WEBVTT - What's the deal with cupping and dry needling? 0:00:01.080 --> 0:00:03.119 Hi, Perry. We're here in person. 0:00:03.480 --> 0:00:05.040 It's so cool to be in person. This is our 0:00:05.080 --> 0:00:06.920 first in person episode. 0:00:07.120 --> 0:00:08.319 It's very nice to see your face. 0:00:08.720 --> 0:00:11.799 You too. We are in the lovely Yale Broadcasting Center 0:00:11.840 --> 0:00:15.120 here in New Haven, Connecticut. We have Ryan McAvoy, our 0:00:15.680 --> 0:00:20.040 Yale side you engineer in the background here making a 0:00:20.160 --> 0:00:23.680 sound amazing, and of course tomorrow our ever producer on 0:00:23.720 --> 0:00:25.080 the other end of the line. So cool. 0:00:25.239 --> 0:00:26.960 This is so fun, a great time. 0:00:27.280 --> 0:00:30.280 We're talking about cupping and dry needling today, and I 0:00:30.400 --> 0:00:35.200 came into this knowing deep in my soul one thing 0:00:35.600 --> 0:00:39.480 being true, and that is that Emily clearly would never 0:00:39.640 --> 0:00:44.160 do dry needling, because you have mentioned in at least 0:00:44.280 --> 0:00:48.560 six episodes so far that you're afraid of needles and 0:00:48.560 --> 0:00:51.200 and would never like do botox or anything like that, 0:00:52.280 --> 0:00:54.920 simply because you don't want someone injecting something into you. 0:00:54.960 --> 0:00:57.240 And then you kind of casually mention offhand like, oh, yeah, 0:00:57.640 --> 0:01:01.400 I had needles in me that they were electric current 0:01:01.480 --> 0:01:02.960 threat I have done. 0:01:03.120 --> 0:01:05.120 I have done this where they stick the needles in 0:01:05.160 --> 0:01:07.280 and they put like a like jumper. 0:01:06.959 --> 0:01:08.679 Cables on them and they go like. 0:01:10.480 --> 0:01:12.400 Yeah, yeah, yeah, and then and then they get your 0:01:12.480 --> 0:01:14.080 your muscle to contract a lot. 0:01:14.840 --> 0:01:16.440 What muscle? Why were you doing this? 0:01:16.680 --> 0:01:17.600 I was injured. 0:01:17.640 --> 0:01:20.280 Were they trying to extract information from you? 0:01:21.240 --> 0:01:25.200 It was it was in the service of recovery, you remember, 0:01:25.280 --> 0:01:29.600 I was. It was my very mean chiropractor who always 0:01:29.600 --> 0:01:30.319 fixes everything. 0:01:30.400 --> 0:01:33.840 His name is Dennis, and I don't know. 0:01:33.920 --> 0:01:36.720 He said that this would fix my problem, and I 0:01:36.840 --> 0:01:39.840 feel like it did, which is a comment about the 0:01:39.840 --> 0:01:40.679 rest of the episode. 0:01:41.920 --> 0:01:46.080 Okay, so I'm starting this episode incredibly surprised. Also hearing 0:01:46.080 --> 0:01:47.920 that Emily has a chiropractor. I don't know what I'm 0:01:47.920 --> 0:01:50.040 gonna do with that. I'm going to take that in 0:01:50.760 --> 0:01:52.600 as we go into the break. 0:01:56.000 --> 0:01:59.080 I'm Emily Aster, I'm an economist and a data expert. 0:01:59.160 --> 0:02:01.240 And I'm Harry Wilson, I'm a medical doctor. 0:02:01.480 --> 0:02:04.520 It's Thursday, June fourth, twenty twenty six. And this is 0:02:04.560 --> 0:02:06.280 wellness actually. 0:02:06.280 --> 0:02:09.760 Because you're getting a staggering amount of health and wellness 0:02:09.800 --> 0:02:13.639 information nowadays from every source imaginable, and some of it 0:02:13.680 --> 0:02:15.240 is awesome and some. 0:02:15.160 --> 0:02:20.320 Of it is well actually both Fortunately we are both 0:02:20.360 --> 0:02:22.919 people who know how to read studies, how to parse 0:02:22.960 --> 0:02:25.680 the data, and can tell you what's worth thinking about 0:02:25.720 --> 0:02:27.480 and what you can safely ignore. 0:02:27.800 --> 0:02:30.080 But before we dig in, a note that this podcast 0:02:30.160 --> 0:02:32.720 is for educational purposes and should not be construed as 0:02:32.760 --> 0:02:35.960 medical advice. We don't know your unique situation, so talk 0:02:36.000 --> 0:02:38.120 to your doctor for personal health decisions. 