Cupping therapy – what nonsense?

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Posted 11 September 2013

A consumer lodged a consumer complaint against Dr Maroula Lambis’s print advertising appearing in the Cape Times during July 2013.

DrMaroulaLambisThe advertisement provides a quick description of what the practice of “cupping therapy” entails, and explains that this, inter alia, “improve[es] circulation by removing toxins, congestion and inflammation … brings nutrient rich blood to the affected area, facilitating the body’s healing process”.

It also specifically lists the following conditions under the heading “Cupping Therapy”: “Joint pain • Muscular tension • Sports injuries • Colds, flu, asthma • Anxiety, stress • Detoxification • Headache, sinusitis • Migraine • IBS, indigestion”

The complainant submitted that there is little evidence that dry-cupping (the procedure advertised) has any efficacy in treating any symptoms.

Cupping Therapy / K Charleston / 22475
Ruling of the : ASA Directorate
In the matter between:
Kevin Charleston Complainant(s)/Appellant(s)
Dr Maroula Lambist/a Holistic Healthcare & Cupping Therapy Respondent

09 Sep 2013

http://www.asasa.org.za/ResultDetail.aspx?Ruling=6674

Mr Charleston lodged a consumer complaint against the respondent’s print advertising appearing in the Cape Times during July 2013.

The advertisement provides a quick description of what the practice of “cupping therapy” entails, and explains that this, inter alia, “improve[es] circulation by removing toxins, congestion and inflammation … brings nutrient rich blood to the affected area, facilitating the body’s healing process”. It also specifically lists the following conditions under the heading “Cupping Therapy”:

• “Joint pain
• Muscular tension
• Sports injuries
• Colds, flu, asthma
• Anxiety, stress
• Detoxification
• Headache, sinusitis
• Migraine
• IBS, indigestion”.

COMPLAINT
The complainant submitted that there is little evidence that dry-cupping (the procedure advertised) has any efficacy in treating any symptoms. An overall evaluation of trials (mostly done on “wet-cupping”, where the patient’s skin is also cut to allow blood flow) found that the trials relied on as evidence were all subject to high bias, and that more research was needed before any definitive conclusions could be drawn.

Normal medicine practice abandoned cupping therapy more than a century ago, and the procedures described in the advertisement make no physiological sense. The complainant explained that even if one were able to increase blood flow to the treated area of skin, it is nonsensical to argue that this blood would be more “nutrient rich” than the blood found in the rest of one’s body. Extrapolating further treatment possibilities related to, inter alia, reducing anxiety or detoxifying the body is ridiculous.

RELEVANT CLAUSE OF THE CODE OF ADVERTISING PRACTICE
The complainant identified Section II, Clause 4.1 (Substantiation) as relevant for this complaint.

RESPONSE
The respondent submitted that there are many modalities of medicine practiced throughout the world which adhere to standard Scopes of Practice. Depending on the modality of medicine being practiced, these Scopes of Practice (i.e. what is considered “normal” protocol) differ.

In South Africa, CAM (Complementary and Alternative Medicine) practitioners use cupping therapy as treatment for various conditions. It added that cupping therapy has not been abandoned. It has been used since around 3000BC and continues to be used to this day by traditional Chinese Medicine and Unani Tibb medicine.

Dealing with the particular issues raised, the respondent submitted that the complainant has misread the reference to “nutrient rich” blood. It explained that the concept of detoxification is well-accepted and practiced in the CAM field. As blood is defined as fluid “carrying nourishment and oxygen”, the reference to “nutrient rich” blood should be interpreted in this context. The suggestion seems to be that the respondent regards blood as “nutrient rich” in general, and that this particular therapy merely draws this “nutrient rich” blood to the area treated.

The respondent further argued that Randomised Control Trials cannot provide conclusive proof of any medical practice, and certainly cannot refute the benefits of a particular method of treatment that is considered standard scope of practice.

The respondent concluded by stating that its practice has successfully treated all the conditions listed in the advertisement. Patients arrived specifically because they desired cupping therapy. The advertisement does not claim to cure, but merely to facilitate the body’s healing process, which cupping therapy does. The complaint is based on personal opinion rather than experience or expertise.

ASA DIRECTORATE RULING
The ASA Directorate considered all the relevant documentation submitted by the respective parties.

