Cupping is a so-called alternative medicine (SCAM) that has been around for millennia in many cultures. We have discussed it repeatedly on this blog (see, for instance, here, here, and here). This new study tested the effects of dry cupping on pain intensity, physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms, and medication use in individuals with chronic non-specific low back pain.
Ninety participants with chronic non-specific low back pain were randomized. The experimental group (n = 45) received dry cupping therapy, with cups bilaterally positioned parallel to the L1 to L5 vertebrae. The control group (n = 45) received sham cupping therapy. The interventions were applied once a week for 8 weeks.
Participants were assessed before and after the first treatment session, and after 4 and 8 weeks of intervention. The primary outcome was pain intensity, measured with the numerical pain scale at rest, during fast walking, and during trunk flexion. Secondary outcomes were physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms, and medication use.
On a 0-to-10 scale, the between-group difference in pain severity at rest was negligible: MD 0.0 (95% CI -0.9 to 1.0) immediately after the first treatment, 0.4 (95% CI -0.5 to 1.5) at 4 weeks and 0.6 (95% CI -0.4 to 1.6) at 8 weeks. Similar negligible effects were observed on pain severity during fast walking or trunk flexion. Negligible effects were also found on physical function, functional mobility, and perceived overall effect, where mean estimates and their confidence intervals all excluded worthwhile effects. No worthwhile benefits could be confirmed for any of the remaining secondary outcomes.
The authors concluded that dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, psychological symptoms or medication use in people with non-specific chronic low back pain.
These results will not surprise many of us; they certainly don’t baffle me. What I found interesting in this paper was the concept of sham cupping therapy. How did they do it? Here is their explanation:
For the experimental group, a manual suction pump and four acrylic cups size one (internal diameter = 4.5 cm) were used for the interventions. The cups were applied to the lower back, parallel to L1 to L5 vertebrae, with a 3-cm distance between them, bilaterally. The dry cupping application consisted of a negative pressure of 300 millibars (two suctions in the manual suction pump) sustained for 10 minutes once a week for 8 weeks.
In the control group, the exact same procedures were used except that the cups were prepared with small holes < 2 mm in diameter to release the negative pressure in approximately 3 seconds. Double-sided adhesive tape was applied to the border of the cups in order to keep them in contact with the participants’ skin.
So, sham-controlled trials of cupping are doable. Future trialists might now consider the inclusion of testing the success of patient-blinding when conducting trials of cupping therapy.
WARNING: after reading this, you might no longer enjoy your favorite breakfast cereal!
‘Biologic living’ is the name John Harvey Kellogg (1852-1943), an influential medical doctor and best-known as the inventor of the cornflakes gave to his health reforms. Biologic living was practiced in Kellogg’s Battle Creek Sanatorium, an institution for re-educating Americans and training of healthcare professionals. Kellogg’s religious beliefs bled into his medicinal practices and the Battle Creek Sanatorium was as much health spar as it was a rehabilitation facility. 
In the sanatorium, there was a strict focus on diet which was meant to cure a person of practically all ills, leading to a kind of purity of the soul. Meat and certain spicy, overly flavourful foods, as well as alcoholic beverages, were thought to overexcite the mind and lead to sinful behavior. A bland dull diet was thus recommended. Kellogg intended for ‘cornflakes’ to become the staple of this diet. Other treatments included the following :
- Vegetarian diet; Kellogg invented an artificial meat substitute based mainly on peanuts, called ‘nuttose’
- ‘Light bath’, a bath under lights lasting hours, days, sometimes even weeks
- Regular exercise
- Various forms of electrotherapy
- Vibrational therapy
- Massage therapy
- Breathing techniques
- Colonic irrigation delivered by specially designed machines that could deliver 14 liters of water followed by a pint of yogurt, half of which was to be eaten, while the other half would be delivered via a second enema
- Water cures of various types
- Sexual abstinence, including various measures to avoid masturbation. For boys, he recommended circumcision without anesthetic, thinking the trauma it caused and several weeks of pain that would follow would curb masturbation. If that did not suffice, Kellogg recommended sewing the foreskin shut, preventing an erection. For girls, he applied carbolic acid to the clitoris as ‘an excellent means of allaying the abnormal excitement.’ He would also recommend binding people’s hands, covering genitalia in specially designed cages, or electroshock therapy, such was his hatred of masturbation.
