness about treating morning sickness," a relationship confirmed to me by General Manager for Duchesnay USA Dean Hopkins.

Of course, she is elegantly holding a bottle of Diclegis in the Instagram photo and post (above), a bit more than raising awareness of the disorder but completely consistent with what's allowed in the U.S. for direct-to-consumer prescription drug advertising. And Kardashian West specifically pointed to the FDA-approved drug information and safety sites, Diclegis.com and DiclegisImportantSafetyInfo.com.

Update, August 11 - In a warning letter to Duchesnay EVP Eric Gervais dated August 7, FDA OPDP Division Director Robert Dean wrote that these hyperlinks were inadequate substitutes for text on the drug's risks that should've accompanied Kardashian West's endorsement. I wrote in greater detail on this development at "FDA Admonishes Drug Maker Over Kim Kardashian Instagram Endorsement."

Hopkins pointed out that Kardashian had been prescribed the drug by her OB/GYN prior to engaging with the company. But when asked about the terms of the partnership, Hopkins replied, "She has been compensated for sharing her experience with our product. The details of our relationship are private."

Whatever the terms, the investment was likely a wise one for Duchesnay. She has 40.8 million Instagram followers and the post received 464,000 likes and 10,980 comments. She counts 34 million followers on Twitter. While the endorsement pegged Diclegis searches on Google Trends on July 20, Kardashian's consistently high search share didn't even register as much as a baby bump. The privately-held company wisely issued a press release.

While one can question the overall value the Kardashian family brings to society, the family's ability to stand out in today's oversaturated media world is remarkable. I strongly recommend Alex Abad-Santos's Kardashian family explainer that appeared earlier this week at Vox.

Rebranded to include the surname of her musician husband, Kayne West, Kardashian West has never been more profitable. She stands at #33 on the 2015 Forbes Celebrity List with earnings of $52.5 million, nearly double that of 2014's $28 million when she ranked at #80.

Duchesnay's Hopkins says that while final web traffic numbers aren't yet available, they've seen a "significant increase." He adds that, "But most importantly, this interest is helping to spark important dialogue between pregnant women and their healthcare professionals about nausea and vomiting of pregnancy (morning sickness) treatment and Diclegis as the only product the FDA has found to be safe and effective for this condition."

Celebrity endorsements via social media are nothing new and other direct-to-consumer advertising for prescription drugs has appeared on television and in magazines - think of Bob Dole for an erectile dysfunction drug.

I've had a strong interest in the public health impact of "medical celebrities" and am in the middle of a 2015 book called, Is Gwyneth Paltrow Wrong About Everything?: When Celebrity Culture and Science Clash. The author is Timothy Caulfield, LL.M., Canada Chair for Health Law & Policy at the University of Alberta, and he focused on the actress's various health promotions as an jumping-off point for celebrity health and wellness proclamations. Caulfield ( Twitter) subjected himself to a variety of Paltrow-recommended cosmetic and diet approaches, counting his blessings that his book came out before she espoused steaming one's vagina.

Caulfied responded by email with his impressions of the Kardashian West endorsement of Diclegis:

"Now, I don't know much about the drug (just what has been said in press), but I do find the use of social media fascinating. As you know, there are a few studies that suggest it may enhance to sway of celebrity, particularly for those who feel like they are in a para-social relationship, via Twitter and Instagram, with Kim K. The endorsement has this I'm-your-buddy vibe to it. She's just chatting with friends about her new drug! It seems like it is really part of her life...

I do think we will see more and more of these kind of advertisements. They are kind of new product placement ads, where the product is placed in the celebs "real" life. It raises interesting regulatory questions too. In many countries, DTC advertising of drugs is not allowed."

Indeed, while Kardashian West spoke on behalf of the US arm of Duchesnay, the Instagram post went worldwide.
An old drug and vitamin reformulated for today's pregnant woman
The combination drug is composed of two very old compounds. Doxylamine was first disclosed in 1949 by Merrill Dow as a first-generation antihistamine. Characteristic of such compounds at the time, with the older drug diphenhydramine (Benadryl) being most common today, these general antihistamines also had anticholinergic effects that contributed to their nighttime allergy and cold relief that could also be considered side effects, such as dry mouth and drowsiness. So as one person's side effects are another's therapeutic effects, doxylamine succinate continues to be sold today as Unisom brand nighttime sleep aid and one component of Nyquil Nighttime, just as diphenhydramine hydrochloride is the active component of Sominex and can be found in many "P.M." analgesic products.

Nausea and vomiting is a natural process believed to have evolved to protect us from ingestion of naturally-occurring poisons from plants and fungi as well as spoiled food that might harbor harmful bacteria. But the vomiting reflex has a very complex neurobiology that includes inputs to the brain from the gastrointestinal tract, blood vessels, and the vestibular system of the ear (the prefix of nausea derives from the same Greek word for "ship" and is represented in nautical). Drugs with anticholinergic effects will slow the progress of contents through the gastrointestinal system but can also affect the vomiting reflex in the brain. Interestingly, older antipsychotic drugs such as chlorpromazine are also still used today to prevent vomiting during surgical procedures because of their anticholinergic effects.

