Sawbones: A Marital Tour of Misguided Medicine - The Brompton Cocktail

Episode Date: July 26, 2022

In the late 1800s, Dr. Herbert Snow observed cancer patients and considered that a mix of different medications might do the trick for slowing down its progress. The Brompton Cocktail, as it was called, was mostly cocaine and morphine. Though used for a long time for pain relief, the cocktail proved to have its problems – but maybe not for the reason you would think.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, talk is about books. One, two, one, of misguided medicine. for the mouth. Wow. Hello everybody and welcome to Sobhones, a marital tour of misguided medicine.

I'm a co-host Justin McAroy. And I'm Sydney McAroy. Oh no. Can you say, I'm not used to podcasting. Grip it and rip it. Thank you Sydney, thank you so much. I will rip it and indeed rip it. Anybody who gripped it, you already,

it's like past tense. You have, you have. I have grip it and indeed rip it. Anybody gripped it? You already, it's like past tense. You have, you have. I have gripped and doth everyth. This Topo Chico Margarita. Mm-hmm. This is Sabo's late night. That's right, one of those rare. The kids are in bed recordings and that means anything goes.

Sydney, what do you enjoy in there over on your side of the table? Well, it's a beer. Local? Is it local? Looks like it. It's kind of kind of bike on it. No, it's from Virginia. Hey, lost Rhino Brewing Company. This is not an ad. It feels like an ad. It feels like an ad. It's good. Okay, well now it's not an ad for that. It's not an ad for beer or to put you go. they didn't pay. And can I just say we just opened these like just the second? Just a second, yeah. We're never intoxicated doing solbones and you have occasionally been accused of being so, but you never have

like you are. I never have. And so, but I don't know what that says about you that you just seem that way. But after the kids are asleep, that is time to open a Tobo cheat go. So the kids are asleep, so I must open the two cheat go. I will manage a few sips, and then finish when the episode is over. But we do not do these intoxicated. I just want to put that out there.

Yeah, once the episode is over, Sydney will, as she does every weeknight, punch me in the face and say, chugalug, stupid, and then up here, in her waiting gullet, when she opens the other one. I will do that. It's just been,

it's been a long couple weeks, y'all. Yeah, y'all. Obviously we're, we're short on our childcare situation, was recording late at night when the kids are asleep, and you're about to leave town. That's true, head on over to Strashing Meow.

Strashing Meow. Strashing Meow. And this shows her, sorry, I can't promote them anymore. No, by the time you hear this, that will be over. Anyway, that's also why I recording early. But so I want to tell you about a different cocktail, Justin. Ooh.

Not, and well, I was gonna say not an alcohol one, but it is an alcohol one, but from that. We'll get into that. This, suggesting came from a listener named Carmen. Thank you, Carmen, because I had never heard of the Brompton cocktail. The Brompton cocktail was a new one on me too, Sid. I didn't know what it was in the email.

It was a look into this. I had no idea what it was, so I looked into it. I think it's an interesting. It's like a little teeny. This episode is like a tidbit of medical history, just a little tiny. Love the tidbits. Love the tidbits. You have tidbits in your area when you're waiting to get into Taste of Asia and they have a big sack of tidbits.

Maybe it's a pizza hut, big sack of tidbits. So like flyers that are two-page brochures basically with just full of trivia. And jokes. And jokes and local ads, tidbits. Sometimes like a word search. Sometimes if you're lucky. No, I'm at small, like an Amos Booshush of medical history, but I think it illustrates a kind of

cool, it's like a bigger idea that it's illustrating in like the change of medicine over time in this little Amos-Bush. So the history, I'm going to tell you, I know right now you're like, well, tell me what the frickin' cocktail is, I'm going to tell you what it is. I promise you, that's part of this. But it's really tied to our understanding of cancer specifically, but more broadly, the idea of like terminal illness, the idea. I mean, you have to think about like, initially, it probably felt like most things we didn't know how to cure, right? Like, most of the time people got sick, you just sort of hoped for the best,

because there was a lot we didn't know, right? And I mean, if you look at like the rate of scientific advancement, especially like as we go from the late 1800s into the early 1900s, and we understand the germ theory of disease, and then we enter the antibiotic era, there must have been a sense that for everything, the cures are just waiting to be found, right?