Biologic living was centered around purity, not merely of the soul but racial purity too. Meat and alcohol were not just bad, they were considered ‘race poisons’. He was a staunch advocate of ‘race suicide’, a term that summed up the fear of white America that their racial purity would be eroded, and they would disappear into ‘inferior races’. Kellogg helped implement a law whereby genetically ‘inferior’ humans such as epileptics or people with a learning disability could be a target. Michigan’s forced sterilization law, which Kellogg himself had a hand in, would not be repealed until 1974.
Today, Kellogg’s biologic living is mostly of historical interest. Yet, it is relevant for understanding some of the more extreme trends in the US related to so-called alternative medicine (SCAM).
Astrology is nonsense!
Hold on, did we not recently discuss an RCT showing that being born under the sign of Pisces was associated with a decreased risk of death? Yes, indeed, we did!
And isn’t there a branch of homeopathy that heavily relies on astrology? Yes, indeed, astro-homeopathy does exist.
This suggests to me that a sizable proportion of my readers do believe in astrology. As I have made a New Year’s resolution to try to be nice and patient to even the weirdest of them, I herewith offer astrology fans an insight into what 2022 will bring. For that purpose, I have taken one key prediction for each star sign from a website fittingly entitled YEARLY HOROSCOPE:
- Aries will have big surprises from his life partner.
- Taurus: dept can increase by leaps and bounds.
- Gemini: expect big developments.
- Cancer: You will have a hard time keeping up with messages and appointments.
- Leo: your abilities will be appreciated.
- Virgo: you should seriously consider advancing your education.
- Libra: you’ll need to work closely with others.
- Scorpio: you, and everyone around you will focus on a variety of challenges.
- Sagittarius: you’ll refuel what might be called your inspiration tank.
- Capricorn: you may meet a fortunate contact.
- Aquarius: don’t burn any bridges that you don’t have.
Being an Aquarius myself, I am struck by the wisdom of not burning bridges that I don’t have. It is brilliant! And so fitting!!!
But then I look at the predictions for all the other signs, and I must say: they also apply to me. In fact, ALL of them apply to me, and not just me – they all apply to everyone.
Does that mean that astrology is nonsense after all?
Does that mean that my attempt to be nice to and patient with even the weirdest of the proponents of so-called alternative medicine (SCAM) has already ended in defeat?
I hope not!
For my last post of the year 2021, I take the liberty to borrow parts of a BMJ editorial entitled A NEW YEAR’S RESOLUTION OF HEALTH WORKERS:
The prospect of a return to normality seems within reach. But what will that normality look like? We believe that health workers, who have been at the frontline of the pandemic, must offer a vision of a healthier future. We must not let the terrible events of this year recast the pre-pandemic world in a glowing light. The normality we departed from at the onset of the pandemic was unjust, unsustainable, and shaped the evolution of, and responses to, the pandemic with devastating consequences, particularly for the most deprived and vulnerable.
The start of a new year offers an opportunity to question old ways of working and to ask how we can create a better future for everyone. It is a cliché to say that you should never waste a crisis. Just as in wartime and in the global financial crisis, many have profited greatly from the pandemic, whether as providers of online services or by taking advantage of the rush to procure essential goods such as personal protective equipment.
