Speaker 1: Hi, Perry. We're here in person.
Speaker 2: It's so cool to be in person. This is our
Speaker 2: first in person episode.
Speaker 1: It's very nice to see your face.
Speaker 2: You too. We are in the lovely Yale Broadcasting Center
Speaker 2: here in New Haven, Connecticut. We have Ryan McAvoy, our
Speaker 2: Yale side you engineer in the background here making a
Speaker 2: sound amazing, and of course tomorrow our ever producer on
Speaker 2: the other end of the line. So cool.
Speaker 1: This is so fun, a great time.
Speaker 2: We're talking about cupping and dry needling today, and I
Speaker 2: came into this knowing deep in my soul one thing
Speaker 2: being true, and that is that Emily clearly would never
Speaker 2: do dry needling, because you have mentioned in at least
Speaker 2: six episodes so far that you're afraid of needles and
Speaker 2: and would never like do botox or anything like that,
Speaker 2: simply because you don't want someone injecting something into you.
Speaker 2: And then you kind of casually mention offhand like, oh, yeah,
Speaker 2: I had needles in me that they were electric current
Speaker 2: threat I have done.
Speaker 3: I have done this where they stick the needles in
Speaker 3: and they put like a like jumper.
Speaker 1: Cables on them and they go like.
Speaker 3: Yeah, yeah, yeah, and then and then they get your
Speaker 3: your muscle to contract a lot.
Speaker 2: What muscle? Why were you doing this?
Speaker 1: I was injured.
Speaker 2: Were they trying to extract information from you?
Speaker 3: It was it was in the service of recovery, you remember,
Speaker 3: I was. It was my very mean chiropractor who always
Speaker 3: fixes everything.
Speaker 1: His name is Dennis, and I don't know.
Speaker 3: He said that this would fix my problem, and I
Speaker 3: feel like it did, which is a comment about the
Speaker 3: rest of the episode.
Speaker 2: Okay, so I'm starting this episode incredibly surprised. Also hearing
Speaker 2: that Emily has a chiropractor. I don't know what I'm
Speaker 2: gonna do with that. I'm going to take that in
Speaker 2: as we go into the break.
Speaker 3: I'm Emily Aster, I'm an economist and a data expert.
Speaker 2: And I'm Harry Wilson, I'm a medical doctor.
Speaker 3: It's Thursday, June fourth, twenty twenty six. And this is
Speaker 3: wellness actually.
Speaker 2: Because you're getting a staggering amount of health and wellness
Speaker 2: information nowadays from every source imaginable, and some of it
Speaker 2: is awesome and some.
Speaker 3: Of it is well actually both Fortunately we are both
Speaker 3: people who know how to read studies, how to parse
Speaker 3: the data, and can tell you what's worth thinking about
Speaker 3: and what you can safely ignore.
Speaker 2: But before we dig in, a note that this podcast
Speaker 2: is for educational purposes and should not be construed as
Speaker 2: medical advice. We don't know your unique situation, so talk
Speaker 2: to your doctor for personal health decisions.
Speaker 3: This week we're asking what's the deal with cupping and
Speaker 3: dry needling? Perry and I will give the official smash
Speaker 3: or pass, and then we'll get to your question of
Speaker 3: the week. But first let's do the health news roundup
Speaker 3: after the break. And now for the health news of
Speaker 3: the week, Harry, I want to start with some really
Speaker 3: good news. There was a meeting of the American Society
Speaker 3: of Clinical Ecology this week, and perhaps the most successful
Speaker 3: presentation was about a new medication called direct sun recib,
Speaker 3: which is a pancreatic cancer treatment. The results in the
Speaker 3: survival curve pictures were so spectacular that the author got
Speaker 3: a forty two second standing ovation, and then, in the
Speaker 3: true spirit of people whose time is limited for their presentations,
Speaker 3: was like, that doesn't count against my time, So this
Speaker 3: is incredibly exciting. I will say, I want to hear
Speaker 3: what you think, but I also want to surface that
Speaker 3: one of the things that's come up some in the
Speaker 3: discussions online amidst the people saying this is amazing. Is
Speaker 3: people saying, oh, well, it's only a median survival increase
Speaker 3: of seven months. You know, where's my cure for cancer?
Speaker 3: And so I'm curious, where's my cure?
Speaker 1: Yeah?
Speaker 2: Okay, I mean, first of all, let's level set a
Speaker 2: little bit here. We're talking about metastatic pancreatic cancer. I mean,
Speaker 2: one of the worst diagnoses a person can possibly get.