Like as we learned all this stuff and our knowledge base accumulated quickly, even things like cancer, we must have had this sort of sense for a while, like, well, we'll figure out the care to that too. We can cure any, like with science, with modern science, we can cure anything. I think in with Sandus, yeah. Exactly.

And we had some ideas with things like radiation and surgery that had been around for a while, even before chemo. However, even as we sort of were coming up with all these other great ideas to like cure infections and things that we never had been able to do before. We were also developing the simultaneous understanding that maybe some things we can't fix yet. Maybe some things. As far as we know, we can't fix.

And there was a recognition that with some of these diagnoses, some of these things that were terminal and like cancer is closely tied to the specific substance, the sprompting cocktail. But I mean, the same would have been true for things like tuberculosis for a lot of history. You watched people progress in their disease. You knew you couldn't stop it. You knew that that would come with pain and depression and some degree of suffering. And so the idea that, you know what, maybe there's also another thing we need to work on, which is how do we take care of those people we can't make better.

And I know that sounds like a really obvious idea now, but at this point in history, it would have been pretty revolutionary to suggest that. Palliative care, we call it. Exactly. So the precursor to this, and this is before the concept of palliative care had been introduced, is a Dr. Herbert Snow. So he is a surgeon and a cancer researcher in the late 1800s and early 1900s. He worked at the Cancer Hospital in Brompton, London. It would later be called the Royal Marston hospital. But anyway, I should note about Dr. Snow that while he is key to the story of the Brompton cocktail, and there are some good things that came from that. He was anti-vaccine.

He did not believe in the germ theory of disease, which is too bad, because the germ theory of disease will believe in you whether Whether you believe in it or not. You know nothing hopes no Well, it's not dwell on those things okay He was also an anti-vivisectionist, which I guess was a big movement that just said we don't need to cut anything open to understand it better Gonna agree with that which but anything open to understand it better. Gonna agree with that.

Which, unfortunately, we do need, we do. We do, we gotta. Maybe not anymore. There's probably didn't have videos, but. Mm. No, still okay. Well, I mean, I'm not suggesting that like, I mean, we understand a lot about anatomy now.

Like, we got a lot of it figured out. Yeah, it's just weird to me. Okay, listen, I'm a layman. But like surgeries still have to happen to me. I'm a layman and this is a bit of a heavy episode. So grant me 30 seconds. Okay. You all don't need to cut people up, it evil.

You get it. Right? You're like the last generation. I feel like that we're the full autopsy was like part of your medical training like Derriger, right? Like there's more modern ways of doing it now. And you guys, you really don't need to cut people, dead people up anymore just for y'all.

That's, well, okay, well, first of all, it was never done for y'all. Not for y' That's, well, okay, well, first of all, it was never done for youx. Not for youx, but I'm just, that dishonors the people who donate their bodies to medical science. I'm just saying, feel like we should have enough videos at this point. No, it, as far as I know in many med school,

I know in our med school, in many med schools, cadaver lab and anatomical dissection is still very much part of medical curriculum. No, okay. They did try to move away from it for a while, but I believe it's back. Anyway, I get, I'll say it's our medical. I'll take your word for it that you need to do it. It just seems a little more, but I don't know.

So Dr. Snow, let's not dwell on his vaccine feelings. He also observed that many of the cancer patients for whom he was providing care and on whom he was researching, he noted that they were suffering and he came up with something to help ease that suffering. He published an article in the British Medical Journal in 1896 about cancer and its causes and the progression. No, he didn't get everything entirely right. I should say. He felt that the root cause of cancer was neuroses. Oh, like you're getting too nervous.

