MD, PhD, FMedSci, FSB, FRCP, FRCPEd

“THERE IS A SUCKER BORN EVERY MINUTE” – this quote is commonly attributed to P.T.Barnum. If he really coined the sentence, he certainly did not think of the little cups sucking in the skin of patients undergoing cupping therapy. Yet, the recent media coverage of cupping made me think of this quote. The suckers here are not the therapeutic devices employed for cupping but the athletes, the journalists and the general public.

In my experience, athletes are often very worried about their body. This is perhaps understandable but, at the same time, it makes them the ideal victims of all types of charlatans. I am therefore not really surprised to see that some Olympic athletes fell for cupping. They want to use every means allowed by the doping rules to enhance their performance. Cupping therapists claim all sorts of strange and unwarranted things, and some athletes seem to be gullible enough to believe them. Belief can perhaps not move mountains, but it might give you the edge in an Olympic competition.

The ‘beauty’ of cupping when applied to an athlete’s body is that its traces are so publicly visible. During Olympic games, this means that the entire world knows within hours about the cupping-habit of an athlete. What could be more exciting for journalists than these odd cupping marks decorating the muscular bodies of some Olympic athletes? If they are not worth a good story, what is?

There is hardly a newspaper on the planet that did not jump on this band-waggon full of snake oil – there is a sucker born every minute! Nothing wrong with reporting what is happening at the Olympic games, of course. But what has sometimes been reported in the press about cupping beggars belief. Rarely have I read so much nonsense about an alternative therapy in such a short time.

Do you need an example? The DAILY MAIL is as good – or rather bad? – as most; this is what the DM published yesterday on the subject: Chinese media have been cheering cupping’s appearance at the Olympics as proof of the value of traditional culture, with both the official Xinhua news agency and Communist Party mouthpiece People’s Daily touting the soft-power benefits. “Chinese traditions and products proliferate Olympic village”, read one headline on the People’s Daily website. Ding Hui, manager of the Lily Spring Health & Spa in Beijing, said she has seen a 30 percent jump in clients asking for cupping treatment since the Olympics started. “Even though Chinese people have known about it for a long time, they see a great athlete does it and see it really works,” Ding said. “For athletes, they build up harmful lactic acid in the body and cupping can help relieve it.”

You might think that, when reporting about a weird therapy, journalists have little options but to interview weird ‘experts’ relating cupping to even weirder ‘energies’, ‘life forces’, ‘meridians’, yin and yang, TCM, etc. But you would be wrong. They do of course have other options; they would only have needed to log on Medline to find hundreds of references related to the subject. If they had done that, they would even have found an abstract of mine that might have answered many of their question and would have clarified many of the questions about the scientific evidence for or against cupping. Here it is:

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

With just one further click on their keyboard, they would have been able to read the full text of my article which cautioned in no uncertain terms: The number of trials and the total sample size are too small to distinguish between any nonspecific or specific effects, which preclude any firm conclusions. Moreover, the methodological quality was often poor.

Sadly, few journalists seemed to have bothered to do this tiny bit of research. Why? Surely, journalists are trained to investigate their subject before putting pen to paper! Yes, most of them are, but a headline like THE EVIDENCE FOR CUPPING IS FLIMSY does not sell newspapers. The public wants something much more interesting – there is a sucker born every minute!

And what should be wrong with that? People deserve a bit of an entertaining story about their Olympic idols! Perhaps, but there is a downside, of course. The media-hype of the last week will create a demand. The general public will now want the very therapy that helped athletes win gold medals (never mind that it didn’t). Thanks to the media, cupping is now destined to become the alternative therapy of the future.

And what is wrong with that? Quite a lot, I think!

For one, quacks will jump on this fast-moving band-waggon filled with snake oil and try to divert as much cash as they can from their victims’ into their own bank accounts. Perhaps that would not be the worst effect. The worst would be, if some people believe what some quacks will undoubtedly tell them, that cupping is effective (“they see a great athlete does it and see it really works”) for all sorts of conditions, including serious diseases (“Cupping has also been used by some as an alternative treatment for cancer.”) – THERE IS A SUCKER BORN EVERY MINUTE (and some might even die sucking)!

19 Responses to There is a sucker born every minute – more thoughts on the Olympic cupping craze

  • If I was a competitor of an athlete who uses cupping (or any other CAM) I would express my incredulity that they could be so gullible and suggest they in fact are using methods which divert ‘inner energy’ and actually slow them down!

    The evidence for this is the same as that for benefit!

    Of course this is an ad hominem attack and we scientists should not be involved, but athletes most certainly do try to ‘out-psych’ each other, and once a little bit of doubt seeps in….

    There is useful paper/article to be developed here: “X % of Olympic atheletes are gullible and vulnerable to unaccountable forces of energy that have not been identified by any reputable scientists.”
    Or even, “Is using faith to improve athletic performance a form of cheating?”

    May the wu be with them all.

    • @Richard: you said, “I would … suggest they in fact are using methods which divert ‘inner energy’ and actually slow them down!”

      “we scientists” should recognize that human body is not a closed system, and therefore the law of conservation of energy does not apply. It is quite plausible that their “methods” might boost body metabolism temporarily (likely over certain time curve), causing increase of stamina and/or performance.

  • “Sadly, few journalists seemed to have bothered to do this tiny bit of research. Why? Surely, journalists are trained to investigate their subject before putting pen to paper!”

