Thanks, Michael Phelps, for glamorizing cupping quackery!

So, in case you hadn’t noticed, I was taking a brief vacation, a long weekend if you will. As a result, I hadn’t planned on posting new completely original material until Wednesday or Thursday. (Monday’s post, some of you noticed, was a modified crosspost from my not-so-super-secret other blog.)

Then something happened.

You know you’re a committed blogger when your vacation can be interrupted by an overpowering urge to write about something in the news. Longtime regular readers (or even not-so-longtime regular readers) can probably guess right away what I’m talking about. Of course, I gave it away with the title of this post, but to drive the point home, let’s take a look at this photo:

Michael Phelps, Rio 2016

Yes, it was all over the news Sunday night, with stories abounding over the purplish red circles on Michael Phelps’ shoulders and back as he helped the US swim team win Olympic Gold in the 4×100-meter relay. As Monday passed and I tried to stay away from skeptical news, I got more and more annoyed, as I saw credulous story after credulous story about the use of cupping by the U.S. Olympic team. It’s nothing new, either. Almost a year ago, Michael Phelps posted this to his Instagram account:

Thanks @arschmitty for my cupping today!!! #mpswim #mp ? @chasekalisz

A photo posted by Michael Phelps (@m_phelps00) on

He’s not alone, either. Eight months ago, American swimmer Natalie Coughlin posted this photo of herself undergoing the treatment:

Laughing because it hurts so bad. Gonna leave a mark! #AthleteLife

A photo posted by Natalie Coughlin (@nataliecoughlin) on

And even a longer time ago, nearly three years, to be precise:

Gee, I hope my #GoldenGoggles dress is open-backed.

A photo posted by Natalie Coughlin (@nataliecoughlin) on

And Olympic gymnast Alex Naddour:

Worse, given that NBC has the rights to cover the Olympics, NBC Sports has been delivering some truly irresponsible and credulous “journalism” about cupping:

Notice the tropes about this “ancient Chinese tradition” being merged with a “modern American one, winning.” It turns out that the head athletic trainer for the US Olympic Swim team, Keith Robinson, fully buys into this particular form of prescientific quackery:

“There is a psychological component where Michael has been doing this to feel good for a long time, about two years,” Mr. Robinson said. “Anything you can do to get the body to feel good — you have to use an educational assessment on it. You have to make sure that what you’re doing is causing a physiological intent to recover.

“I’m not just going to throw a stick of butter on him,” Robinson said, adding, “I’m going to make sure I have an educated approach to it.”

While there’s no question that many athletes, coaches and trainers believe in the treatment, there’s not much science to determine whether cupping offers a real physiological benefit or whether the athletes simply are enjoying a placebo effect.

If the goal is just to make the body “feel good,” then why bother with the nonsense that is cupping? A good massage would be The entire rationale behind cupping, as a hundred credulous stories tell us, is this:

In traditional Chinese medicine, the theory is that cupping can influence the flow of energy or “qi” through the body, says Bauer. If someone’s flow is blocked or stagnant, a practitioner might use cupping to impact the flow. Western practitioners may focus more on what the therapy might be doing to muscles or blood flow.

Is there any evidence for this? Certainly, as I’ve discussed in many posts about acupuncture, there’s no evidence that “qi” even exists, much less that acupuncture or cupping or anything else can influence its flow for healing effect. As for scientific evidence, there are studies. Heck, there are even systematic reviews. Typical reviews include this one, which suggests “a potential positive short-term effect of cupping therapy on reducing pain intensity compared with no treatment, heat therapy, usual care, or conventional drugs” and this PLoS review, which suggests “potential effect in the treatment of herpes zoster and other specific conditions” but concludes that “further rigorously designed trials on its use for other conditions are warranted.” However, even reviews in woo-friendly journals aren’t that enthusiastic; e.g. this one, which concludes that “there are few RCTs testing the effectiveness of cupping in the management of pain,” that “most of the existing trials are of poor quality,” and that “more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.” Personally, though, I tend to believe Edzard Ernst, when he did an overview of systematic reviews:

In essence, this means that the effectiveness of cupping is currently not well-documented for most conditions. This is in sharp contrast to the many claims made by the proponents of this therapeutic modality, including those practicing traditional Chinese medicine or complementary and alternative medicine.

All five systematic reviews relied on primary studies from China. Several groups have demonstrated that nearly 100% of all acupuncture studies from China generate positive results [9,10]. This finding raises considerable doubts about the reliability of these data. Table 1 also shows that the quality of the primary studies is often poor. Trials of poor quality tend to produce false positive results.