But many were far less fortunate, living in circumstances that rendered them vulnerable to an infection that spread especially rapidly through communities where successive generations had been living ever more precarious lives. As the recovery begins, the powerful groups who benefited from the social and economic systems that created those conditions will, once again, seek to shape the world to their advantage. Health workers cannot remain silent. They must offer a compelling vision of how we should reconfigure the world so that it produces and sustains health for all, resilient in the face of future threats…
A country navigating the pandemic is like a ship navigating treacherous and unpredictable waters in a storm. If the ship, its crew, and its passengers are to come through the experience unscathed it needs three things. First, it needs an experienced captain who understands the ship and commands the trust of the crew. Unfortunately, in some of the countries worst affected, captains were either away from the bridge, denied there was a storm, or had lost the trust of those on whom they depended.
Second, it needs a crew that is adequate for the size of the ship, that is well trained, and that is working as a team to achieve the same goal. Yet in too many countries, skeleton crews were working in health systems that were highly fragmented. Dissenting voices who raise the alarm about the integrity of the ship, the working of the team, or its leadership must not be silenced or lives can be lost. It also needs passengers who are as seaworthy as possible so that they can withstand the storm. One of the sentinel challenges of covid-19 was finding large segments of the population weighted by a disproportionate burden of preventable disease that predisposed them to severe covid-19 once infected.
Third, we need a ship that is securely constructed. Yet in many of the countries that have fared worst, we have been working in vessels that are full of holes. Social safety nets have been ripped asunder, allowing too many people to fall through the holes. We have made many demands on our people—to stay at home, to face loss of income—and we have added greater uncertainty to what were already difficult situations, particularly for certain racially and economically marginalised groups. The disproportionate exposure to covid-19 of many in these groups—a consequence of precarious jobs and social circumstances that denied them the luxury of social distancing—drove, in large part, the high burden of covid-19 among minority and marginalised groups worldwide.
As we look to the prospect of a covid-19 secure future, with effective vaccines, new treatments, and continued countermeasures as necessary, we must ask how we can strengthen the foundations of our societies, coming together to repair the torn safety nets. We must never be afraid to challenge our political leaders when they are going in the wrong direction, and we must insist that they really are guided by the science, and not just those bits that support their beliefs. And we must ensure that our fellow citizens are as healthy as possible so they can withstand the inevitable storms that lie ahead. We must insist that our health systems and other public systems are adequately staffed, with the tools needed to do the job, with teams that are working together, pulling in the same direction. If we do all this, then we, and the populations we serve, can be confident that we can weather any future storms.
The editorial was written by 4 authors:
- Martin McKee, professor of European public health
- May C I van Schalkwyk, NIHR doctoral research fellow
- Nason Maani, assistant professor in public health evaluation
- Sandro Galea, dean
I think it is most sensible and thought-provoking and I suspect many of us agree with its sentiments. If it did not make you think, perhaps this information will do so:
Yes, 2021 has disappointed many of our hopes and turned out to be a difficult year.
I wish us all that 2022 will be better, much better.
Always on the lookout for so-called alternative medicine (SCAM) that we have not yet covered on this blog, I came across a really weird one. ‘Access Consciousness’ (AC) is claimed to be a form of self-improvement therapy based on the idea that you are not wrong, that you know, and that consciousness can shift anything. It gives you access to the possibilities that exist when you no longer stick yourself and no longer believe that you are stuck.  Gary Douglas ([pictured below] “bestselling author, international speaker and business innovator”) pioneered this set of transformational tools in the 1990s. His work is claimed to have now spread to more than 170 countries and is claimed to have transformed the lives of tens of thousands of people.
Access Consciousness allegedly empowers people to help themselves. The techniques of AC focus on your knowledge about yourself and the world around you. Part of what makes AC so different, according to its promoters, is that it is continuously being created.  AC promises to assist people with their health, weight, money, sex, relationships, anxiety, etc. It promises members, known as ‘Accessories,’ to become more conscious. To fully get it, Accessories should take part in classes. There they have 32 points on their heads lightly touched which is supposed to help them let go of all the thoughts, ideas, and emotions stored in any lifetime. Accessories are claimed to be able to “uncreate” memories of the past, or preconceived ideas picked up throughout a lifetime. As far as I can see, there is no evidence to suggest that AC is effective.