0:02:39.320 --> 0:02:42.519 This week we're asking what's the deal with cupping and 0:02:42.639 --> 0:02:45.880 dry needling? Perry and I will give the official smash 0:02:45.960 --> 0:02:47.880 or pass, and then we'll get to your question of 0:02:47.919 --> 0:02:50.280 the week. But first let's do the health news roundup 0:02:50.480 --> 0:03:04.320 after the break. And now for the health news of 0:03:04.400 --> 0:03:07.640 the week, Harry, I want to start with some really 0:03:08.520 --> 0:03:11.639 good news. There was a meeting of the American Society 0:03:11.639 --> 0:03:15.360 of Clinical Ecology this week, and perhaps the most successful 0:03:15.400 --> 0:03:20.320 presentation was about a new medication called direct sun recib, 0:03:21.000 --> 0:03:26.160 which is a pancreatic cancer treatment. The results in the 0:03:26.240 --> 0:03:31.360 survival curve pictures were so spectacular that the author got 0:03:31.440 --> 0:03:35.080 a forty two second standing ovation, and then, in the 0:03:35.240 --> 0:03:38.680 true spirit of people whose time is limited for their presentations, 0:03:38.840 --> 0:03:42.840 was like, that doesn't count against my time, So this 0:03:42.960 --> 0:03:45.840 is incredibly exciting. I will say, I want to hear 0:03:45.840 --> 0:03:48.560 what you think, but I also want to surface that 0:03:48.600 --> 0:03:50.160 one of the things that's come up some in the 0:03:50.200 --> 0:03:53.680 discussions online amidst the people saying this is amazing. Is 0:03:53.680 --> 0:03:57.280 people saying, oh, well, it's only a median survival increase 0:03:57.320 --> 0:03:59.960 of seven months. You know, where's my cure for cancer? 0:04:00.520 --> 0:04:02.360 And so I'm curious, where's my cure? 0:04:02.880 --> 0:04:03.200 Yeah? 0:04:03.280 --> 0:04:06.040 Okay, I mean, first of all, let's level set a 0:04:06.040 --> 0:04:10.920 little bit here. We're talking about metastatic pancreatic cancer. I mean, 0:04:11.560 --> 0:04:15.560 one of the worst diagnoses a person can possibly get. 0:04:15.600 --> 0:04:19.560 The one year survival after a diagnosis of metastatic pancreatic 0:04:19.600 --> 0:04:24.400 cancer is something like ten percent. Right, this is an 0:04:24.440 --> 0:04:30.240 absolutely terrible disease. This new drug, deroxonra sib is an 0:04:30.400 --> 0:04:34.720 oral RAS inhibitor, so it's not chemotherapy per se. It's 0:04:35.320 --> 0:04:39.279 it's obviously quite powerful, but it targets a mutation that's 0:04:39.279 --> 0:04:42.919 commonly found in these cancers. And this was a phase 0:04:42.960 --> 0:04:46.039 three randomized control trial of five hundred patients with metastatic 0:04:46.080 --> 0:04:49.920 pancreatic cancer, pretty big trial in this space. And the 0:04:50.279 --> 0:04:57.000 difference in median survival was about six months. Associated you 0:04:57.000 --> 0:05:01.000 can translate that into a survival rate different or hazard 0:05:01.080 --> 0:05:04.560 ratio of zero point four or five, So you can 0:05:04.600 --> 0:05:07.240 think of that like a fifty five percent reduction in 0:05:07.320 --> 0:05:11.160 the risk of death over time. This is unheard of 0:05:11.720 --> 0:05:16.040 in this disease, Like, it's really there's nothing that's ever 0:05:16.040 --> 0:05:18.480 come close to this, hence the standing ovation at the 0:05:18.520 --> 0:05:23.240 ASCO meeting. But yes, it's not a cure, you know, 0:05:23.279 --> 0:05:28.440 it's unlikely, sadly to say, like curing absolutely curing any 0:05:28.560 --> 0:05:31.000 given disease is always a bit of a pipe dream, 0:05:31.279 --> 0:05:34.440 with the exception of rare infectious diseases that only infect 0:05:34.520 --> 0:05:37.120 humans and can be prevented with vaccines, and even then 0:05:37.360 --> 0:05:39.800 we have a great deal of difficulty doing that. People 0:05:39.839 --> 0:05:43.440 will continue to die of pancreatic cancer because there's a 0:05:43.440 --> 0:05:46.839 lot of mutations and things that can make different cancers different. 