Exactly. Basically, reading the “evidence” for cupping tells me that there is no compelling evidence that cupping is effective for any condition. Certainly, there is no credible evidence that it helps athletic performance, be it in swimming or any other sport. Moreover, by the principles of science-based medicine, in which prior probability based on basic science is taken into account, the clinical evidence that weakly suggests a benefit can justifiably be called into serious question based on the extreme ridiculousness of the therapy and the lack of any sort of plausible rationale grounded in basic human physiology suggesting that it should work. In other words, the whole physiologic rationale for cupping is bullshit. As we know from other similar modalities, when that’s the case seemingly “positive” clinical trials become much less convincing.

Unfortunately, even though all of this is true, NBC Sports provided the template for a thousand local TV stations to do stories on cupping. For example, my local NBC affiliate sent one of its anchormen, Steve Garagiola, to a quack clinic to undergo cupping himself:

In this case, Lisa Vel of Renew Detroit Health is given carte blanche to lay down some howlers, like her appeal to antiquity in which she claims that “ancient Chinese medicine” like cupping has been practiced for 5,000 years. As I noted the last time I discussed cupping, even if it does date back 5,000 years, arguably so does bloodletting. If I were to argue that there must be something to bloodletting because it’s been practiced for thousands of years, you’d laugh at me—and rightly so. Yet, for some reason, when it comes to cupping (and, let’s face it, acupuncture and a lot of other traditional Chinese medicine quackery) this appeal to antiquity comes across as persuasive. I like to point out that 4,000 years ago in ancient Egypt, medicine and religion were one in the same, and the cause of a lot of disease was believed to be evil spirits. Indeed, what made Hippocrates’ views so revolutionary in ancient Greece is that he was among the first to argue that diseases had physical causes that could be addressed and were not caused by the gods or evil spirits.

Just out of curiosity, I checked out Renew Detroit Health’s website and immediately noticed a whole lot of quackery, primarily functional medicine, or, as I like to call it, making it up as you go along. Of course, as I’ve also mentioned many times, functional medicine embraces just about any form of pseudoscience and quackery you can imagine, complete with lab kits that cost $200 to $400 per kit. So it’s no surprise to me that Renew Detroit Health offers cupping. It’s also no surprise to me that my local NBC affiliate would so readily fall for this pseudoscience. After all, it did a when I first moved back to my hometown.

Sports celebrities are, of course, not a source of reliable health information. For one thing, athletes are notoriously superstitious. How many times have you seen stories of athletes who wear the same article of clothing endlessly as long as they are on a winning streak, no matter how disgusting it becomes? Or what about athletes who refuse to shower or shave as long as they are on a winning strak? You get the idea. Athletes have a distressing tendency to embrace pseudoscience, as long as they think it can give them an edge. For example, they believe that IV hydration helps them when it doesn’t; that kinesiology tape protects them from musculoskeletal injury when it doesn’t; and that acupuncture works when it doesn’t.

Yet, none of this stops advocates of cupping and other pseudoscience from promoting it as though it works, even though there is no evidence that it does. In fact, there is evidence that cupping can cause harm, up to and including full thickness skin necrosis that is, for all intents and purposes, no different than a full thickness burn. Just to jog your memory, I’ll repost a photo I posted before of this very phenomenon:

Yes, this can happen, and, yes, those are basically indistinguishable from bad burns, even though the injury is not due to heat.

Yes, this can happen, and, yes, those are basically indistinguishable from bad burns, even though the injury is not due to heat.

That’s what irritates me. Just because an Olympic champion like Michael Phelps believes that cupping works does not mean that it actually works. It doesn’t, and it can in some cases cause harm. It’s basically all risk, no objectively demonstrable benefit.

Sorry, Mr. Phelps, but all those nasty hickeys from cupping are all for naught.

Sorry, Mr. Phelps, but all those nasty hickeys from cupping are all for naught.

Unfortunately, that’s not the message we’re getting from the press. Oh, sure, there is the occasional nod to skepticism in some—but by no means close to all—stories in which it is mentioned, often almost in passing, that there is no evidence that cupping does any of the things its proponents claim that it does, that all it does is to produce what are, in essence, huge hickeys. However, even that little bit of skepticism, when it even manages to make its way into a story, is promptly overwhelmed by the glamor, attractiveness, and excitement of genuine Olympic athletes using this quackery. A better advertisement for cupping and traditional Chinese medicine is hard to imagine! Yet, that’s what most of the news media are providing us, brief infomercials for quackery.