So, I mean, neuroses was like a bigger concept, but I mean, it was certainly tied to probably like a manifestation of anxiety. And like when you think about like that sort of like, we think it was like terminal restlessness now, the pain and the like emotional repercussions of that that he was observing, like, you can see where that all will get tied together. And especially if you could give somebody a medicine that would ease some of those outward signs of suffering, you may believe you're actually doing something

to fix it, right? Because they seem less distressed. So maybe you've made them better. We understand better, I mean, like we understand now that just like providing analgesia doesn't necessarily fix a problem. I got you. But at the time, you wouldn like we understand now that just like providing analgesia doesn't necessarily fix a problem I got you but at the time you wouldn't have necessarily known that it gave you the exterior appearance of Solving the problem. So we gave people a mixture of morphine and cocaine. Oh, yeah, and

What he found is people seem a lot. No, we say there's no such thing as a curl over here By bet that gets you halfway at least for most stuff. So what he found is that people felt a lot better when you gave them morphine and cocaine. Yes. As many kid rock songs will it test? The morphine, of course, was known to do pain and the cocaine was thought to provide vitality.

You can see why. Yeah. Yeah. Love them and vigor. Now, again, the idea of doing that at the time was pretty were even though that doesn't sound revolutionary like so somebody was hurting and you treated their pain Of course, well, this would have been a bigger deal at the time Now the addition of cocaine would cause a problem. It's not the problem you think though Really the problem that it caused for Dr. Snow at his hospital was cost. Cocaine was expensive.

Yeah, it's been my problem with it, too. And the hospital was not willing to continue to supply her person as patients with cocaine. Yeah, I understand, especially if they weren't valuing or prioritizing pain management. So his cocktail, his concoction, his mixture fell out of favor within like a year of him introducing it simply because the hospital just could not afford to continue to buy Coke cane for the patients. But once that idea, once an idea like that gets out, you know it's going to catch on. So throughout the early part of the 1900s, you start to see other physicians writing

in articles and in their medical records about employing a similar substance for their patients, and they begin calling it the Brompton Cocktail. Now this was widely adopted at Brompton Hospital, which was near the cancer hospital, near the Royal Marsden. So, the Brompton name could have come from the hospital specifically, just generally from the fact that they were in Brompton, either way. So, they start calling this make sure the Brompton cocktail. And at the Brompton Hospital surgeons began using it for patients who were recovering from a thoracotomy from having a surgery where their chest was opened, that would be a very painful recovery process.

Can't imagine that. And so having a mixture of morphine and cocaine probably would be very helpful in that recovery. And they improved upon it by mixing them in a base of gin and honey. Oh. So. Now it's even more recactyl.

Now it's a cocktail. Now it's a cocktail. Now it's a cocktail. That made it taste dear and I more fun probably okay over at Kings College Hospital at St. Luke's they begin using the hospital at different hospital or begin using cocktail different hospitals throughout London and the name remained the Brompton cocktail even though like the ingredients would change depending on the physician the hospital It's the same concept and I will say for the most part morphine and cocaine were pretty like standard in every mixture the other ingredients would vary

Like any alcohol would do after a while, you know, didn't have to be Jen in 1952 the Brompton hospital actually added like a recipe for the, like, codified Brompton cocktail to the national formulary. And at that point, the recipe was a quarter grain of morphine, a sixth grain of cocaine, 90% alcohol, and you need 30 minutes of that. I'm not sure. 30 minutes, I'm sorry I'm taking notes here.

60 minutes of syrup, so some sort of simple syrup, probably sugar, a sugar base, right, for the alcohol. And then chloroform water was actually added in there, half pounds. Yeah. So. Can you drink this? Yeah, you would take this, you would take this orally.

