Bloodletting has been used for centuries in many cultures. Its principle, it was assumed, consisted in re-balancing the body’s four humours. Bloodletting had a detrimental effect on most diseases and must have killed millions. It is a good historical example of the harm that ensues, if healthcare adheres to dogma. Today, we know that bloodletting is useful only in rare conditions such as polycythaemia vera or haemochromatosis (and some 30 years ago, a variation of bloodletting, isovolaemic haemodilution, was being discussed as a treatment for circulatory diseases such as intermittent claudication or stroke).
Yet, in so-called alternative medicine (SCAM), there are some practitioners who seem to find it hard to concede that ancient treatments might be not as good as they think. Thus, bloodletting has survived in this realm as a therapy for a wide range of conditions. This study assessed the efficacy of bloodletting therapy (acupoint pricking and cupping) in patients with chronic idiopathic urticaria (CIU) in a randomized, control, parallel-group trial.
A total of 174 patients with CIU were randomized into three groups:
- group A was treated with bloodletting therapy and ebastine (an anti-histamine),
- group B was treated with placebo treatment (acupoint pseudopricking and cupping) and ebastine,
- group C was treated with ebastine only.
The treatment period lasted 4 weeks. An intention-to-treat analysis was conducted, and the primary outcome was the effective rate of UAS7 score being reduced to 7 or below after treatment phase.
The effective rates at the end of treatment phase were different among the three groups, which were
- 73.7% in group A,
- 45.6% in group B,
- and 42.9% in group C.
Multiple analysis indicated differences between groups A and B (P < 0.0125) and groups A and C (P < 0.0125) and no difference between groups B and C (P > 0.0125). No severe bloodletting therapy-related adverse events were observed.
The authors concluded that one month of bloodletting therapy combined with ebastine is clinically beneficial compared with placebo treatment combined with ebastine and treatment with ebastine only. Thus, bloodletting therapy can be an effective complementary treatment in CIU.
How on earth might bloodletting help for CIU? Luckily, the authors have an answer to this question:
The clinical feature of urticaria with wheals and pruritus coming and going quickly is the manifestation of wind-evil that lurks in and circulates with blood. Hence, in the treatment of urticaria, dispersing wind is the one of the principle methods, and treating blood before wind is an important procedure because when blood flows fluently , wind-evil will resolve spontaneously. Bloodletting therapy is a direct and effective way of regulating blood.
You see, it’s all perfectly clear!
In this case, the results must be true. And the argument that patients might have known in which treatment group they had ended up (and were thus not blinded) can be discarded.
Even the NEW SCIENTIST seems alarmed about Gwyneth and her activities:
Psychic readings, energy healing and vampire facials are just a few of the adventures had by actor and alternative health guru Gwyneth Paltrow and her team in her forthcoming Netflix series The Goop Lab. Goop, Paltrow’s natural health company, has already become a byword for unrestrained woo, but the TV series takes things to the next level.
Don’t make the mistake of thinking you can stick your fingers in your ears and pretend it isn’t happening. There is unlikely to be any escape from The Goop Lab after it is released on 24 January, judging by the current explosion of interest in Goop’s latest offering, a candle scented like Paltrow’s vagina, which has reportedly sold out…
Yet, I am sure we got her all wrong!
Good old Gwennie is really one of us – she is a true sceptic!
Think about it; it’s the only explanation.
When she first started dabbling in woo, she only wanted to test us. I’ll just display a few cupping marks and see how they react, she thought.
Then she saw that most people were so gullible that they bought it. Of course, she thought, if they buy it, I might as well take their money. In her attempt to see how far she can push her boat out, she decided to conduct a sceptical experiment and went further and further. This is when she started to focus on her vagina – jade eggs, steaming it, etc. Surely, she thought, eventually they must realise that I am a sceptic taking the Mikey!
But they never did realise it; at least not so far.
So, she decided to do something even more brazen and sell candles to dispense the smell of her vagina in the homes of her fans. That will do it, she felt, now they will realise what I want to achieve with all this.
But what happened? They sold out in no time (actually, both the candles and the gullible public)! That was a surprise even to our Gwennie. She thought she had seen it all, but she was wrong.
Now she is trying to think of something even more outrageous – but she admits, it’s not easy. What can be a more obvious and disgusting hoax than filling people’ homes with the smell of my genitals and let them pay through their noses for the pleasure? she asks herself.