Speaker 2: The one year survival after a diagnosis of metastatic pancreatic
Speaker 2: cancer is something like ten percent. Right, this is an
Speaker 2: absolutely terrible disease. This new drug, deroxonra sib is an
Speaker 2: oral RAS inhibitor, so it's not chemotherapy per se. It's
Speaker 2: it's obviously quite powerful, but it targets a mutation that's
Speaker 2: commonly found in these cancers. And this was a phase
Speaker 2: three randomized control trial of five hundred patients with metastatic
Speaker 2: pancreatic cancer, pretty big trial in this space. And the
Speaker 2: difference in median survival was about six months. Associated you
Speaker 2: can translate that into a survival rate different or hazard
Speaker 2: ratio of zero point four or five, So you can
Speaker 2: think of that like a fifty five percent reduction in
Speaker 2: the risk of death over time. This is unheard of
Speaker 2: in this disease, Like, it's really there's nothing that's ever
Speaker 2: come close to this, hence the standing ovation at the
Speaker 2: ASCO meeting. But yes, it's not a cure, you know,
Speaker 2: it's unlikely, sadly to say, like curing absolutely curing any
Speaker 2: given disease is always a bit of a pipe dream,
Speaker 2: with the exception of rare infectious diseases that only infect
Speaker 2: humans and can be prevented with vaccines, and even then
Speaker 2: we have a great deal of difficulty doing that. People
Speaker 2: will continue to die of pancreatic cancer because there's a
Speaker 2: lot of mutations and things that can make different cancers different.
Speaker 2: But this is obviously a huge improvement over the status quo.
Speaker 2: I think the other thing that I want to ask
Speaker 2: you about, because I'm sure you'll have a thought on this,
Speaker 2: is people looking at the difference in median survival of
Speaker 2: like okay, six months or whatever, and they say, oh, well,
Speaker 2: but how much are we spending for six months of life?
Speaker 2: And I know we've talked about this offline, like, I
Speaker 2: don't think this is the right way to think about this.
Speaker 2: Tell me how you think.
Speaker 1: Yeah, I don't think so.
Speaker 3: I mean I think often people hear that and they think, well,
Speaker 3: if I didn't get the treatment, you would live for
Speaker 3: three months, and if you got the treatment, you would
Speaker 3: live for nine months, as if those things are sort
Speaker 3: of set in stone. But in fact, what this is
Speaker 3: sort of translating to is at all time points, people
Speaker 3: are less likely to die. And they've kind of aggregated
Speaker 3: that out. But what it means is that you're getting
Speaker 3: increased survival, you know, potentially for quite.
Speaker 1: A long time.
Speaker 2: And it's an average.
Speaker 3: It's an average, and so when we think about like
Speaker 3: what would it mean to cure something or what would
Speaker 3: it mean to sort of deliver a lengthy period that
Speaker 3: would be very meaningful. Some of the people who are
Speaker 3: treated with this new treatment lived. In fact, about half
Speaker 3: of them were still alive at a year, which is
Speaker 3: again compared to ten percent, and you know, again some
Speaker 3: of those people are going to be live longer than that,
Speaker 3: so you're buying some time on the on the tail.
Speaker 3: I think the other thing people miss is, Okay, this
Speaker 3: is a first line of this, like we're going to
Speaker 3: get better, The side effects are gonna.
Speaker 1: Presumably be better under.
Speaker 3: Control, and it's you know, opening up new lines for
Speaker 3: how we would have longer term survival. And if you
Speaker 3: look at something like metastatic breast cancer, which you know
Speaker 3: has had prior to this a lot of innovation, the
Speaker 3: way people are thinking about the potential survival and that
Speaker 3: disease is very different than they were ten years ago,
Speaker 3: including to the point of saying, you know, maybe people
Speaker 3: could live ten twenty years with metastatic ye breast cancer.
Speaker 2: So just this feels like the same thing, like with
Speaker 2: metastatic melanoma, which also used to be like, oh, that's
Speaker 2: a death sentence, and now with immunotherapies and some other therapies,
Speaker 2: it's like, no, okay, people are living. I mean, take
Speaker 2: Jimmy Carter right a long time with metastatic melanoma. So
Speaker 2: this is huge progress. It's just we've made a lot
Speaker 2: on abashedly good.
Speaker 1: News, exactly very very good news.
Speaker 2: We don't usually think about mosquitoes as being good news,
Speaker 2: but maybe it is Google. Yep, Google and the alphabet
Speaker 2: company that Google wants to release thirty two million mosquitoes
Speaker 2: in Florida and California, presumably so that we all stay
Speaker 2: inside and use their services more.
Speaker 1: It's a pitch towards the Internet.
