Following is a transcript of this video; note that errors are possible:
Rohin Francis, MBBS: This isn’t a video… [BEEPING] Many hours later, well, let’s try this again. It’s now the night and for some reason my right ear is exceedingly hot. Now, this is a totally unplanned video. It’s not the one I intended to be working on at the moment, but I couldn’t miss the opportunity to tell you about something that happened this week.
While you could argue, indeed with a great deal of veracity, that this video is mostly about me showing off, actually, I think there are several … three or four really genuinely interesting things that have come out of Dwayne freaking Johnson responding to me on Twitter in what I hope you’ll agree was a perfectly civilized 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 are probably the best known.
For those of you that haven’t seen the channel before, my name is Rohin. I’m a doctor in the U.K. and I’m going to tell you what The Rock is cupping. Actually, this isn’t even a video about cupping. It’s much more interesting than that.
So what words were actually exchanged between a rock and a hard face? Now, I’m a huge fan of The Rock. I follow him online, and I saw on Instagram that he’d posted his experience of cupping to his 221 million followers. He said he enjoyed it and he didn’t say anything false. He said that he’s proactive in looking for things to help heal his body, which he obviously puts through a great deal.
I noticed Michael Phelps, who I think could be credited with really mainstreaming cupping when he appeared at the Olympics covered in the characteristic round bruises — I guess that would have been 2016 — cheering him on in the comments.
I tweeted the picture and I just said that, “Cupping’s not effective, Dwayne. Please don’t waste your time on it.” In a slightly dubious move for a doctor, I recommended that he drink tequila instead.
Amazingly, he replied within a few minutes to say, “No big deal. Don’t get vexed. I tried it out. I liked it.”
Then I finally responded by saying that the greatest Olympian in history and the biggest movie star in the world, one who’s particularly well-known for his physical prowess posting about quack therapies, even if not saying anything specific, can have ramifications.
I’ll explain why in this video, but first, for those of you genuinely interested in cupping, a quick paragraph or so.
Now, cupping has been tested repeatedly over the years. A meta-analysis from a few years ago analyzed 135 separate trials on cupping. Most were very poor quality, meaning they were not randomized controlled trials. Even those that were scored very low on the Cochrane risk of bias tool, and yet the sum of these trials showed that cupping offered no real 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 valid 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 about it to check out the references below. I’ve linked to easy-to-read studies and summaries from reputable sources, including researchers in China and from centers dedicated to studying complementary medicine, so I think, I hope, you’ll agree that I’ve tried to be as neutral as possible in the references.
Do take a read, but for everybody else, you can replace “cupping” with any alternative medicine practice for the purposes of this video and you’ll follow along just fine, because this isn’t about any specific one practice. It’s about understanding some key concepts in medicine.
Now, one thing I hate about social media is straw-manning. You’ve probably heard about this. It’s when you take the worst form of your opponent’s argument and treat that as the thing to disagree with and to make the argument easier. So while I saw people responding to cupping claims saying that it can be dangerous, that’s not why I don’t think it should be recommended.
Now, having thought about it, I’m not sure that that is straw-manning at all, but you see what I’m getting at here. I’m not making out cupping to be worse than it is. The meta-analyses, indeed, didn’t report any significant adverse effects. Some quack therapies are inherently dangerous, like bleach ingestion, highly restrictive diets, or pretty much anything that appears in a Chubbyemu video.
Those should be opposed because they’re dangerous — but just because others are harmless, or indeed completely inert in the form of something like homeopathy, it doesn’t mean they should be given a free pass.
From here on in, you can mentally replace cupping with any similar non-dangerous alternative therapy like sunning your perineum, or turmeric shakes or juice cleanses, homeopathy, reiki, or vitamin infusions.
Many of the comments … I’ll sort of take you through the points which were brought to me by comments that were made in response to the tweet or the Instagram post … many of the comments angrily demanded that I provide evidence that cupping doesn’t work, and they’ve got it backwards. The null hypothesis is that a therapy doesn’t work. You have to prove that it does.
Pharmaceutical companies, who I get the impression that fans of cupping are probably none too fond of, don’t bring out a new tablet and tell everyone it’s amazing and then shout at you, “Show me evidence it doesn’t work.” Believers in religion demand the same thing from atheists with that same logic.
I mention religion deliberately because I know there’s many, if not most of the replies to Dwayne Johnson’s original Instagram post seem to be people saying that cupping is an Islamic practice, and it’s favored by the Prophet, and it definitely works, and when practices have spiritual or religious or cultural significance, it can be really hard for people to look at them objectively, and we see this a lot with traditional medical systems.
Leading on from that, another comment that I got a lot was “Why do you think that 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 here, then I also assume you must defend their relentless efforts to drive endangered species to complete extinction in pursuit of aphrodisiacs and other pathetic quackery.