Yes, poor old Gwennie is at loss! Stuck in her own vagina, so to speak.
Perhaps you can help her? Please suggest what vaginal gimmick she might sell next to make her position inescapably clear to even the dumbest of the gullible. Just mention your ideas in the comment section below; I have a feeling she is an avid reader of this blog. Gwennie might even show herself generous; if she likes your innovation, she will certainly make it worth your while.
Because, by Jove, she can afford to be generous. Apparently her business is now worth a quarter of a billion US$. But we must not be envious. Knowing that she did all this merely to stimulate sceptical thinking in the general public, you will not be surprised to learn what she intends to do with all this dosh: once she has succeeded in demonstrating to all the gullible pin heads and devotees that she really is on the side of the angles, she will donate all of it to sceptic organisations across the globe.
So, sceptics of the world: stop snarling at my friend Gwennie, rejoice and prepare for a major windfall.
Cupping is a so-called alternative medicine (SCAM) that has existed in several ancient cultures. It recently became popular when US Olympic athletes displayed cupping marks on their bodies, and it was claimed that cupping is used for enhancing their physical performance. There are two distinct forms: dry and wet cupping.
Wet cupping involves scarring the skin with a sharp instrument and then applying a cup with a vacuum to suck blood from the wound. It can thus be seen (and was traditionally used) as a form of blood-letting. Wet cupping is being recommended by enthusiasts for a wide range of conditions. But does it work?
This study compared the effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP). In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping or conventional treatment. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional treatment group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively.
The results show that there was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups. Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits. The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly superior compared to the conventional treatment group. The final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01).
The authors concluded that wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy.
Perhaps the authors were joking? In any case, their conclusions cannot be taken seriously. Why? There are several reasons, but the most obvious ones are:
- There was no adequate control of the presumably substantial placebo effects of wet cupping.
- The control group received a treatment that is known to be ineffective or even detrimental.
For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. Thus comparing wet cupping to a control group treated with bed rest is bound to generate a false-positive outcome for wet cupping.
My final point is perhaps the most important: wet cupping can lead to serious complication, and I therefore do not recommend it to anyone – other than masochists, perhaps.
The authors of this systematic review aimed to summarize the evidence of clinical trials on cupping for athletes. Randomized controlled trials on cupping therapy with no restriction regarding the technique, or co-interventions, were included, if they measured the effects of cupping compared with any other intervention on health and performance outcomes in professionals, semi-professionals, and leisure athletes. Data extraction and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted independently by two pairs of reviewers.
Eleven trials with n = 498 participants from China, the United States, Greece, Iran, and the United Arab Emirates were included, reporting effects on different populations, including soccer, football, and handball players, swimmers, gymnasts, and track and field athletes of both amateur and professional nature. Cupping was applied between 1 and 20 times, in daily or weekly intervals, alone or in combination with, for example, acupuncture. Outcomes varied greatly from symptom intensity, recovery measures, functional measures, serum markers, and experimental outcomes. Cupping was reported as beneficial for perceptions of pain and disability, increased range of motion, and reductions in creatine kinase when compared to mostly untreated control groups. The majority of trials had an unclear or high risk of bias. None of the studies reported safety.
The authors concluded that no explicit recommendation for or against the use of cupping for athletes can be made. More studies are necessary for conclusive judgment on the efficacy and safety of cupping in athletes.
Considering the authors’ stated aim, this conclusion seems odd. Surely, they should have concluded that THERE IS NO CONVINCING EVIDENCE FOR THE USE OF CUPPING IN ATHLETES. But this sounds rather negative, and the JCAM does not seem to tolerate negative conclusions, as discussed repeatedly on this blog.
The discussion section of this paper is bar of any noticeable critical input (for those who don’t know: the aim of any systematic review must be to CRITICALLY EVALUATE THE PRIMARY DATA). The authors even go as far as stating that the trials reported in this systematic review found beneficial effects of cupping in athletes when compared to no intervention. I find this surprising and bordering on scientific misconduct. The RCTs were mostly not on cupping but on cupping in combination with some other treatments. More importantly, they were of such deplorable quality that they allow no conclusions about effectiveness. Lastly, they mostly failed to report on adverse effects which, as I have often stated, is a violation of research ethics.
In essence, all this paper proves is that, if you have rubbish trials, you can produce a rubbish review and publish it in a rubbish journal.