The greatest concern with doxylamine in any form is that it can cause severe sedation with any other antihistamine or central nervous system depressant, including alcohol, and can cause disturbances in balance and memory. Those who still take monoamine oxidase inhibitors for depression should not take any product with doxylamine. Higher doses can cause hallucinations and both doxylamine and diphenhydramine have been used in this regard for recreational purposes.

Pregnant and lactating women have an increased requirement for vitamin B6 and that led to its investigation in treating morning sickness even before doxylamine was around. It's benefit alone is not significant, reported as early as 1946 and confirmed in a study just published in the July 2015 issue of the Journal of Clinical Pharmacology. But it was included in the earliest three-drug preparation of what was sold as Bendectin, and remained in 1956 after an ineffective component (dicyclomine) was removed. In the 1960s, after the birth defect tragedies occurred with thalidomide and diethylstilbesterol, public sentiment on drugs during pregnancy grew negative and by 1983 Bendectin was voluntarily withdrawn from the market, but not because of safety or efficacy problems.
No increased incidence of birth defects
The FDA estimates that up to 25% of pregnant women took Bendectin between 1956 and 1983 (aforementioned NEJM paper). Subsequent studies have shown repeatedly that doxylamine poses no risk to the fetus. Even the most conservative re-analysis of doxylamine safety data examining 24 studies where 24,485 pregnant women were exposed to any antihistamine and 14,624 to doxylamine showed no increase in congenital abnormalities of offspring. Some of the concern about the drug in the past was clouded by the 1 to 3 percent sporadic incidence of congenital birth defects.

Researchers from the Motherisk program at the Hospital for Sick Kids in Toronto led the clinical trials of a delayed-release combination product developed by Duchesnay. One criticism is that virtually all of the recent clinical work on doxylamine comes from this unit; on the other hand, the program, established in 1985, is one of the world's most active evidence-based research and counseling programs, with informational hotlines that have served over a million mothers and health care professional since its inception.

The pivotal 2010 Phase III randomized, double-blind trial of doxylamine/pyridoxine was led by Dr. Gideon Koren at Motherisk and funded by Duchesnay in Canada, but was independently conducted by a Philadelphia contract research firm with pregnant women suffering from NVP enrolled at the University of Texas at Galveston, the University of Pittsburgh, and Georgetown University.

A total of 256 volunteers were randomized to receive placebo (125) or doxylamine succinate and pyridoxine HCl (131) for 14 days as two delayed-release Diclectin tablets (the Canadian brand name) containing 10 milligrams of each drug. Up to two additional tablets were taken based on the severity of symptoms. The subjects were evaluated for quality of life and a previously-validated pregnancy-unique quantification of emesis instrument, abbreviated PUQE (I am not making this up). The PUQE score is based on three patient-reported measures of being "sick to your stomach," number of vomiting episodes, and number of retching or dry heave episodes over the previous 24 hours.

The placebo effect was high but the doxylamine/pyridoxine tablets statistically outperformed the placebo (p = 0.006), with PUQE scores (scale of 3 to 15) reduced by 4.8 ± 2.8 relative to 3.9 ± 2.6 in the placebo group. The area-under-the-curve changes that compiled PUQE scores each day also statistically favored the active drug. Global well-being was statistically improved relative to placebo.

At the end of the study, the researchers offered the subjects the opportunity to continue their randomized treatment under a compassionate use condition of the trial. Of the subjects receiving the active Diclectin, 48.9 percent elected to continue the drug. While again statistically superior to placebo, 32.8% of placebo subjects chose to continue their "medication."

The high placebo response rate could certainly be attributed to spontaneous resolution of pregnancy related nausea and vomiting. So it's somewhat of a misnomer to call this a placebo effect but rather a natural-course-of-the-disorder effect. In fact, the company supported trial investigators' publication of a 2013 analysis in the Journal of Obstetrics and Gynecology of those choosing to continue their study tablets. Both groups were represented by those subjects that experienced the greatest mean improvements in PUQE score and were more compliant with taking their tablets than those not choosing compassionate use.

The indication for the combination drug deserves reiteration: it's intended for those women whose nausea and vomiting are not controlled by adjusting one's diet and not for those small percentage of pregnant women with a severe form of NVP called hyperemesis gravidum. Diet and nutrition approaches include staying well-hydrated and avoiding heavy, spicy or highly pungent foods. The BRAT diet - bananas, rice, applesauce, and toast - is sometimes recommended until symptoms resolve. Ginger supplements or beverages made with real ginger root are also recommended by the American College of Obstetrics and Gynecology.

But in the event none of these approaches work and your doctor makes a recommendation for Diclegis, your decision to use it may depend most on cost issues and insurance coverage. We'll take up that issue in my next post.

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The Kim Kardashian-Endorsed Morning Sickness Drug Is The Real Deal

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The well-known reality show star made headlines last week by telling her 40.8 million Instagram followers about her success with a medicine for pregnancy-associated nausea and vomiting. Does it work, is it safe, or is it just another celebrity medical misadventure?