Some ex-members have alleged that AC is a “scam cooked up by a conman to rinse the vulnerable of their savings, a Scientology knock-off, and even a cult”. One ex-Accessory, for instance, claimed the group “programs its members to think like robots. It is very clever how it is done. Because it’s not like any other cult but it is mind control.”  In each 90-minute session, which costs up to US$ 300, 5,000 to 10,000 years of “limitations” are released, it is claimed.
My conclusion: there is no evidence that AC is plausible or effective and it is a SCAM and possibly also a cult.
THE GUARDIAN published an interesting article about vaccination hesitancy yesterday. Here is a short passage from it:
One major missing piece of the puzzle, currently under consideration, is a strategy that gets to the bottom of why 5 million people remained unvaccinated, especially those in communities with an ingrained distrust of authority.
No 10 even turned to an artificial intelligence (AI) company earlier in the year to determine the causes of vaccine hesitancy, but Whitehall sources acknowledge there is still a lack of understanding about how many of the unvaccinated remain so because of entrenched anti-vax ideology, misconceptions that could be turned around, a lack of time or transport to get to vaccine centres, or just apathy.
Yesterday, it was also reported in DER STANDARD that the Austrian Science Minister Martin Polaschek has commissioned a study from Statistics Austria, which for the first time was to look at the vaccination status of the population according to socio-economic characteristics.
The study yielded fascinating findings that might shed some light on the phenomenon of ‘entrenched anti-vax ideology’:
- Across all age groups, the proportion of vaccinated persons, including recovered persons, is 67%.
- Slightly less than four percent of the population are only recovered, and about 30% are neither one nor the other.
- There are no marked differences between men and women.
- The willingness to vaccinate is strongly related to the level of education.
- The vaccination rate in the group of 25-64 year-olds with a university degree is about 84% and thus significantly higher than among those who have only basic education (68%).
- In this age group, it also seems important whether someone has a job (76%) or not (69%).
- People employed in the information and communication sector (85%) and public administration (83%) are the most likely to be vaccinated.
- Workers in agriculture and forestry (67%) and construction (65%) are the least likely to accept vaccinations.
- Health and social services personnel have a vaccination rate of 79%.
- More than half of the 600,000 schoolchildren had already been vaccinated, and in the upper secondary school it was even 72%.
- The rate among teachers is also high, at 85%.
- 86% of the approximately 395,000 students at universities had been vaccinated.
- As 92% of all medical students were vaccinated.
- The vaccination rate among Austrian nationals, at about 70%, is clearly higher than that of people without an Austrian passport (52%).
- The difference between those born in Austria and those not born in Austria is only five percentage points.
- The willingness to be vaccinated is higher among people from Turkey (73%) than among those born in Austria (68%).
- Among Germans and Afghans, it is around 72%.
- People from Romania (43%) and the Russian Federation (45%) have the lowest vaccination rates.
- The percentage of vaccinated people is highest among those between 75 and 84 years.
Similar findings have, of course, been reported from other countries. However, what seems new to me here is the finding that vaccination rates are strongly correlated to the level of education: the anti-vax brigade tends to be uneducated and ignorant. If confirmed, this suggests that education might be a way to make them accept vaccinations.
Of course, correlation is not causality. But there seems to be a dose-response relationship between education and willingness to vaccinate. This makes a causal effect more likely.
THOSE WHO KNOW NOTHING MUST BELIEVE EVERYTHING
Bloodletting therapy (BLT) has been widely used for centuries until it was discovered that it is not merely useless for almost all diseases but also potentially harmful. Yet in so-called alternative medicine (SCAM) BLT is still sometimes employed, for instance, to relieve acute gouty arthritis (AGA). This systematic review aimed to evaluate the feasibility and safety of BLT in treating AGA.