    Sadly, most journalists are like most lawyers; they know nothing about nearly everything. Not once in their education have they had to confront hard realities as those who are in the areas of science. Their existence is based on competing ideas, though the most prevalent, and the one to which they most adhere, is how to make a quid (for themselves).

    It is an odd conundrum about so-called journalists many (most) can’t even write properly. What would happen to any science-based profession if they did not understand their chosen science?

    • Different “science-based professions” are dealing with object of vastly different complexity. As result, scientific criteria differ vastly, and you should not brush all “science-based professions” with the same brush. When a subject of science has a tremendous complexity (as human body, or Earth climate), there are very many shades of gray, and unfortunately grey-level “scientists” dominate, by sheer numbers. So, nothing is happening in these professions even if they are highly ignorant in lots of areas, and utter BS usually dominates, as it currently happening with the Olympic cupping. As you can see, some scientists are trying to change the subject of global energizing effects of “blood doping” to “treatment option for pain”. Cupping is not “pain treatment”, and never was. So I would really advise not to use the well-known logical fallacies as an argument.

      • @ Ali Chen on Friday 12 August 2016 at 22:14

        English may not be your first language, so I suggest you seek assistance before you post any further tripe. Maybe then I could understand your post.

        “So I would really advise not to use the well-known logical fallacies as an argument.”

        Which one/s have I supposedly used?

        • @Frank, you just have demonstrated another fallacy – you attacked my spelling or grammar instead of commenting on the essence of my argument. My remark about fallacies was not directed at your particular verbiage, but towards overall direction of main article, where the cupping issue was substituted with a false premise of being as pain treatment, followed by “successful” debunking of this substitute.

          While I agree with all your sentiments about lawyers and journalists, your perception of science is naive, bringing it to the level of same lawyers and journalists.

          In simple English: you apparently have no foggiest clue how wide is the real spectrum of sciences.

  • If cupping actually did improve performance it would be banned by the IOC.

  • It reminds me of Rothmans International PLC, which was a British tobacco manufacturer:
    https://en.wikipedia.org/wiki/Rothmans_International#Sponsorship_of_motorsports

  • I believe that this blog publication misses the essence of the issue. The issue is about athletics and cupping. The article substitutes the thesis “does cupping of a perfectly healthy athlete somehow boosts his/her performance” with “does the cupping have any effect on treatment of sores or diseases”. So this is a standard logical fallacy, and analysis of the actual issue was not presented.

    Could it be that some elements of reaction of a healthy body to controlled hemorrhages (inflicted by cupping) have escaped an attention of this reputable blogger and guest advocates? I can’t believe that there were no studies on effect of cupping on athletic performance.

    Can we expect a third article, something like “Second thoughts on Olympic cupping craze”?

    • “does cupping of a perfectly healthy athlete somehow boosts his/her performance”
      THE ANSWER IS NO!
      if you disagree, show us the evidence.

  • Thank you Dr.Ernst,

    You have asserted that THE ANSWER IS NO! to the root question.

    However, as I mentioned above, your blog article addresses a totally different question, and brings up evidences for a loosely related side of the issue. Therefore, all assertions form your top article should be dismissed as fallacious with regard to the question at hands. Would you agree?

    Given your vast experience in the field of alternative medicine, could you please produce a reference to a study, preferably from an area of sports medicine, that supports your unconditionally negative assertion?

    Thank you in advance,
    – Ali Chen

    • no, I would not agree!
      I do not need to provide a reference for the fact that your claim has no support; your request does not make any sense at all.

    • @Ali Chen

      You really are impervious to reason. If you had read and understood some of the things you yourself have quoted and if you had followed this blog before, perhaps you would understand the simple fact that you cannot prove the negative
      Let’s take the example of Santa Claus. We can probably agree that he does not exist.
      OK. Let’s try to devise a method of proving he does not exist… Think hard now…
      … No, you cannot think of a way… That’s right, you simply cannot PROVE that Santa Claus does NOT exist. You can only try to look for him and if you fail, you will have to admit that you cannot find him and therefore, the theory that he does not exist can be accepted. If you met him in person and could verify, preferably more than once and have others check it, then you could say you have proven that he exists. But because he really does not exist, you cannot ask the professor or anyone for proof that he does not exist. Such proof does not exist either, only the inference that he does not exist.

      If you say cupping works (i.e. “works” in a positive meaning… of course it “works” by producing injury if you want o define “works” in the widest possible manner), you can either show that cupping works by finding consistent, repeatable, independently verifiable evidence that it does… or you can try to find evidence that it works and if you fail you will have to accept the fact that its efficacy is probably is nonexistent. You can never positively PROVE that cupping DOES NOT work because of the simple fact that it doesn’t.
      Nobody has been able to prove in a positive way that it does and on top of that it is also very improbable that it does as I have outlined in many comments before.
      This is how fact finding works in science.

    • The burden of proof is upon those who claim cupping has an effect distinguishable from placebo. If I came up to you and claimed cutting off your right arm would make you live forever, you would presumably, and rightly so, ask for evidence of my claim. You would not think, well, he might be right! Who can say for sure? Let’s try it out and see what happens! The same should occur for any claim of something having a therapeutic benefit.

  • Don’t see you winning Olympic Games! It works for Michael!

  • “What could be more exciting for journalists than these odd cupping marks decorating the muscular bodies of some Olympic athletes?”

    How about the faddish application of ‘Kinesio Tape’ decorating athletes’ bodies these days? e.g. http://www.today.com/health/what-weird-tape-olympians-are-wearing-930471

    Perhaps Edzard could write an article on this topic.

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