Cupping; the policy of pseudoscience

Why evidence doesn’t matter when it comes to regulation of bogus treatments

Remember the now-infamous picture of Michael Phelps’ stunningly crafted body (the man is basically Adonis) sporting some odd-looking hickeys? Alternative or ‘complementary’ medicine is a personal favorite of mine, so I’m going to take you through the wonderful world of cupping; one of the many hilariously nonsensical treatments that I have personally tried.

Cupping just isn’t the same without some added magic

If you’re anything like me, you spent many a teenage makeout session with someone awkwardly trying to suck the skin off your neck whilst simultaneously elbowing you in the groin. With that experience under your belt, cupping will feel familiar but with a few differences; generally there is somewhat less elbowing, it’s not just on your neck, and your practitioner will only rarely use tongue. In brief, cupping is the ancient practice of creating suction against the skin via a cup, usually made of glass, which is then left on for a period of time. This is thought to have a vast panoply of effects on the body, with the primary claims that it can improve circulation and remove toxins*.

Which is nonsense; everyone knows that eye cucumbers are the only treatment for toxins.

Cupping is currently used by many athletes to improve their performance, primarily due to the claim that it can treat pain and reduce recovery time. Some athletes consider it an effective way to boost performance without resorting to drastic and illegal measures, and many more are willing to try just in case their opponents are getting an edge through spit-less hickeys.

“But Roger!” You cry, “That sounds completely nonsensical! Suction on your skin can’t magically improve your performance!”. You may have gotten my name wrong, but you’re mostly correct. Cupping is an ancient treatment, and much like malaria therapy (curing syphilis with malaria), bloodletting (draining blood to cure disease) and fire therapy (setting someone on fire), it has no plausible mechanism of action. To put it simply, there is no reason that cupping would have any effect on your body other than some round marks.

But remember; magic

Now you might be thinking that, for athletes to put their faith in a treatment, there must be some sort of scientific evidence behind it. After all, people stake their careers and even lives on the treatments, so it can’t all be crap, right?

Wrong.

Well, kinda.

There is very little evidence in support of cupping for any health condition. This doesn’t mean that there haven’t been some reasonably good studies. There have. They have shown that, overall, cupping performs no differently to placebo. The only exception is that there may be some effect for cupping in reducing chronic pain, but the evidence is exceptionally inconclusive and fairly weak as well.

The basic picture is that cupping has no reason to work, probably shouldn’t work, and has been shown not to work when we look at all the evidence to date.

So why do we let people do it?

Policy

It’s worth noting that regulation of alternative therapies like cupping is, at best, a tricky proposition. People like thinking that they can cure their problems with easy treatments, and practitioners usually firmly believe that their treatment works, even if presented with evidence that it doesn’t. They think they’re helping people. No one wants to stop helping people. Any politician who tries to cut back on these treatments is inevitably vilified.

However, the general policy in Australia (luckily for us) is that it is not acceptable for practitioners to advertise or perform services for which there is a distinct lack of an evidence base. And whilst cupping is generally quite innocuous, it’s worth remembering that there are dangers attached to the therapy (don’t follow that link unless you enjoy throwing up).

However, the policy is only as good as it’s enforcement. And whilst the Australian Health Practitioners Regulation Agency technically forbids advertising something that creates “an unreasonable expectation of beneficial treatment”, very rarely are practitioners pulled up on any of the multitudinous claims that they make. So next time you see someone advertising cupping, take a photo and write a quick complaint to AHPRA. I’ve done it several times. Making your voice heard is always a good idea. If you have time, write a note to the Health Minister in support of further reviews of the regulation of alternative practitioners in Australia, or to your local member about the bogus practices taking place in their back yard.

If we all make some noise, maybe we can get cupping replaced with something that actually works. Maybe we can put the money spent on nonsense to good use where it’s actually needed.

I live in hope.

*It’s always worthwhile remembering that the word ‘toxin’ relies on some common and simple misunderstandings of science. If you hear someone use it, run away.