There were other formulations that would be made with some of the substances that would be injectable, but oral formulations were most common. And like I said, as a recipe spread from London and outside the UK, sometimes they traded out certain ingredients like, for instance, morphine was occasionally traded for something called diamorphine. This is also an opioid. Obviously, it's a synthetic form, like chemical alteration

of the compound morphine, right? It's faster. You can use less for the same effect. So it's super morphine. Yeah, you may know it by a different name. Oh. Heroin. Ah, okay, got it. Yes. So at this point, like now you know the rest of the drugs. Yes. Diamorphine is also, I mean, like it's a, it's a heroin is a crude form of diamorphine. Depending on heroin is a colloquial term.

It's not a met, you know, like it's not a medicine. So it is, it can be applied to multiple substances that might have slightly different chemical formulations, crudely speaking, dimorphine was heroin at the time. And in addition to trading dimorphine in for morphine, which obviously would make it much stronger and faster acting, some physicians would add things

like thorazine, which was like an early anti-psychotic, that would be sedating. I also had like a lot of side effects. And then sometimes things like Promethazine Finnergan, an anti-histamine that we use for nausea nowadays, for nausea and sedation and things like that. And this Brompton cocktail in one of these formulations with these various substances became like not just a mainstay of taking care of people with pain or recovering from surgery, whatever in hospitals, but like almost took on like a mythical kind of quality.

Like it was this magic mixture of substances that was thought to provide so much relief that it must be doing something beyond like the some it was synergistic the some of its parts was greater. It must not just beginning you drunken high very quickly. It did there was a lot written and talked about how somehow by it's not just the morphine in the cocaine they do something when they're mixed together that we can't understand, that is beyond what you would expect the properties of these individual medicines to be. And so that is how the Brompton cocktail

became this kind of like, it was an idea as much as it was an actual thing. The idea of giving someone who is in great suffering this elixir. And the words I'm using are very specific, because that's how it was referred to, these elixirs, concoctions, potions. It sounds kind of magical.

It wasn't. I'm not a bit of magical thinking though. And this would call to the eras of medicine before, where like that wouldn't have been uncommon. I mean, if you think about tinctures and poltuses and all the different things that people use, a ton of different ingredients would go into those things a lot of times. It would be like a myth or a date kind of thing, something the antidote to all poisons. But of course that would change.

Yes, sadly. But before I tell you about that. Before you reign on the proverbial parade. Before I've become Buzz Killington. Let's go to the buildington. Let's go to the building department. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Let's go. Hi, my name is Graham Clark and I'm one half of the podcast stop podcasting yourself. I show that we've recorded for many, many years and at the moment

instead of being in person, we're recording remotely and you wouldn't even notice. You don't even notice the lag. It's right, Graham. And the great thing about it, go ahead. No, you go ahead. Okay, and go ahead. And you can listen to us every week on maximumfun.org or wherever you get your podcasts. Your podcasts. Hi, it's me, Dave Hill from Before.

Here to tell you about my brand new show on Maximum Fun, The Dave Hill Good Time Hour, which combines my old Maximum Fun Show, Dave Hill's podcasting incident with my old radio show, The God Damn Dave Hill Show, and the one new futuristic program from the future. If you like delightful conversation with incredible guests, technical difficulties, and actual phone calls from real-life listeners, you've just hit a street called easy. I'm also joined by my incredible co-host, the Boy Criminal Chris Grisbeck. Say hi, Chris. Hey, Dave, it's really crazy. That's enough, Chris. And New Jersey Chicken Rancher, Des. Say hi, Des. Hey, Dave. Dave Hill, good time,

hour. Brand new episodes every Friday. Unack some fun. Plus, the show's not even an hour. It's 90 minutes. Take that stupid rule. We nailed it. All right, Sid. Oh, Dr. No Fun is back on duty. So there is a doctor who I think would probably be comfortable with me saying he's the Dr. No Fun of this episode.