Murdering animals for medicine is probably far more ancient than cupping, so anyone who thinks that just because something has been around a while, that means it’s effective, I’m afraid you just haven’t studied any history. This is a naturalistic fallacy. It’s sometimes called the “Appeal to Ancient Wisdom.”
Another comment I got a lot was, “Well, it worked for me.” Now, people replied saying it helped them with their back pain or whatever like that, and I think this is where I think people infer my opinion incorrectly. I’m not some cynical BOT-3000 without human emotions.
When patients tell me that their pain is better after having done something that I know is not proven, I don’t Neil deGrasse [Tyson] their ass and say, “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 something I say repeatedly is that “placebo” is not a dirty word.
Many things that I do here in the hospital have a placebo effect. When I give medications or put stents in, or when people do operations, 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 I say nothing, the patient will hopefully derive a benefit, but if I say, “That went fantastically well. I’m really confident you’re going to feel much better. You’ll be thrashing your brother at tennis in no time,” then I’m doing what I can to help them harness that powerful placebo effect.
I’m not lying of course. You can’t tell a lie, but the placebo effect is the mind’s incredible power, producing physical effects.
If somebody says “I swear by Gwyneth Paltrow’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 that’s not evidence that 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 effect, you need randomized, blinded, controlled medical trials.
Finally, Michael Phelps and other elite athletes or megastars posting about unproven therapies might seem harmless. After all, they’re not actively saying anything false. They’re saying they tried it and it helped them, but that in itself is a massive influence on their followers. “The Rock tried it? The most decorated athlete in Olympic history credits it with helping him get to gold? Sign me up.”
And I sympathize that people want to share things that they’re doing, and celebrities are no different from other people, but they are different. They have much bigger following and they are influencers, the original influencers.
Then you might counter, “Well, so what? As we’ve said before, it’s not harmful.” Well, that’s only if I’m using it for something like back pain, which is normally not life-threatening. What if I go to a less scrupulous practitioner, one who claims that he can help my diabetes, my lupus, my cancer?
By mainstreaming and legitimizing practices outside proven science, it increases acceptance of things that don’t work and regular people can be harmed through neglecting effective therapies.
We’ve seen this with chiropractic, that I have no problem at all with people using it for their musculoskeletal problems. But because it’s become an accepted practice, then there’s this creep of unscrupulous chiropractors saying that it can do more than just relieve musculoskeletal pain.
Secondly, The Rock is rich, super-rich. But in some countries, like America for example, people often have to make choices about what healthcare they can afford. If they regard cupping as comparable to a proper therapy from a physiotherapist or another practitioner, and they can only afford one, they could make a choice that will harm them by choosing the wrong thing.
Now, 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.
Now, some people might say that I was a lot more receptive to things like the cold water immersion, but I think money is a key thing here. I don’t mind people doing things even if they don’t have a proven benefit, because I am a fan of the placebo effect, if that thing is free, but I don’t want people wasting money on things that don’t have a proven benefit.
Now, if you’re going to reply to this saying, “But conventional medicine fails people.” Don’t bother. I know. I agree. I’ve made videos about that too. This is not a defense of modern medicine. It’s an explanation as to why I was not comfortable with Dwayne Johnson promoting cupping, because, like it or not, that’s what he was doing, even if unknowingly.
Joe Rogan once said he started his podcast for fun and he isn’t trying to tell people what to do or to believe. He’s a comedian that enjoys talking to interesting people and it’s snowballed into this massive phenomenon. 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 and has one of the world’s biggest platforms and things do need to change. You can’t necessarily get away with the same stuff, just like Dwayne Johnson, and maybe they do need to be mindful about what they post.
We all agree with someone like Kim Kardashian and her vapid ilk promoting detox teas and other diarrhea-based weight loss techniques, but that’s bad. So we should also see that there’s a major difference between a private citizen curiously posting about trying out cupping to their 40 followers versus 211 million, and if that seems unfair, then I’m afraid that is the cost and the benefit of fame — people listen to what you say.
(video clip) The Rock: Ha, ha, ha. It works.
Francis: So let’s summarize. Number 1, the burden of evidence lies with proponents of a therapy, not the other way round.
Number 2, 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 that they will work for you, and I hate people being conned out of their money.
Number 3, just because something is ancient, it doesn’t mean that it’s good; I mean, just look at Rupert Murdoch.
Number 4, I believe celebrities and influencers do need to be extremely wary of their role in legitimizing unproven therapies. They might not say anything explicitly factually incorrect, but they inculcate acceptance of quackery, which might not be a big deal to multimillionaires, but to people with limited resources this can mean choosing an ineffective therapy over a proven one.
Number 5, 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 feet 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, and we’re going to star in a remake of Twins.
Rohin Francis, MBBS, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won’t find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.