My last word (I hope): Michael Phelps, cupping, and “integrative medicine” [Respectful Insolence]

As I mentioned yesterday, there are news events involving medicine (more specifically pseudoscience in medicine) that are so ubiquitous and irritating that they’re enough to bring me briefly out of my vacation to bang out a quick post. So it was when I wrote my post yesterday about Michael Phelps’ enthusiasm for cupping, a practice attributed to traditional Chinese medicine that is actually an ancient practice that seems to have been independently thought up in multiple cultures, such as the ancient Egyptians. Basically, cupping therapy is a near-universal practice dating back at least 3,500 years that was commonly practiced until at least the 1800s. Not surprisingly, the very ancientness of the practice is frequently used by advocates of cupping to argue for its efficacy, but I tend to like to turn that argument around and point out that a practice that’s it’s very telling that a practice that’s been around some 3,500 years has so little evidence for its efficacy. That’s plenty of time to prove a treatment works.

Be that as it may, it hadn’t been my intent to revisit cupping after yesterday, but then a reader pointed something out to me, namely how a part of the reason why cupping is now so accepted is because of the embrace of the prescientific medical system known as traditional Chinese medicine (TCM) by some of our most respected academic medical centers as part of “complementary and alternative medicine” (CAM) or, as it’s more commonly referred to, “integrative medicine.” Of course, it is obligatory (for me, at least) to point out whenever discussing integrative medicine that what integrative medicine involves is “integrating” pseudoscience, prescientific mystical beliefs, and quackery into real medicine. Traditional Chinese medicine is, after all, a prescientific belief system that is largely quackery in today’s world retconned by Chairman Mao to seem as though there’s something to it but that did, as many ancient medical systems have, find the occasional gem that actually works. The rest, particularly acupuncture, cupping, and tongue diagnosis, is based in prescientific vitalism.

Athletes, however, are notoriously superstitious. So it’s not too surprising that Michael Phelps and a lot of other American athletes would embrace cupping, particularly given that the US Olympic Swim Team trainer is clearly a believer. However, physicians, particularly physicians at our greatest academic medical centers, should know better. Unfortunately, they do not, which is a large part of the reason why integrative medicine is flourishing. Unfortunately, the Michael Phelps story revealed this to anyone paying attention. Here’s how. Basically, when on Sunday reporters noticed the large, ugly hickeys all over Michael Phelps’ shoulders and back, asked what the heck that was all about, and found out about cupping, they needed “experts” to interview for their stories. Integrative medicine programs all over the country provided those “experts,” who all gave answers that ranged from endorsement to what Kimball Atwood used to like to call the weasel words of woo.

For example, take a look at what Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, says in this story in VOGUE:

Dr. Alex Moroz, director of the Integrative Sports Medicine program at NYU Langone Medical Center’s Rusk Rehabilitation, uses cupping at home on himself and his family. He believes there’s wisdom in the ancient practice, as well as common sense. Cupping’s effect, he says, is “mechanical, much like a massage,” and though Moroz has not treated professional athletes personally, he says, “It makes sense that it would work for that group of muscular skeletal injuries and problems.”

One notes that massage doesn’t involve intentionally popping a bunch of capillaries in order to produce a bunch of huge hickeys that, when they get out of hand, can turn into full thickness necrosis of the skin. Yes, this complication is very uncommon, but when there is no objectively detectable benefit to cupping, that makes cupping all risk and no benefit.

Joining the crowd of academic “integrative medicine” specialists, there was a story this story from CBS Newsfeaturing Dr. Adam Perlman, director for Duke Integrative Medicine:

Perlman said he first spotted an Olympic athlete with telltale cupping marks while watching the women’s gymnastic competition this past weekend with friends.

“I was pleasantly surprised to see cupping marks. It really speaks to this level of integration we’re seeing with many things that are considered complementary medicine,” said Perlman, who has tried cupping for back pain and said it gave him relief.

Did you hear that? Dr. Perlman was happy to see Olympic athletes with cupping marks on them because they were evidence of the popularity of “complementary medicine.” Meanwhile, Dr. Robert Glatter, an ER doc at New York’s Lenox Hill Hospital, lays down a load of credulous BS:

“It causes blood vessels to dilate and increases blood flow,” said Glatter, an emergency physician at New York’s Lenox Hill Hospital, who is in Rio de Janeiro for the Olympics.

The aim of cupping is to relieve any blockages in the flow of energy and blood and lead to better recovery, Glatter explained.

“Blockages in the flow of energy”? It would appear that Dr. Glatter buys into the prescientific vitalistic thinking at the heart of TCM. One wonders what he would say if he were to be asked specifically what form of “energy” flow is “blocked” and describe a physiological mechanism that doesn’t involve handwaving and appeals to mysticism by which cupping “unblocks” it. One wonders if Dr. Glatter knows he’s spouting pure bullshit. Indeed, while admitting there’s no good evidence that cupping does what its proponents claim it does, Dr. Glatter joins Dr. Perlman in laying down more of the same:

But both Glatter and Perlman said the ancient therapy isn’t scientifically proven to heal anything.