0:05:46.839 --> 0:05:50.440 But this is obviously a huge improvement over the status quo. 0:05:51.080 --> 0:05:52.440 I think the other thing that I want to ask 0:05:52.480 --> 0:05:55.240 you about, because I'm sure you'll have a thought on this, 0:05:55.440 --> 0:05:59.039 is people looking at the difference in median survival of 0:05:59.120 --> 0:06:01.840 like okay, six months or whatever, and they say, oh, well, 0:06:01.880 --> 0:06:04.120 but how much are we spending for six months of life? 0:06:04.360 --> 0:06:06.920 And I know we've talked about this offline, like, I 0:06:06.960 --> 0:06:08.600 don't think this is the right way to think about this. 0:06:08.720 --> 0:06:09.680 Tell me how you think. 0:06:09.760 --> 0:06:10.280 Yeah, I don't think so. 0:06:10.520 --> 0:06:12.640 I mean I think often people hear that and they think, well, 0:06:12.640 --> 0:06:14.120 if I didn't get the treatment, you would live for 0:06:14.120 --> 0:06:15.520 three months, and if you got the treatment, you would 0:06:15.520 --> 0:06:17.320 live for nine months, as if those things are sort 0:06:17.360 --> 0:06:21.560 of set in stone. But in fact, what this is 0:06:21.800 --> 0:06:26.120 sort of translating to is at all time points, people 0:06:26.200 --> 0:06:29.720 are less likely to die. And they've kind of aggregated 0:06:29.760 --> 0:06:32.440 that out. But what it means is that you're getting 0:06:32.880 --> 0:06:35.880 increased survival, you know, potentially for quite. 0:06:35.600 --> 0:06:36.240 A long time. 0:06:36.880 --> 0:06:38.000 And it's an average. 0:06:38.040 --> 0:06:40.279 It's an average, and so when we think about like 0:06:40.320 --> 0:06:42.560 what would it mean to cure something or what would 0:06:42.560 --> 0:06:47.680 it mean to sort of deliver a lengthy period that 0:06:47.720 --> 0:06:50.599 would be very meaningful. Some of the people who are 0:06:50.680 --> 0:06:54.240 treated with this new treatment lived. In fact, about half 0:06:54.279 --> 0:06:58.080 of them were still alive at a year, which is 0:06:58.240 --> 0:07:02.360 again compared to ten percent, and you know, again some 0:07:02.400 --> 0:07:04.120 of those people are going to be live longer than that, 0:07:04.200 --> 0:07:06.919 so you're buying some time on the on the tail. 0:07:07.000 --> 0:07:09.640 I think the other thing people miss is, Okay, this 0:07:09.720 --> 0:07:12.200 is a first line of this, like we're going to 0:07:12.280 --> 0:07:14.240 get better, The side effects are gonna. 0:07:14.240 --> 0:07:16.400 Presumably be better under. 0:07:16.080 --> 0:07:18.920 Control, and it's you know, opening up new lines for 0:07:19.000 --> 0:07:21.600 how we would have longer term survival. And if you 0:07:21.640 --> 0:07:25.560 look at something like metastatic breast cancer, which you know 0:07:25.680 --> 0:07:30.600 has had prior to this a lot of innovation, the 0:07:30.680 --> 0:07:33.280 way people are thinking about the potential survival and that 0:07:33.400 --> 0:07:37.200 disease is very different than they were ten years ago, 0:07:37.400 --> 0:07:39.400 including to the point of saying, you know, maybe people 0:07:39.400 --> 0:07:42.760 could live ten twenty years with metastatic ye breast cancer. 