Clause 4.1 of Section II stipulates that any and all claims (whether direct or implied) that are capable of objective verification, should be verified by an independent and credible expert in the field to which the claims relate.

Considering the advertising as a whole, the Directorate is satisfied that it promotes the practice of cupping therapy on the premise that this will assist with (the advertisement refers to “Enjoy the benefits …” all the conditions listed at the top of this ruling. The advertisement also elaborates on what consequences such therapy would have (improving circulation, removing toxins, congestion and inflammation, and bringing nutrient rich blood to the affected area). The point is also made that “Cupping is effective as a stand-alone treatment, or in combination with other therapies” and that “Acute conditions respond quickly to cupping, whereas chronic conditions may require initial weekly sessions followed by monthly sessions”. Subsequent to this, the therapy is touted as beneficial for:

• “Joint pain
• Muscular tension
• Sports injuries
• Colds, flu, asthma
• Anxiety, stress
• Detoxification
• Headache, sinusitis
• Migraine
• IBS, indigestion”

These benefits are communicated as a matter of fact, not of potential depending on whether or not one subscribes to a particular belief or paradigm (Scope of Practice). As such, the advertising and relevant efficacy claims are clearly capable of objective verification in terms of Clause 4.1 of Section II.

The respondent has not submitted any independent verification from an independent and credible expert in the field to which these claims relate (i.e. circulation, removal of toxins, congestion, inflammation, joint pain, muscular tension, sports injuries, colds, flu, asthma, anxiety, stress, headaches, sinusitis, migraine, IBS or indigestion). It has merely explained that it subscribes to a particular paradigm insofar as healing is concerned, and alleged that it has had success in treating each of the conditions listed in the advertising.

At best, this amounts to anecdotal evidence and unsupported allegation, which is not sufficient for the purposes of Clause 4.1 of Section II.

It should also be emphasised that it is trite that the ASA requires product-specific evidence. In this case, the advertising promotes a specific manner of treatment, which would therefore require evidence that the specific manner in which the respondent applies its treatment will guarantee the claimed results.

Given the lack of any kind of evidence as required by the Code, the Directorate has no option but to find that the advertising at issue is in breach of Clause 4.1 of Section II of the Code.

The respondent is therefore required to:

Withdraw the advertising and relevant efficacy claims,

Ensure that it actions the required withdrawal with immediate effect upon receipt of this ruling,

Ensure that the advertising and relevant claims are withdrawn within the deadlines stipulated in the Code,

Ensure that the advertising and relevant claims are not used again in their current format in future unless adequate substantiation has been submitted, evaluated, and accepted by way of a new Directorate ruling.

The respondent’s attention is also drawn to the provisions of Clause 15.5 of the Procedural Guide, which effectively requires it to withdraw the advertising and claims from any media in which they appear, irrespective of the fact that the complainant might not have alluded to a particular media.

The complaint is upheld.

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18 Responses to Cupping therapy – what nonsense?

  1. Francois 22 August, 2014 at 5:32 pm #

    I am 56 years of age and are very hyperactive and have been on many medications in order to control the unbearable itching that occurs when stressed. I have scratched myself many times until the it bleeds in order to relieve it. Many neurologist have tried varies “cures” but with no success. I have even been on some of the strongest epelipsy meds. I have some time ago tried vacuum cupping, home kit with a hand pump. I place it on the stress point on my back and when I apply vacuum after a while the the first blood that appears are brown of colour an very thick. after acupping session I can go for another month well relieved. This works for me. I focus on the local area and use it only when needed. I fully support that it could work for other simpyoms also. The problem is whem people claim that a certain therapy cures all.

  2. Jennifer 30 November, 2014 at 8:55 pm #

    Cupping is such a New Age rip off. be warned, all it does is leave ugly marks where the cups have been. This is horse manure, snake oil rubbish at its best. Spend not one cent on this!

  3. Derrick Z. Venter 28 July, 2015 at 1:06 pm #

    In response to one…Jennifer.

    First of all there is nothing NEW AGE about Cupping Therapy..It is and has been in use in different cultures dating as far back as the writings of the prophet Mohammed and has been prolific in the East for more than 1500 years.Was a time not so long ago that Western Allopathic medicine practitioners said the same thing you are saying about acupuncture which now is a mainstream alternative and natural treatment modality accepted as such worldwide.

