This is a totally unplanned video but I couldn’t miss the opportunity to tell you about something
that happened this week - and while you could argue, indeed with some veracity,
that this video is mostly about me showing off, actually I think there are three really
interesting points to talk about that have come out of Dwayne Freaking Johnson responding to me
on twitter, in what I hope you’ll agree was a perfectly civilised exchange. The subject was
cupping and I’m not talking about prison tailors, I’m talking about the practice of placing suction
cups on the body which is done in many ancient medical systems like traditional Chinese or
Arabic medicine. My name is Rohin, I’m a doctor in the UK and I’m going to tell you what the
Rock is cupping. Actually this isn’t even a video about cupping, it’s more interesting than that.
So what words were actually exchanged between a Rock and a Heart Face? I am a huge fan of
The Rock & follow him and saw on instagram that he’d posted his experience of cupping to his 221
million followers. He said he enjoyed it and he’s proactive in looking for things to help
heal his body which he obviously puts through a lot. I noticed Michael Phelps, who I think
could be credited with really mainstreaming cupping when he appeared at the Olympics
covered in the characteristic bruises, cheering him on. I tweeted the pic saying cupping is not
effective and saying Dwayne please don’t waste your time on it and in a slightly dubious move for
a doctor I recommended he drink tequila instead. Amazingly, he replied within a few minutes to say
no big deal, don’t get vexed, I tried it out and liked it and finally I replied saying that the
greatest Olympian in history and the biggest movie star in the world posting about quack therapies,
even if not saying anything specific, can have ramifications. I’ll explain why in a sec.
But first, for those of you genuinely interested in cupping, a quick paragraph. Cupping has been
tested repeatedly over the years. A meta-analysis from a few years ago analysed 135 separate trials
on cupping. Most were very poor quality studies, meaning they were not randomised controlled
trials - and even those that were scored low on the Cochrane risk of bias tool. And yet the sum
of these trials showed that cupping offered no benefit except perhaps in herpes zoster,
or shingles. Another analysis of over 500 trials again showed limited value,
concluding that there is insufficient high-quality evidence to support the use of cupping therapy
on relevant diseases. The only trials that showed some benefit
in certain pain syndromes were not deemed of good enough quality to draw any conclusions. Honestly
that’s about all I want to say about cupping because frankly, it doesn’t really interest me.
I do urge anyone who wants to learn more to check out the references below.
I’ve linked easy-to-read studies and summaries from reputable sources including researchers
in China and from centres dedicated to studying complementary medical techniques.
You can replace ‘cupping’ for any alternative medicine practice for the purposes of this video
and you’ll follow along fine, because this is more about understanding some key concepts in medicine.
One thing I hate about social media is straw-manning, ie
taking the worst form of your opponent’s argument and treating that as the thing to disagree with.
So while I saw some people responding saying that cupping can be dangerous, that’s not why I don’t
think it should be recommended. The meta-analyses didn’t report any significant adverse events.
Some quack therapies like bleach ingestion, highly restrictive diets, or pretty much
anything in a ChubbyEmu video, should be opposed as they’re dangerous. But just because others
are harmless, or indeed completely inert, it doesn’t mean they should be given a free pass.
So from here on in, you can mentally replace cupping
with any similar non-dangerous alternative therapy like sunning your perineum, turmeric
shakes, juice cleanses, homeopathy, reiki or vitamin infusions.
Many of the comments angrily demand I provide evidence that cupping doesn’t work. They’ve
got it backwards. The null hypothesis is that a therapy doesn’t work, you have to prove it does.
Pharmaceutical companies, who I get the impression fans of cupping are none too fond of, don’t bring
out a new tablet, tell everyone it’s amazing and shout “show me evidence it doesn’t work!”
Believers in a religion demand atheists show god doesn’t exist with the same logic, and I mention
that as most of the replies to Dwayne’s original insta post seem to be people saying
cupping is an Islamic practice favoured by the prophet and it definitely works.
When practices have spiritual, religious or cultural significance, it can be very hard for
people to look at them objectively and we see this a lot with traditional medical systems.
Another comment I got a lot was “why do you think you know better than a practice
that’s been around for thousands of years, it wouldn’t have lasted if it didn’t work”. I mean,
if traditional Chinese medicine is your model then I assume you’d also defend their relentless
efforts to drive endangered animals to complete extinction in pursuit of aphrodisiacs and other
pathetic quackery? Murdering animals for medicines is probably more ancient than cupping. Anyone who
thinks that just because something has been around a while, that means it’s effective, I’m afraid
just hasn’t studied any history. This naturalistic fallacy is called the Appeal to Ancient Wisdom.