Although, what we're really talking about is a shift in our understanding that like taking care of people, even if your goal isn't adding more years to their life, if your goal is adding quality to the time they have, is just as valuable as it of a discipline. And that idea came about with the introduction of palliative care as its own separate discipline in the 1960s and 70s. The originator of what we think of as the modern hospice movement was Dr. Sissley Saunders who was a physician, a nurse, a social worker who established like the first hospital, St. Christopher's Hospital, where palliative care was really developed as like a distinct science as something you could practice.

Because I was going to say like, I've heard a lot of the history of medicine. Palliative care is like the one form of care that we probably did have like that was effective and well, I mean, how much of it, what we're doing was palliative, you know, like because we had so few fears and anything. You are absolutely right. I think that the change isn't so much in like giving somebody something to feel better, even if it doesn't make them better. It's the understanding, the very clear understanding that that's what you're doing.

This will not necessarily make you better. It will just make you feel better. And then also approaching that in a scientific way, because you can see where there would be like sort of this, a lure of just giving somebody something that would make them really drunk or really high or just knock them out, right? Like all of those would achieve that end, but in a very unscientific and ultimately not focusing on quality of life. If you just make somebody sleep all the time, you haven't given them quality of life. So alleviating pain, but also giving them the opportunity

to engage with their family and stuff. Sure. That's, those are higher goals, and you needed a scientific discipline like palliative care to achieve them. So in the early days of palliative medicine, they were still using the Brompton cocktail. And it seemed to fit Cicely Sa Saunders introduced the idea of total pain.

And the concept is basically what, what seems, again, common sense to us, but nobody had really described, which is like, it's pain that's more than physical. If you're thinking about like a terminal diagnosis or an end of life pain, it's mental, it's emotional, it's social, it's emotional, it's social, it's psychological, it's multiple levels, right? And so in that setting, the Brompton cocktail made a lot of sense to people because it got a bunch of different stuff in it.

So it's doing a bunch of different things. And again, there was this sort of idea, like you're treating all these different feelings you might be having as well as the physical pain. And then also it's doing something that we don't even understand. And they started studying that different places. There was like a Montreal-based palliative hospital where they tested like the use of the bronch and cocktail in a palliative care setting and found that it was like 90% effective. talked to you in a palliative care setting and found that it was like 90% effective. So you know, it seemed it was working.

That was the thought. Like, well, we don't love this as scientists because it's not standardized. The amounts can vary, the substances can vary. This whole sort of mystical synergy that people are imbuing it with. Yeah. Doesn't make sense to us, but at the same time, if it works, you know, yeah, I work, yeah, keep using it. Yeah. Well, there was one researcher who wasn't willing to settle for that. Okay.

Does it, does Dr. Nofun? I, I, I mean, I hate his column, Dr. Nofun, but I guess in this context, Dr. Robert Twy Cross. And he was a researcher who had, early in his career had sought to work with Dr. Saunders. That was his goal, greatly admired her work, wanted to be part of the palliative care and hospice movement and research. And this was the field he had endeavored to enter.

He even created a medical society for her to come speak at, just for the opportunity to meet her and get in her little black book as this is a doctor I could work with someday, just to make that connection. So he went to work with her and he was unsure of the necessity of the Brompton cocktail.

Of like, are all these components really necessary? He was really concerned with how variable the cocktail could be and then also the shelf stability of it. It was not with the stuff that was in it and the way it was put together. It was not particularly shelf stable. And so you're talking about something that like, you're gonna mix up and then it's gonna sit in a pharmacy

and who knows what's there by the time you're giving it to people. And that really concerned him too, just as somebody who was trying to come at this from a very, like, I will give you this medicine and I can predict the effect. You couldn't do that in this case, right? And you certainly couldn't predict, like, based on weight and size and gender and age and all the other things that influence our metabolism of medications. So he went about to sort of like pick apart the brompton cocktail.