0:07:42.800 --> 0:07:45.120 So just this feels like the same thing, like with 0:07:45.240 --> 0:07:47.880 metastatic melanoma, which also used to be like, oh, that's 0:07:47.880 --> 0:07:51.800 a death sentence, and now with immunotherapies and some other therapies, 0:07:51.840 --> 0:07:53.440 it's like, no, okay, people are living. I mean, take 0:07:53.480 --> 0:07:56.560 Jimmy Carter right a long time with metastatic melanoma. So 0:07:56.600 --> 0:07:58.360 this is huge progress. It's just we've made a lot 0:07:58.560 --> 0:07:59.520 on abashedly good. 0:07:59.400 --> 0:08:01.720 News, exactly very very good news. 0:08:02.000 --> 0:08:05.600 We don't usually think about mosquitoes as being good news, 0:08:05.800 --> 0:08:10.960 but maybe it is Google. Yep, Google and the alphabet 0:08:11.000 --> 0:08:15.680 company that Google wants to release thirty two million mosquitoes 0:08:15.800 --> 0:08:20.200 in Florida and California, presumably so that we all stay 0:08:20.200 --> 0:08:21.840 inside and use their services more. 0:08:23.200 --> 0:08:24.880 It's a pitch towards the Internet. 0:08:24.960 --> 0:08:29.920 No So the goal here is to release mosquitos male 0:08:30.000 --> 0:08:36.400 mosquitoes that are sterile and that would then outcompete the 0:08:36.480 --> 0:08:41.040 non sterile mosquitoes for sexual partners, but then be unable 0:08:41.440 --> 0:08:45.520 to fertilize the eggs due to being sterile, and that 0:08:45.520 --> 0:08:48.840 that would lower the mosquito population. So it's basically an 0:08:48.880 --> 0:08:53.199 attempt to control the longer term mosquito population by introducing 0:08:53.200 --> 0:08:56.640 a bunch of mosquitoes that are shooting blanks in the 0:08:56.760 --> 0:08:58.040 hope that you will get fewer later. 0:08:58.160 --> 0:09:02.679 By the way, a mosquito vest actimy veryal surgery, very difficult, delicate. 0:09:02.800 --> 0:09:03.560 Very delicate. 0:09:03.760 --> 0:09:08.520 Fortunately they're using other techniques to achieve this. So this 0:09:08.600 --> 0:09:12.400 is actually something that has been tried with some success 0:09:12.440 --> 0:09:16.840 in other settings, particularly in places where malaria is endemic. 0:09:16.920 --> 0:09:19.160 This is something people have talked about as a potential 0:09:19.240 --> 0:09:24.120 approach to eliminating the species of mosquitoes that spread malaria, 0:09:24.120 --> 0:09:27.960 and we've had we've had some success with that. The 0:09:28.080 --> 0:09:30.240 trick here is, of course, you probably don't want to 0:09:30.280 --> 0:09:32.760 get rid of all of the mosquitoes, and most species 0:09:32.840 --> 0:09:36.360 of mosquitoes do not cause disease in people. 0:09:36.400 --> 0:09:37.480 So in the US there are. 0:09:37.400 --> 0:09:40.040 Some diseases you get through mosquitoes like a snile, you 0:09:40.040 --> 0:09:43.480 can get triple E, which is very bad. But most 0:09:43.520 --> 0:09:47.000 mosquitoes are just annoying and they also feed the birds 0:09:47.000 --> 0:09:48.920 and the frogs and other things that we like. So like, 0:09:48.960 --> 0:09:51.640 completely getting rid of mosquitos is probably not a good idea. 0:09:51.679 --> 0:09:55.320 But this isn't a potential approach. You think you're okay 0:09:55.360 --> 0:09:57.520 with it now, but then there's no frogs, and then there's. 0:09:57.360 --> 0:09:58.440 No whatever is bigger. 0:09:58.440 --> 0:10:02.160 Okay, listen, it's it's an ecosystem. 0:10:02.320 --> 0:10:02.600 Okay. 0:10:03.160 --> 0:10:06.000 By getting rid of the mosquitoes that that give you 0:10:06.120 --> 0:10:08.960 terrible diseases is something people are interested in, and this 0:10:09.040 --> 0:10:12.280 is this is one sort of simple approach that is, 0:10:12.559 --> 0:10:16.080 you know, arguably better than spraying up with a bunch 0:10:16.080 --> 0:10:17.760 of toxins, which we've tried in the. 0:10:17.679 --> 0:10:19.320 Past and have some downsides. 0:10:19.600 --> 0:10:24.680 All right, all right, Perry, there's a new study about farting, 0:10:25.040 --> 0:10:27.200 and I love you to just say more about farting. 