Next, “it worked for me”. People replied saying it helped them with their back pain. And this is
where I think people infer my opinion incorrectly. I’m not some cynical-bot 3000 without feelings.
When patients tell me their pain is better after having done something I know is not proven,
I don’t Neil Degrasse their ass with an ‘well actually’, I say “that’s great!” And you know why
I say that, because contrary to what people assume doctors will say, I love the placebo effect! I’ve
said this many times now but there are new viewers and whatnot, but placebo is not a dirty word.
Many things I do have a placebo effect. When I give medications or put stents in,
they have scientifically proven benefit. But EVERY SINGLE MEDICAL THERAPY has
an additional placebo or nocebo effect on top. If I do an operation and say nothing,
the patient will hopefully derive a benefit. But if I say “that went fantastically well, I’m
very confident you’re going to feel much better, you’ll be thrashing your brother at tennis again!”
then I’m doing what I can to help them harness the placebo effect. I don’t
lie, but the placebo is the mind’s incredible power producing physical effects.
So if someone says “I swear by Gwyneth’s Essential Oil collection, it cured my long COVID” that’s
genuinely wonderful. That person’s suffering has improved, the effect is real for them. But. But.
That’s not evidence it works. That has no implication that it will work for YOUR long COVID.
You may get a similar placebo effect, you may not. For information about whether things work
beyond placebo effects, you need randomised, blinded, controlled clinical trials.
Finally, Michael Phelps and other elite athletes or mega stars, posting about
unproven therapies might seem harmless enough to you. After all,
they’re not actively saying anything false. They’re saying they tried it, it helped them.
But that in itself is a massive influence on their followers. The Rock himself tried it?
The most decorated athlete in Olympic history credits it with helping him to gold? Sign me up!
And then you might counter, well so what, as we’ve already said it’s not harmful.
That’s only if I’m using it for my back pain. What if I go to a less scrupulous practitioner?
One who claims that he can help my lupus, my diabetes, my cancer? By mainstreaming
and legitimising practices outside proven science, it increases acceptance of things that don’t work
and regular people can be harmed through neglecting effective therapies.
Secondly, The Rock is rich. But in some countries like America,
people often have to make choices about what healthcare they can afford.
If they regard cupping as comparable to proper therapy from a physio or another practitioner,
and they can only afford one, they could make a choice that will harm them.
You don’t need me to tell you the litany of stories of people that have come to harm or died
because they put all their faith - and their money - into quacks instead of conventional medics.
If you’re going to reply to this with “but conventional medicine fails people”,
don’t bother - I know. I agree. I’ve made videos about that too. This isn’t a defence
of modern medicine, it’s an explanation on why I wasn’t comfortable with Dwayne Johnson
promoting cupping. Because, like it or not, that’s what he was doing, even unknowingly.
Joe Rogan once said he started his podcast for fun and isn’t trying to tell people what to do or
believe etc. He’s a comedian that enjoys talking to interesting people. But by allowing guests to
promote pseudoscience on the biggest podcast in the world, it doesn’t matter what his intentions
are, he has to understand that he is now one of the world’s biggest influencers, just like Dwayne
Johnson. And maybe they do need to be mindful about what they post. We all agree that Kim
Kardashian and her vapid ilk promoting detox teas and other diarrhoea-based weight loss techniques
is bad, so we should also see that there is a major difference between a private citizen
curiously trying out cupping and posting about it to their 40 followers, vs 211 million. If that
seems unfair, then I’m afraid that is the cost and benefit of fame - people listen to what you say.
Let’s summarise:
The burden of evidence lies with proponents of a therapy, not the other way around.
The placebo effect is not a bad thing! I’m all for harmless alternative therapies
helping people harness the power of their mind but anecdotes don’t mean they will work for you.
Just because something is ancient, doesn’t mean it’s good. Just look at Rupert Murdoch.
I believe celebrities and influencers do need to be extremely wary of their role in legitimising
unproven therapies. They might not say anything explicitly factually incorrect,
but they inculcate acceptance of quackery which might not be a big deal to a multi-millionaire
but to people with limited means, this can mean choosing an ineffective therapy over a proven one.
And most of all, don't let me distract you from the fact that in 1998,
The Undertaker threw Mankind off Hell In A Cell, and plummeted 16 ft through an announcer's table.
So moral of the story, The Rock and I are best friends and I’m quitting medicine to
join the WWE as The Pebble aaand we’re starring in a remake of Twins together. Goodbye suckers.