Okay. To try to figure out like what's necessary, what does this actually work, what is happening with this sort of mystical thing? What parts of this are just getting people stunned. So throughout the 70s, he's doing this research. The first thing he was studying was the diamorphine. Because at this point, we were beginning to be concerned about diamorphine.

We think it might be heroin. So we should start over. It was heroin. And there was concern. Well, first of all, like it was much stronger, it was very fast-acting. You can see potential for harm there, if not, dose correctly. Yeah, of course.

The other thing that concerned people was just the amount of euphoria that was associated with it too. It did. It made you feel better and it had fewer side effects was a thought process. So the first thing you did is he compared concoctions that use diamorphine with ones that use morphine. And what he found is that the morphine was fine. There was really no advantage to using the diamorphine and there were some risks to it. So he recommended like, just stick with the morphine. We don't need to mess around with that other stuff.

In certain settings where somebody's tolerance was incredibly high for some reason or if they needed massive amounts and you needed it to act really quickly There was a place for diamorphine is like especially as an injectable and we see medicines like that today, right? Like the the although it's the subject of media scrutiny for another reason fentanyl is used in hospitals because it is so strong and fast-acting if you come in as like a trauma if you got a broken femur Something like fentanyl is exactly what you need in that situation, to provide quick, reliable, predictable pain relief

to somebody who's in an excruciating pain. So, but he found that morphine for most patients is gonna be fine. So that was the first kind of thing. Let's get rid of the dimorphine, switch to morphine. Okay, then he started doing these crossover studies where he compared like, okay, you're getting the morphine in cocaine, and now we switched you to just morphine.

And did we notice any difference? And comparing groups and doing that. And what he found, and this was a huge breakthrough, is that for the first like two weeks, you do notice there was a significant difference in alertness with the cocaine. But after two weeks, there is zero difference between patients who were receiving morphine and cocaine and patients who were just receiving morphine. Weird. So they're like acclimated to the psychological effects of the cocaine. And so you were getting nothing from the cocaine at that point.

Except addicted to cocaine, I would imagine. Yeah. And then I mean, I guess the cost was still an issue, I would say. But at that point, what he said was, I don't think we need the cocaine. The morphine is what is doing the trick. We just need the morphine. If we focus on the fewer components in this thing, the more we can standardize how we're giving it to people, and we could also adjust the dose more easily. If you think about it,

like if you have something that has a set amount of morphine and cocaine in it, and you're giving it to- You're gonna do the math on the ratios. Exactly. And like you can't just give people twice as much morphine without also giving them twice as much cocaine and you know, all that.

So- If you ever tried to double a cupcake recipe, you know what's happening exactly So they switched to just morphine at St. Christopher's in a solution of chloroform water still And then they added something for nausea as well, and they just ditch the cocaine So that was the first big breakthrough Which I imagine was like a pain in the butt for all the doctors in the hospital I'd be like everybody stop the thing you're writing like Like you probably had it all written out, and you just...

You have big vat of it. So, and then the researchers back in Canada decided like, well, we see what y'all are doing there, we're going to up the ante. We're going to take it even a step further. So they did a study where they'd said, okay, part of you get this brown-toned cocktail, and some of you just get straight up morphine and flavored water. Oh. Forget the go came, forget the chloroform, forget the alcohol, forget the nausea medicine,

forget it all. Just morphine. It's morphine. It's morphine in some flavored water for palatability, so it didn't taste better. And what they found is there was no difference. It was the morphine all along. Okay. There was a morphine during the trick.

Yeah. Yeah. It would take a while for everybody to catch on. I always think that's really interesting. So like they did all these studies and really by the end of the 70s, it was known to the people who studied such things that you really just need to give people the morphine. And yes, of course, as palliative care is advanced, there are a variety of other medicines we give for other symptoms, right?