0:10:28.120 --> 0:10:30.120 So I wrote about this study this week, and it's 0:10:30.120 --> 0:10:32.160 what she did, because of course I did. Because the 0:10:32.200 --> 0:10:34.280 Derek sonracib study comes out and it's like, oh, this 0:10:34.400 --> 0:10:37.400 is the greatest advanced in metastatic pancreatic cancer in you 0:10:37.440 --> 0:10:40.360 know history, and I'm like, but this week I'll be 0:10:40.400 --> 0:10:46.240 writing about fart yep, So here we are. So a 0:10:46.280 --> 0:10:51.080 new study in gem and Network open tracking the gaseous 0:10:51.120 --> 0:10:55.199 emissions of a bit over six thousand Australians as part 0:10:55.200 --> 0:10:59.040 of a citizen science initiative. They they all volunteered and 0:10:59.040 --> 0:11:02.480 downloaded an app called Chart Your. 0:11:02.400 --> 0:11:05.400 Fart, Chart Your Fart and uh. 0:11:05.840 --> 0:11:09.200 When you fart, you open the up and you mark 0:11:09.280 --> 0:11:12.840 the time of day and you can also optionally like 0:11:13.240 --> 0:11:18.920 rated across several scales, including the smell and the audibility, 0:11:19.000 --> 0:11:21.960 and actually one of the things was the detectability, which 0:11:22.000 --> 0:11:28.360 is you know, to test weather you smelt it. The 0:11:29.000 --> 0:11:32.880 actual reason for the study is to generate normative data 0:11:33.400 --> 0:11:36.600 on how often people fart, so that you can have 0:11:36.720 --> 0:11:40.920 some baseline against which to measure outcomes for gas or 0:11:40.960 --> 0:11:45.599 intestinal illness trials. So if people are complaining about excessive flatulence, 0:11:45.800 --> 0:11:47.640 like you need to know what normal is. You can 0:11:47.640 --> 0:11:49.640 be like, oh, yes, that is excessive, so you need 0:11:49.640 --> 0:11:51.320 to kind of have a normal distribution. That's what the 0:11:51.360 --> 0:11:54.880 study was for. I was looking into a little bit 0:11:54.920 --> 0:11:59.160 of the history of studies of farting. Farting. One of 0:11:59.160 --> 0:12:04.360 the earliest was from seventeen eighty one. There was a 0:12:04.840 --> 0:12:08.040 seventy five year old scientist who noted that we fart 0:12:08.080 --> 0:12:10.400 about seven times a day, by the way, the Australian 0:12:11.080 --> 0:12:13.320 study said about five times a day, men slightly more 0:12:13.400 --> 0:12:14.720 than women. But I think women are lying. 0:12:15.800 --> 0:12:18.359 Men are also lying, but it's probably. 0:12:18.120 --> 0:12:20.920 More than that, right anyway, back in seventeen eighty one, 0:12:21.480 --> 0:12:23.720 seven times a day, according to this scientist, and he 0:12:23.800 --> 0:12:27.400 wanted to create a prize to invent a substance that 0:12:27.440 --> 0:12:30.240 could be added to our food that would make quote, 0:12:30.760 --> 0:12:33.640 the natural discharges of wind from our bodies not only 0:12:33.679 --> 0:12:37.960 an offensive but agreeable as perfumes, sort of saying like why. 0:12:37.679 --> 0:12:39.160 Can't we just why can't our fart smell that? 0:12:39.400 --> 0:12:41.320 And yeah, why can't our fart smell better? And you know, 0:12:41.400 --> 0:12:45.400 it's been more than whatever twound amost two hundred fifty 0:12:45.480 --> 0:12:49.199 years and we have not we have not cracked that 0:12:49.520 --> 0:12:58.800 particular chestnut. Do you know who that scientist was, Benjamin Franklin, Benjamin. 0:12:58.840 --> 0:13:00.640 Okay, that guy had a lot of good ideas and 0:13:00.679 --> 0:13:01.839 some less good ideas. 0:13:01.679 --> 0:13:02.959 And I think it was like a little bit of 0:13:03.000 --> 0:13:03.600 a dirty bird. 0:13:04.240 --> 0:13:06.480 Okay, do you think I think a little bit. You know, 0:13:06.600 --> 0:13:07.400 they probably all were. 0:13:08.520 --> 0:13:10.079 The other thing that I thought was interesting from this 0:13:10.120 --> 0:13:11.960 study is when people fart, they fart at night. 0:13:12.360 --> 0:13:15.439 So you far like the majority of it, but you're 0:13:15.480 --> 0:13:16.440 not tracking at night. 0:13:17.840 --> 0:13:20.960 Between seatween six and ten pm after dinner, when people 0:13:21.000 --> 0:13:24.079 have consumed a larger meal, more fiber, that's when the 0:13:24.160 --> 0:13:25.640 farts get going. 