Seven databases were searched from the date of establishment to July 31, 2020, irrespective of the publication source and language. BLT included fire needle, syringe, three-edged needle, and bloodletting followed by cupping. The included articles were evaluated for bias risk by using the Cochrane risk of bias assessment tool.
Twelve studies involving 894 participants were included in the final analysis. A meta-analysis suggested that BLT was highly effective in relieving pain (MD = -1.13, 95% CI [-1.60, -0.66], P < 0.00001), with marked alterations in the total effective (RR = 1.09, 95% [1.05, 1.14], P < 0.0001) and curative rates (RR = 1.37, 95%CI [1.17, 1.59], P < 0.0001). In addition, BLT could dramatically reduce serum C-reactive protein (CRP) level (MD = -3.64, 95%CI [-6.72, -0.55], P = 0.02). Both BLT and Western medicine (WM) produced comparable decreases in uric acid (MD = -18.72, 95%CI [-38.24, 0.81], P = 0.06) and erythrocyte sedimentation rate (ESR) levels (MD = -3.01, 95%CI [-6.89, 0.86], P = 0.13). Lastly, we demonstrated that BLT was safer than WM in treating AGA (RR = 0.36, 95%CI [0.13, 0.97], P = 0.04).
The authors concluded that BLT is effective in alleviating pain and decreasing CRP level in AGA patients with a lower risk of evoking adverse reactions.
This conclusion is optimistic, to say the least. There are several reasons for this statement:
- All the primary studies came from China (and we have often discussed that such trials need to be taken with a pinch of salt).
- All the studies had major methodological flaws.
- There was considerable heterogeneity between the studies.
- The treatments employed were very different from study to study.
- Half of all studies failed to mention adverse effects and thus violate medical ethics.
I came across this article via a German secondary report about it entitled “Scientists discover what else protects from severe symptoms” (Forscher finden heraus, was noch vor schweren Symptomen schützt). The article rightly stressed that vaccination is paramount and then explains that, once you have caught COVID, nutrition can prevent serious symptoms.
Even though I rarely discuss standard nutritional issues on my blog (nutrition belongs to mainstream not so-called alternative medicine [SCAM], in my view), this subject did attract my attention. Here are the essentials of the original scientific paper:
Australian scientists studied the association between habitual frequency of food intake of certain food groups during the COVID-19 pandemic and manifestations of COVID-19 symptoms in adult outpatients with suspected SARS-CoV-2 infection. They included 236 patients who attended an outpatient clinic for suspected COVID-19 evaluation. Severity of symptoms, habitual food intake frequency, demographics and Bristol chart scores were obtained before diagnostic confirmation with real-time reverse transcriptase PCR using nasopharyngeal swab.
The results of the COVID-19 diagnostic tests were positive for 103 patients (44%) and negative for 133 patients (56%). In the SARS-CoV-2-positive group, symptom severity scores had significant negative correlations with the habitual intake frequency of specific food groups. Multivariate binary logistic regression analysis adjusted for age, sex, and occupation confirmed that SARS-CoV-2-positive patients showed a significant negative association between having higher symptom severity and the habitual intake frequency of legumes and grains, bread, and cereals.
The authors concluded that an increase in habitual frequency of intake of ‘legumes’, and ‘grains, bread and cereals’ food groups decreased overall symptom severity in patients with COVID-19. This study provides a framework for designing a protective diet during the COVID-19 pandemic and also establishes a hypothesis of using a diet-based intervention in the management of SARS-CoV-2 infection, which may be explored in future studies.
So, the authors seem to think that they found a causal relationship: A CHANGE IN DIET DECREASES SYMPTOMS. In different sections of the article, they seem to confirm this notion, and they state that they tested the hypothesis of the effect of diet on SARS-CoV-2 infection symptom severity.
Yey, the investigation was merely a correlative study that cannot establish cause and effect. There are many other variables that might be linked to dietary habits which could be the true cause of the observed phenomenon (or contributors to it).