Like, I'm not saying we don't treat anxiety or nausea or those other things, but when it came to this pain, the morphine is what you really needed. And the advantage of knowing that is then you can dose it appropriately and you can adjust it appropriately and you can address each patient's symptoms

and experience a lot more individually because you predict, you know what response you're gonna get to the medicine. And you limit harm that way too. But it would take a while for everybody to catch on. The Brompton cocktail survived well into the 80s and 90s. That way.

Yes, where people were still getting it. I would imagine there may be somebody listening to this podcast who knows like, oh, I remember like how to, you know, either they remember their parent or grandparent, like, remembers that this happened, like, maybe somewhat familiar with the concept of the Brompton cocktail because it was so widespread and imbued with so much importance for a long time. And I don't know, you know know how much longer it may have stuck around in other places.

If you think about, like, in West Virginia, goody powder is still something patients ask me for. It's a mixture of acetaminophen, tylenol, aspirin, and caffeine. And in most places, you just don't use that much. It's just an old thing. But I mean, there are still people who will say, don't use that much. It's just an old thing. I'll just get used to something. But I mean, there are still people who will say like,

when I just prefer goody powder. I don't have any evidence that that specific combination would be better than any other at a headache, but there are definitely people who still use it. So you'll see that. You'll see these sort of, well, we think of as like patent medicines, although this would have been much different prescription level. We see those things hang around. I

can think of a couple other examples around here today. I want to put to meeting people on blast, but it's interesting to me because while this is just a story of the Brompton cocktail, which as far as I know is not being used anywhere today. Impalitive care is a science, it is a progeny scientific fashion. There is a way to take care of people and give them the best quality of life. And that's studied. It's not just about pain control. It's about overall quality. Life quality.

Yes. And making the best of whatever time you have. And so it's much bigger than pain control now. But it's interesting because this was one example of sort of getting red of some of those kind of magical elements that still linger, and still to this day kind of linger around different parts of medicine from our roots of something that wasn't a standardized scientific practice, something that was very much like,

did that seem to work? Okay, it did. Oh, let's just do it again. Without much thought as to the why and the how and the could we reproduce it and the scientific method of it all. And so, you know, the problem was obvious. It was not standardized, different ingredients, different amounts, not shelf-sable, all that stuff, no clear evidence of how it worked, no clear evidence of synergy, all that kind of stuff. But it took us a really long time to let go of it because of the importance we sort of hung. And it feels like that concept.

Yeah, you use something long enough and it just feels, feels right, deep down. Like sitting and I just discovered a while back the beer doesn't actually go bad when you let it get warm and then cool it off again. Yeah, it doesn't skunk. And it just feels wrong. It doesn't feel right. That feels incorrect. But that is the case.

It's very true. And you know, even when they did the first study to, in the one I referenced in Montreal, to compare just morphine with the Brompton cocktail, they referenced the morphine as morphine elixir. Morphine elixir. Why? I... because it sounds... I don't know. I don't know. Why do you need to call it that?

It's just... I mean, but I think that's why. I think because we have these sort of emotional connections to these sorts of things and they're hard to let go of. I mean, I very only people in medicine are really going to understand what I'm saying with this, but like I still feel this way about steroid tapers. Oh, yeah. Medicine has really shifted where we don't give people long tapers of steroids for certain conditions nearly as often as we use to. And that's only been within my years of practice. And it is still like, it is hard for me emotionally to let go of these long steroid tapers. Even though I know the evidence shows I shouldn't do them, I always worry. I become anxious about it. So.

There you have it. All these prominent cocktails, cool name. It is. It's a great name. Great name. Yeah. Thank It's a great name. Great name. Yeah. Thank you so much for listening to our podcast. Thanks to the taxpayers for the use of their song medicines. It's the intro and outro of our program.

Thanks to you for listening. We really appreciate it. Thanks, Max Fun, for having us on their network and what happened. That is going to do it for us this week. So until next time, my name is Justin McAroy. I'm Sydney McAroy. And as always, don't throw a hole in your head. Alright!