0:13:25.920 --> 0:13:28.360 I mean, that's certainly when my dog is farting them, right. 0:13:29.480 --> 0:13:32.079 No comment on yourself. Okay, all right, that's it for 0:13:32.160 --> 0:13:34.200 the health news of the week. After the break, what's 0:13:34.240 --> 0:13:36.439 the deal with cupping and dry needling? 0:13:42.760 --> 0:13:45.600 And we're back. We are going to talk about cupping 0:13:45.720 --> 0:13:48.160 and dry needling. Today is a two for one episode. 0:13:48.840 --> 0:13:52.240 We'll start with We'll start with cupping. Smash your past cupping, 0:13:52.760 --> 0:13:54.960 then move on to dry needling, do the same thing. 0:13:55.200 --> 0:13:56.640 So I want to start with cupping, and I'm going 0:13:56.679 --> 0:13:59.920 to play you a clip from a science y talking 0:14:00.280 --> 0:14:03.679 influencer online, you know, saying like, what is this cupping 0:14:03.720 --> 0:14:04.920 stuff that people are talking about? 0:14:05.240 --> 0:14:08.400 For over three thousand years, Cupping was an ancient practice 0:14:08.600 --> 0:14:11.880 that helped people accelerate their bodies healing. The practice was 0:14:11.960 --> 0:14:15.280 documented in ancient Egypt and China, and it was also 0:14:15.440 --> 0:14:18.000 endorsed by Hippocrates, and so how cupping works is that 0:14:18.080 --> 0:14:21.560 it applies a gentle vacuum pressure upon the surface of 0:14:21.640 --> 0:14:23.880 the skin and tissues, and it's more than just pulling 0:14:23.920 --> 0:14:26.840 on your skin. Studies have shown that cupping dilates your 0:14:26.840 --> 0:14:31.200 blood vessels to improve circulation, removes metabolic waste by improving 0:14:31.280 --> 0:14:34.800 your lymphatic drainage, and supports the local immune function in 0:14:34.880 --> 0:14:38.320 that area. And past randomized control trials show that cupping 0:14:38.480 --> 0:14:42.560 is an amazing complementary therapy, helping people with chronic lower 0:14:42.640 --> 0:14:47.360 back or neck pain, fibromyalgia, and even migraines. And even better, 0:14:47.680 --> 0:14:51.920 cupping helps you fight stress by improving your body's parasympathetic 0:14:52.000 --> 0:14:55.920 tone and also regulating the stress hormone called cortisol. Key 0:14:56.040 --> 0:14:58.480 takeaway here is don't judge a book by its cruise cover. 0:14:58.840 --> 0:15:02.040 Cupping is one of those agent practices fused with modern 0:15:02.080 --> 0:15:04.880 science that shows it accelerates your body's healing. 0:15:05.440 --> 0:15:06.800 Walk me through, what do you think when you hear 0:15:07.240 --> 0:15:08.120 that off the top? 0:15:09.880 --> 0:15:10.760 This is ridiculous. 0:15:10.840 --> 0:15:12.720 It's the same thing I think when I see I mean, 0:15:12.760 --> 0:15:14.720 I just like that is my first REACTIONA my brother 0:15:14.800 --> 0:15:15.360 has this done? 0:15:15.440 --> 0:15:15.760 Actually? 0:15:15.920 --> 0:15:18.680 Oh, and he's always showing up to family vacations with 0:15:18.800 --> 0:15:22.520 these like bruises, not bruises, but these things all over. 0:15:22.440 --> 0:15:23.440 Oh no, they're bruises. 0:15:23.560 --> 0:15:24.960 Okay, He's always showing. 0:15:24.800 --> 0:15:26.960 Up with all of these things all over himself, and 0:15:27.680 --> 0:15:29.680 I always just think, I think it's ridiculous, and I 0:15:29.760 --> 0:15:31.720 make fun of him, as one does with one siblings. 0:15:32.040 --> 0:15:34.120 Yeah, I mean, you should always make fun of your siblings. 0:15:34.200 --> 0:15:37.480 But we do need to check what the evidence actually shows. 