“There’s no scientific evidence. There are multiple trials out there but no quality evidence. Producing giant welts on the body which basically make you feel better locally but injure local tissue doesn’t have any systemic impact,” said Glatter.

Of course, “integrative medicine” physicians like Dr. Perlman are anxious to claim legitimacy for cupping in light of so many Olympic athletes having shown their enthusiasm for the procedure. Perhaps they see potential new business coming their way. Wait. Scratch that. There’s no “maybe” about it:

If athletes or anyone else in the audience is seeing the alternative therapy and is interested in trying it, they should seek a qualified health expert, said Perlman.

“People should be looking for someone trained in traditional medicine and licensed and trained in Chinese medicine and who has graduated from an accredited school,” he advised, noting that cupping is usually part of a more comprehensive medical approach, used in combination with other therapies.

It’s an approach also advocated by another director of “integrative medicine” in another story about Phelps and cupping in TIME Magazine:

There is a difference between how cupping is practiced in traditional Chinese medicine and how it is used in Western medicine, says Dr. Brent Bauer, director of the Mayo Clinic Complementary and Integrative Medicine Program. Bauer says a traditional Chinese medicine practitioner would likely offer cupping as part of a larger integrative health check, which might include recommendations around nutrition and other health things, and not just as a one-off therapy. “It’s kind of an American phenomena, I think, to consider cupping by itself,” he says.

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.

Yes, like Duke, the Mayo Clinic has gone all in for quackademic medicine. It has one of the bigger and more prominent “integrative medicine” programs. Be that as it may, it’s amazing how much alike Dr. Perlman and Dr. Bauer sound. It’s also depressing that, even more than Dr. Glatter, Dr. Bauer, who is faculty at one of the most respected academic medical centers in the country—nay, the world!—is spewing vitalistic nonsense as though it were legitimate medicine, with his credulous discussion of “qi.”

The list of once proud and science-based academic medical centers that offer cupping is depressingly long. For instance, the University of Maryland offers it. So does Beth Israel Deaconness. In fact, it’s a pretty good bet that any academic medical center that offers acupuncture and TCM probably offers cupping because cupping is an integral part of TCM. Perhaps the most disturbing and irresponsible media statements on cupping came from the Cleveland Clinic, which, as I’ve described before, has gone all-in with TCM and “functional medicine” quackery. Check out the Cleveland Clinic’s Twitter feed:

.@TeamUSA sports a different kind of @Olympics ring at #Rio2016. It’s called #cupping. Listen as we explain.https://t.co/dL9CcR1NGh

— Cleveland Clinic (@ClevelandClinic) August 9, 2016

Note that this video features a TCM practitioner from the Cleveland Clinic touting the benefits of cupping. The complete video is right here on the Cleveland Clinic media page, which features Jamie Starkey, Lead Acupuncturist, Center for Integrative Medicine:

Yes, you saw it right here. A major academic medical center features on its media website a video showing one of its own employees, the “Lead Acupuncturist,” administering a quack therapy to a patient and touting its benefits for chronic pain and even asthma. (Yes, you heard that right, asthma.) There’s something wrong here, but unfortunately, the Cleveland Clinic apparently doesn’t see it. It gets worse, though.

More disturbing was this Tweet:

@da2102 (2 of 2) though other providers in traditional Chinese therapy will use cupping for asthma, GI issues and fatigue

— Cleveland Clinic (@ClevelandClinic) August 9, 2016

Yes, that’s the Cleveland Clinic’s official Twitter account. It’s sort of backing off Starkey’s claim that acupuncture is useful for asthma, while not really backing off. More importantly, in response to numerous requests from other Twitter users for actual scientific evidence supporting the use of cupping, the Cleveland Clinic can’t or won’t provide any. It’s almost as though the Cleveland Clinic knows that what it’s offering in its integrative medicine program is pure quackery but doesn’t care.

Sadly, the overall message coming from advocates of “integrative medicine” quackery is as disciplined and consistent as that of any political party and candidate. In this case, it is: When seeking pseudoscientific or prescientific treatments, be very sure that you only utilize a “qualified” and “licensed” practitioner (i.e., someone employed by Dr. Perlman’s program or other “legitimate” academic “integrative medicine” programs). Personally, I like to characterize this ploy as: Come for the cupping. Stay for the “comprehensive” quackery that “integrative medicine” integrates into real medicine.

That’s the message. Cupping is basically a gateway to the rest of the quackery integrative medicine “integrates” into real medicine.