    Cupping Therapy works for me in many different ways including headaches and migraines, stress reduction (Better than and way more comfortable than deep tissue stress relief massage), sport injury recovery including broken clavicle and rheumatoid pain.

    There are many anecdotal comments from leading medical practitioners that cupping therapy works as an alternative and healthier choice for a growing list of ailments and injuries…

    Case in point…Dr. Elliot Shevel, Head of the Johannesburg Headache and Migraine Clinic…A world recognized and constantly quoted physician, in a Fair Lady article about 2 years ago, stated that Cupping Therapy Silicone Massage Cups are the BEST natural alternative for consistent and painful headaches and migraines.

    More and more people from all walks of life are finding cupping therapy is the answer to problems that have persisted for years that our so called medicines (pharmaceuticals) were unable to address…

    • Harris 28 July, 2015 at 1:43 pm #

      @Derrick and other readers
      Cupping has not been shown to work for all conditions claimed, although it may occasionally give an anecdotal positive results. Anecdotes have no place as evidence. The problem is that scam artists now make claims that cupping will be effective for a range of conditions that have never been evaluated in studies, e.g., cellulite, weight-loss, and a myriad of other conditions. The few studies have been poorly conducted and not rigorous enough. For example, a recent study of the effectiveness of cupping for low back pain, found it to be effective. However the conclusions clearly state: “Placebo-controlled trials are needed.” In other words, the results may have been simply a placebo result. In a study of cupping for treating neck pain in video display terminal users versus a heating pad, there was evidence that the former was more beneficial than the latter and that 4 participants reported mild adverse events of cupping.

      Here is the conclusions of a recent published Chinese review (2015):
      “To know the research progress of cupping therapy all over the world, the authors analyze the research of cupping therapy in recent 5 years. It indicates that cupping therapy can be applied to extensive curable disease, but has poor clinical evidence. Some improvements in the mechanism research of cupping therapy have been made, but it needs further research. The adverse events of cupping therapy attract attention.”

      I urge readers to be careful in ensuring that the claims are valid for cupping. In the majority of claims, there is simply no evidence to may those claims.

  4. Derrick Z. Venter 28 July, 2015 at 2:01 pm #

    So Harris…why don’t you initiate a clinical trial and do further research…I know what cupping therapy has done for me and my family and many friends…The main reason I have invested a lot of money into developing the perfect medical silicone cupping therapy massage cup and MIRA DYNAMICS…Further to the lack of evidence as you put it…I guess a billion people or more on the planet that swear by this alternative treatment on a daily basis must be experiencing a placebo effect.

    I have long suffered migraine and arthritis because of Haemochromatosis and since discovering cupping 3 years ago I am yet to fill a pharma prescription…and probably will never do so again.

    I have thousands of people that have told me that cupping has worked for them for many, many different ailments…including photographic evidence from hundreds that have treated cellulite successfully…at home.

    • Harris 28 July, 2015 at 2:21 pm #

      @Derrick
      “a billion people or more on the planet that swear by this alternative treatment” – this is your belief but there is no proof that this is true. In fact, highly unlikely I would guess.
      “migraine and arthritis because of Haemochromatosis and since discovering cupping 3 years ago I am yet to fill a pharma prescription” – if this is true for you, great. Of course, since you sell this product, your claims could be truly believed or simply to induce people to use your treatment that may, for all we know, be nothing more than placebo.
      “I have thousands of people that have told me that cupping has worked for them” – could be true, could be simply stated to get people to buy your product.
      “why don’t you initiate a clinical trial and do further research” – you will note that the study I quote above, was conducted by Chinese researchers (Deng XL, Chen B, Chen ZL), who should know a lot more about cupping than you or I. However, I agree with you, research is needed – why do you not put up the money and approach Health Sciences at UCT or Stellenbosch University to confirm your claims, for a condition of your choosing?

  5. Francois Greeff 28 July, 2015 at 2:10 pm #

    One question to people making it of as not working, have you ever tried it?
    It does stimulate blood flow and my wife also use it for her accute Eczema – It works by promoting the circulation. She has been most of of the scecialists and the best treatments of cortozone etc. She use cupping in the specific area when is gets out of control and within a day the results can be seen. So please try is as localised treatment to assist with blood circulation.
    I Have Evidence – I Have Prooved It.
    I cannot vouch for using it in other forms like acupunture.