0:15:37.680 --> 0:15:40.760 I mean, one of the things when our listeners are 0:15:40.880 --> 0:15:43.560 hearing that there are things that often show up in 0:15:43.680 --> 0:15:47.400 this space that sound legitimate and kind of aren't. One 0:15:47.520 --> 0:15:50.360 is called the argument from antiquity, which you know, he said, 0:15:51.280 --> 0:15:53.480 you know, from the over the for at least three 0:15:53.520 --> 0:15:57.800 thousand years, people have been doing this, and they're implicit 0:15:57.920 --> 0:16:01.080 in that statement is like, well it must work if 0:16:01.120 --> 0:16:03.080 people have been doing it for three thousand years. And 0:16:03.360 --> 0:16:06.640 of course there's countless counterexamples of things that people have 0:16:06.800 --> 0:16:11.480 done for a very long time, like bleeding people for disease. 0:16:11.520 --> 0:16:16.320 They have ideas, you know, crushing which is under large stones, 0:16:16.360 --> 0:16:18.360 and other things that they did for an awfully long 0:16:18.440 --> 0:16:20.440 time that probably weren't a good idea. So I always 0:16:20.520 --> 0:16:22.080 kind of when I hear the argument from antiquity, I 0:16:22.160 --> 0:16:23.440 kind of roll my eyes and like, all right, but 0:16:23.480 --> 0:16:23.800 we can do. 0:16:23.840 --> 0:16:25.800 Better than that. Yeah, I agree with that. 0:16:25.880 --> 0:16:27.640 I also I want to take a step back on 0:16:27.720 --> 0:16:29.640 both cupping and try anything, because I think this is 0:16:29.680 --> 0:16:33.360 a place where we are going to have to engage 0:16:33.640 --> 0:16:35.720 aggressively with the placebo effect. 0:16:35.960 --> 0:16:37.880 So we talked about the placebo effect a lot. 0:16:39.000 --> 0:16:41.720 Just to be clear, the placebo effects refers to the 0:16:41.800 --> 0:16:43.760 fact that when you do something to someone or have 0:16:43.880 --> 0:16:46.280 somebody take something or tell them in some way something 0:16:46.400 --> 0:16:49.400 might make them better, even if you did nothing, even 0:16:49.440 --> 0:16:51.160 if the pill you give them is a sugar pill. 0:16:51.320 --> 0:16:55.880 Even if the cups are not effective and do nothing 0:16:56.680 --> 0:16:58.920 you can, you will are still likely to get people 0:16:59.000 --> 0:17:01.720 to respond because they think something's going to happen. 0:17:02.200 --> 0:17:06.760 And that is a very very powerful effect. And this 0:17:06.960 --> 0:17:08.440 works even better than we think. 0:17:09.440 --> 0:17:12.080 So one piece of this is that placebo effects tend 0:17:12.119 --> 0:17:14.400 to work better when people believe that they're going to work, 0:17:15.000 --> 0:17:16.840 So if you believe in something, it's. 0:17:16.760 --> 0:17:20.160 More likely to show up as a placebo. 0:17:21.280 --> 0:17:23.200 The second thing, and this is I think my most 0:17:23.320 --> 0:17:25.840 interesting fact about placebo effects, is that you can get 0:17:25.880 --> 0:17:27.200 a placebo effect even if. 0:17:27.080 --> 0:17:28.280 You tell someone it's a placebo. 0:17:28.600 --> 0:17:30.800 So if you tell someone I am giving you a 0:17:30.920 --> 0:17:33.440 sugar pill, but a lot of people find that it 0:17:33.520 --> 0:17:36.040 helps even though there's nothing in this pill, you will 0:17:36.080 --> 0:17:38.760 get a placebo effect versus telling them, you know, versus 0:17:38.840 --> 0:17:39.480 not telling them that. 0:17:39.920 --> 0:17:42.560 Like, people can get the placebo. 0:17:42.200 --> 0:17:44.639 Effect even if they know it's fake. And I think, like, 0:17:44.760 --> 0:17:48.520 that's it's crazy that brain. The brain is so interesting. 0:17:48.720 --> 0:17:51.440 But what that means for this stuff is or for 0:17:51.600 --> 0:17:54.920 any kind of any kind of attempt at a causal 0:17:54.960 --> 0:17:59.840 inference of some treatment, is you really need to generate 0:18:00.080 --> 0:18:03.960 a placebo feeling in everyone. So if you give people 0:18:04.359 --> 0:18:07.440 a vaccine, we give everybody a vaccine. We don't just 0:18:07.480 --> 0:18:09.040 give half the people a vaccine and tell the other 0:18:09.080 --> 0:18:10.800 people while you're in the control group, we give them 0:18:10.840 --> 0:18:12.679 a vaccine of something else, so they think that they 0:18:12.760 --> 0:18:13.920 got the vaccine. 