What’s the harm? If the article makes people adopt a healthier diet, all is pukka!
Perhaps, in this case, that might be true (even though one could argue that this paper might support anti-vax notions arguing that vaccination is not important if it is possible to prevent severe symptoms through dietary changes). But the confusion of correlation with causality is both frequent and potentially harmful. And it is unquestionably poor science!
I feel that we need to be concerned about the fact that even reputable journals let such things pass – not least because the above example shows what the popular press subsequently can make of such misleading messages.
DNP (2,4-dinitrophenol) is highly toxic. In the UK, it is illegal to sell DNP for human consumption. DNP causes serious harm to health. Its consumption has resulted in a significant number of deaths in the UK. Other side effects of DNP include:
- flushed skin
- rapid breathing
- an irregular heartbeat.
All this does not seem to deter entrepreneurs in so-called alternative medicine (SCAM). One of them has just been jailed. Jack Finney, 25, of Northwich in Cheshire, sold the highly toxic chemical 2.4-Dinitrophenol (DNP) between June 2017 and July 2020 on the dark web. Finney was sentenced at Chester Crown Court and was handed a 28-month prison sentence.
Several deaths have involved people in the bodybuilding world or those trying to lose weight. Bodybuilder Sean Cleathero, a 28-year-old, died at a hospital in High Wycombe, Buckinghamshire, in October 2012 after taking DNP. In another high-profile case, 23-year-old Sarah Houston tragically died after the medical student consumed a fatal dose of DNP while studying at Leeds University in 2013. In 2007, 26-year-old Selena Walrond, died after having taken DNP in a bid to lose weight. She too bought the deadly pills over the Internet.
In 2018, 31-year-old businessman Bernard Rebelo, from east London, was the first person to be convicted of manslaughter in relation to the sale of DNP pills. Mr Rebelo became a millionaire after selling the ‘weight-loss capsules’ to clients, but he was jailed for seven years after selling them to bulimic student Eloise Parry, who later died.
Reginald Bevan, Deputy Head of the National Food Crime Unit, said: ‘We welcome today’s sentencing as it sends a strong message to anyone seeking to profit from the illegal sale of this life-threatening substance. We continue to be relentless in pursuing and bringing to justice those who are endangering the public and breaking the law. This operation continues to demonstrate how seriously the NFCU takes the illegal sale of DNP for human consumption in the UK and through our close working partnership with local authorities and other law enforcement agencies in the UK and abroad that we are able to tackle offenders, close websites and work to disrupt possible supply routes within and into the UK.’
Don’t worry -it happens to the best of us: you have forgotten to get a present for someone.
Do not panic!
Here are five items that we discussed in 2021 on this blog and which might be suitable as a last-minute festive present:
- IRONY OF IRONIES: Gadgets allegedly protecting us from radiation have been shown to emit harmful radiation
How about a neckless? I know, it is perhaps not everyone’s taste but it has the additional advantage that, contrary to the manufacturer’s claim that it protects you from disease-causing radiation, it actually emits (radioactive) radiation. Ideal for a radiant Christmas, would you not agree?
- The ‘LOVETUNER’: Have a look at this, and you will never again think that Deepak Chopra is a charlatan
The festive season is foremost the season for love. If you want to make sure that your partner is tuned in, you must quickly get the LOVETUNER. Yes, it does work, after all, Deepak Chopra recommends it!
Another recommendation comes from the renowned Prof Harald Walach: a rosary! It is hard to imagine a present that befits Christmas better than this one.
Many people will over-indulge during the festive season. For them, Prince Charles’ Detox Tincture is the perfect present. You might have to search hard for it though; if I am correctly informed he had to take it off the market.
My final recommendation is divine – yes, truly! This divine protection oil is a must-have, particularly if you are not fully vaccinated.
PLEASE STAY HEALTHY OVER THE FESTIVE SEASON AND DON’T OVERDO IT,
WHATEVER YOU ARE UP TO.