    • Harris 28 July, 2015 at 2:24 pm #

      @Francois
      Research has shown that up to around 30% of people with eczema can have a marked placebo responses. For example, I once saw a teenager with severe eczema and on a very restricted diet. By simply stopping his restricted diet (implemented elsewhere), resulted in his eczema resolving as it was highly contributed to by stress (of the diet)

  6. Francois Greeff 28 July, 2015 at 2:50 pm #

    @Harris
    Before you talk get your facts straight.
    Topical eczema has nothing to do with placebo effect.
    My wife (57) was born with it and both my 2 boys was born with same condition. Everything was tried, alergy tests, diets etc. The only thing that got it in remision was complete withholding of any chemical, soaps, nail polish, the LOT. Epizaone E and Cortozone(no so safe as it thins the skin and has many other side effects) when it gets severe. My wife it the most sceptical person alive, please don’t come with your plecebo theory. Nothing you say will convince me otherwise. Try it youself on something as simple as a pimple. Like I said. I can speak of it on localized area to assist with bloodflow. Read my other post. You don’t have to use it, it works for me.

    • Harris 28 July, 2015 at 2:59 pm #

      @Francois
      You will note, I have stated elsewhere that if a product works for you, great. But that is not evidence but anecdotal, i.e., may be true, may be placebo, may be anything including natural remission of the condition, regression to the mean, etc. I am simply making the argument that unless there is proper evidence that a claim can be proved to be true for most if not all users of that product, then one cannot know whether the claim is true, a belief, a placebo response, remission, regression to the mean, a Hawthorn effect, or the myriad of other reasons why some people get better even when a product is nothing but a scam. For example, individuals have claimed to lose weight with a specific product, but when the product was checked, had no ingredients present.
      So if cupping worked for you, great. But that is not evidence that it does work for people in general.

  7. Derrick Z. Venter 28 July, 2015 at 3:14 pm #

    You may postulate placebo…etc. Fact is…Cupping Therapy works…Works for my headaches and migraines, my arthritis, tennis elbow and broken bone recovery…I had classification 4 clavicle break. Was told by 3 different surgeons here in CT that I needed surgery, that I was going to be in a sling for 8 weeks followed by 8 weeks of physio and 9 to 12 months full recovery…NOT…Exactly 59 days after accident I had 99.9% use of my arm and shoulder…10 days in a sling, no surgery, no physio…Solution at home…30 – 40 minutes per day of parked static cupping…done!

    • Harris 28 July, 2015 at 4:48 pm #

      @Derrick
      The fact that this works for you does not mean anything except that you are expressing a belief. From this I cannot know or express a point of view whether you truly believe this, or simply making this claim in order to induce people to buy your products. CamCheck is full of comments from owners of companies who swear that their product works even when study after study shows it to be false, or even when the product contradicts the laws of physics and science.

      I contacted Dr Shevel regarding your comment, i.e., he supports cupping. He responded “I have never heard of Bellabaci and most certainly would never endorse cupping as a headache treatment. This is a complete scam”. I asked permission to share his position. He replied that “. . .what I may have said about cupping in general is that like any alternate therapy, if it works for you that is fine – but I certainly would never have recommended it”.

      As I have stated earlier, readers need to be very careful with claims being made by someone selling a product, including Big Pharma products, and the evidence they state supports their claims.

  8. Derrick Z. Venter 28 July, 2015 at 3:15 pm #

    Anecdotal..yeah…Evidence…most positively so…

  9. Derrick Z. Venter 28 July, 2015 at 6:08 pm #

    I never said that Elliot Shevel endorsed the product…Inthe Fair Lady article in 2011, I believe…I have looked for it and unfortunately cannot find it online…Elliot Shevel was being interviewed and there was insert where he…Elliot Shevel, said that cupping therapy… and specifically next to a picture of the Bellabaci massage cup displayed…This was the best alternative to pharmaceuticals for migraines…and I will maintain that he spoke in a favorable light about Bellabaci…whether he remembers or not is his problem…

    Further more…I am certainly not expressing a belief…I am telling you my first hand experience with these cups for a broken clavicle…”sheared”.