0:18:13.800 --> 0:18:17.399 Or yeah, some different, some different we give them like 0:18:17.480 --> 0:18:18.280 that they have to believe. 0:18:19.560 --> 0:18:22.960 It is very difficult to do that kind of placebo 0:18:23.040 --> 0:18:27.040 control trial with something where the result of the treatment 0:18:27.119 --> 0:18:29.520 is to end up with giant welts all of yourself. 0:18:29.400 --> 0:18:31.879 Because it's like, what is the fake welts, you know. 0:18:32.119 --> 0:18:34.000 Yeah, and it comes up in the needling stuff too, 0:18:34.160 --> 0:18:37.119 Like it's people have to know that they did this, 0:18:37.240 --> 0:18:39.240 And we can talk about how how studies try to 0:18:39.240 --> 0:18:39.760 control for this. 0:18:39.880 --> 0:18:42.479 But for me, this whole space is like very wrapped 0:18:42.560 --> 0:18:44.520 up in the fact that it could just be all 0:18:44.560 --> 0:18:46.240 the placebo effect or a huge share of it. 0:18:46.480 --> 0:18:48.879 Yeah, when we talk about the studies, we'll try to 0:18:48.920 --> 0:18:53.159 flag when studies are quote sham controlled, which is the 0:18:53.280 --> 0:18:56.600 idea being that they do something to you. It's the 0:18:56.720 --> 0:18:59.399 equivalent of a placebo. But as you're pointing out, this 0:18:59.560 --> 0:19:01.080 is a case where that's very like how do you 0:19:01.160 --> 0:19:02.639 do that right? And what we'll talk about that and 0:19:02.680 --> 0:19:04.960 whether it's adequately controlled. The other thing I want to 0:19:04.960 --> 0:19:09.600 say about placebo effects is that there are certain outcomes 0:19:09.640 --> 0:19:12.479 that are more amenable to placebo and some that are 0:19:12.640 --> 0:19:18.880 less so. Subjective outcomes things like pain, mood, energy, fatigue, 0:19:18.920 --> 0:19:21.719 things that you kind of self report are quite susceptible 0:19:21.800 --> 0:19:28.920 to placebo effects, you know, things like death, LDL, cholesterol stuff. 0:19:28.640 --> 0:19:31.199 Like that you get this infectious disease YEA. 0:19:31.920 --> 0:19:35.280 Those are more objective, and although there are actually some 0:19:35.480 --> 0:19:38.080 studies that even show placebo effects in those areas, they 0:19:38.119 --> 0:19:40.400 generally are not as strong as we'll see in this area. 0:19:40.520 --> 0:19:44.080 And so when you come to wellness things like cupping 0:19:44.119 --> 0:19:47.680 and dry needling, it's like a perfect storm of Okay, 0:19:48.040 --> 0:19:51.880 is this placebo? Is something biological actually happening? And there's 0:19:51.960 --> 0:19:54.879 one other whole set of things that we'll hit on 0:19:55.000 --> 0:19:57.560 here as long as we're taking a fifty thousand foot 0:19:57.640 --> 0:20:00.440 view before we really dive in. And that's thing called 0:20:00.480 --> 0:20:05.200 co intervention bias. So a classic example of co intervention bias. 0:20:05.320 --> 0:20:07.840 Let's say I have a new blood pressure drug and 0:20:07.920 --> 0:20:09.719 I'm going to test it against placebo. So I got 0:20:09.760 --> 0:20:11.280 a sugar pill and a new blood pressure drug, and 0:20:11.280 --> 0:20:12.920 I split my group in half and half get the 0:20:12.920 --> 0:20:15.879 blood PRESSU drug, half get the placebo. But you know, 0:20:16.560 --> 0:20:18.720 in the group that gets the blood pressure drug, I 0:20:18.840 --> 0:20:21.240 call them once weak to check in to see if 0:20:21.240 --> 0:20:23.600 they're having any side effects. I know the placebo people 0:20:23.600 --> 0:20:25.680 aren't having side effects. It's a sugar pill. But I'm 0:20:25.680 --> 0:20:27.000 a little worried, So I'm going to call once a 0:20:27.000 --> 0:20:28.359 week and be like, hey, like, how you doing. You 0:20:28.400 --> 0:20:33.920