    There is no study claiming that cupping therapy does not work only that there are few studies to prove that it does…Nothing false about my claims and certainly not using this platform to “SELL” my products…

    Furthermore, perhaps you should read up on cupping from people that practice this modality on a daily basis…BTW..very few practitioners have the deep pockets to do a clinical case study…certainly, I would love to.

    • Harris 28 July, 2015 at 6:48 pm #

      @Derrick
      I doubt that Dr Shevel would have forgotten, and he certainly would have told me whether he had changed his opinion.

      The point I will repeat: unless there is robust evidence to confirm that cupping does indeed support the claims being made, one cannot know whether they are true or a scam.

      For readers who remain unsure about cupping, here is a good review in Wikipedia
      “Very few scientific studies have been conducted on the validity of cupping as an alternative medical practice. In fact, a significant amount of studies either do not support cupping practices or are unable to reach a conclusion concerning its effectiveness.” “A 2012 review of the evidence in an article published in PLOS ONE said that studies appeared to show that cupping therapy was effective for treating a number of conditions, but that “nearly all included trials were evaluated as high risk of bias” – better designed studies would be needed in order to reach definitive conclusions.” [135 studies were evaluated]

      Furthermore, readers should be alerted to the fact that adverse effects occur. Here are a few of many.

      “The adverse events of cupping therapy are commonly caused by improper manipulation of medical practitioners, ignoring contraindication and patient’s constitution. Clinical practitioners should use cupping therapy cautiously, follow strictly the rules of standard manipulation and medical core system, pay attention to the contraindication and take strict precautions against the occurrence of adverse events.”
      Zhou X, Ruan JW, Xing BF. [Analysis on the adverse events of cupping therapy in the application]. [Chinese] Zhongguo Zhen Jiu. 2014 Oct;34(10):1023-5.

      Cupping may be associated with bloodborne infections.
      Rehman A, Ul-Ain Baloch N, Awais M. Practice of cupping (Hijama) and the risk of bloodborne infections. Am J Infect Control. 2014 Oct;42(10):1139. doi: 10.1016/j.ajic.2014.06.031.

      Mycobacterium massiliense infection associated with cupping therapy.
      Lee SY, Sin JI, Yoo HK, Kim TS, Sung KY. Cutaneous Mycobacterium massiliense infection associated with cupping therapy. Clin Exp Dermatol. 2014 Dec;39(8):904-7.

  10. Derrick Z. Venter 28 July, 2015 at 6:22 pm #

    In closing…I find it rather limiting to have to deduce and formulate a conclusion based on a “clinical trial” by so called “experts” and Big Pharma marching out the “paid for shills” to write their findings in so called industry periodicals and interviewed on main stream media “specialty shows” that such and such a product works for this and that.

    As an example…It is becoming more evident by the day that so called “cure cancer treatments” are by all accounts more dangerous and insidious than the disease itself…and just because there are no clinical trials that conclude that cannabis oil cures cancer does not mean that cannabis oil does not…

    In my humble opinion…and experience…and I am by no means a doctor or trained in the field…MY EYES advise me as to what I believe and conclude…

    My great granny would give sage advice on natural alternatives to the crap we are sold…with no side effects…and oftentimes that granny remedy worked…I have to take into account the wisdom of passed down remedies over corporations and their shills to heart.

    • Harris 28 July, 2015 at 7:01 pm #

      @Derrick
      This is a false argument. The fact that Big Pharma has major problems, has ‘shills’, etc., does not excuse alternative scams or unproven treatments, nor let them off the hook. We as consumers have to guard against ALL therapeutic fraud, whether it be Big Pharma or CAMS. Scientific evidence is at present the only tool we can utilise to separate facts from fiction. Belief is just that, a belief.

      And sadly, your eyes could deceive you. Many years ago, doctors firmly believed their own eyes that bleeding patients made them better. Only a study showed that their own eyes were deceiving them, which led to the end to the bleeding of patients. Many other examples!

  11. Derrick Z. Venter 28 July, 2015 at 7:13 pm #

    @Harris…

    Listen…I am not wanting an argumentative conflagration with you…My eyes and what I have experienced with cupping specifically is what it is…and I will strand by that statement…

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