Speaker 3: No So the goal here is to release mosquitos male
Speaker 3: mosquitoes that are sterile and that would then outcompete the
Speaker 3: non sterile mosquitoes for sexual partners, but then be unable
Speaker 3: to fertilize the eggs due to being sterile, and that
Speaker 3: that would lower the mosquito population. So it's basically an
Speaker 3: attempt to control the longer term mosquito population by introducing
Speaker 3: a bunch of mosquitoes that are shooting blanks in the
Speaker 3: hope that you will get fewer later.
Speaker 2: By the way, a mosquito vest actimy veryal surgery, very difficult, delicate.
Speaker 1: Very delicate.
Speaker 3: Fortunately they're using other techniques to achieve this. So this
Speaker 3: is actually something that has been tried with some success
Speaker 3: in other settings, particularly in places where malaria is endemic.
Speaker 3: This is something people have talked about as a potential
Speaker 3: approach to eliminating the species of mosquitoes that spread malaria,
Speaker 3: and we've had we've had some success with that. The
Speaker 3: trick here is, of course, you probably don't want to
Speaker 3: get rid of all of the mosquitoes, and most species
Speaker 3: of mosquitoes do not cause disease in people.
Speaker 1: So in the US there are.
Speaker 3: Some diseases you get through mosquitoes like a snile, you
Speaker 3: can get triple E, which is very bad. But most
Speaker 3: mosquitoes are just annoying and they also feed the birds
Speaker 3: and the frogs and other things that we like. So like,
Speaker 3: completely getting rid of mosquitos is probably not a good idea.
Speaker 3: But this isn't a potential approach. You think you're okay
Speaker 3: with it now, but then there's no frogs, and then there's.
Speaker 2: No whatever is bigger.
Speaker 3: Okay, listen, it's it's an ecosystem.
Speaker 2: Okay.
Speaker 3: By getting rid of the mosquitoes that that give you
Speaker 3: terrible diseases is something people are interested in, and this
Speaker 3: is this is one sort of simple approach that is,
Speaker 3: you know, arguably better than spraying up with a bunch
Speaker 3: of toxins, which we've tried in the.
Speaker 1: Past and have some downsides.
Speaker 3: All right, all right, Perry, there's a new study about farting,
Speaker 3: and I love you to just say more about farting.
Speaker 2: So I wrote about this study this week, and it's
Speaker 2: what she did, because of course I did. Because the
Speaker 2: Derek sonracib study comes out and it's like, oh, this
Speaker 2: is the greatest advanced in metastatic pancreatic cancer in you
Speaker 2: know history, and I'm like, but this week I'll be
Speaker 2: writing about fart yep, So here we are. So a
Speaker 2: new study in gem and Network open tracking the gaseous
Speaker 2: emissions of a bit over six thousand Australians as part
Speaker 2: of a citizen science initiative. They they all volunteered and
Speaker 2: downloaded an app called Chart Your.
Speaker 1: Fart, Chart Your Fart and uh.
Speaker 2: When you fart, you open the up and you mark
Speaker 2: the time of day and you can also optionally like
Speaker 2: rated across several scales, including the smell and the audibility,
Speaker 2: and actually one of the things was the detectability, which
Speaker 2: is you know, to test weather you smelt it. The
Speaker 2: actual reason for the study is to generate normative data
Speaker 2: on how often people fart, so that you can have
Speaker 2: some baseline against which to measure outcomes for gas or
Speaker 2: intestinal illness trials. So if people are complaining about excessive flatulence,
Speaker 2: like you need to know what normal is. You can
Speaker 2: be like, oh, yes, that is excessive, so you need
Speaker 2: to kind of have a normal distribution. That's what the
Speaker 2: study was for. I was looking into a little bit
Speaker 2: of the history of studies of farting. Farting. One of
Speaker 2: the earliest was from seventeen eighty one. There was a
Speaker 2: seventy five year old scientist who noted that we fart
Speaker 2: about seven times a day, by the way, the Australian
Speaker 2: study said about five times a day, men slightly more
Speaker 2: than women. But I think women are lying.
Speaker 1: Men are also lying, but it's probably.
Speaker 2: More than that, right anyway, back in seventeen eighty one,
Speaker 2: seven times a day, according to this scientist, and he
Speaker 2: wanted to create a prize to invent a substance that
Speaker 2: could be added to our food that would make quote,
Speaker 2: the natural discharges of wind from our bodies not only
Speaker 2: an offensive but agreeable as perfumes, sort of saying like why.
Speaker 1: Can't we just why can't our fart smell that?
Speaker 2: And yeah, why can't our fart smell better? And you know,
Speaker 2: it's been more than whatever twound amost two hundred fifty
Speaker 2: years and we have not we have not cracked that
Speaker 2: particular chestnut. Do you know who that scientist was, Benjamin Franklin, Benjamin.
Speaker 1: Okay, that guy had a lot of good ideas and
Speaker 1: some less good ideas.
Speaker 2: And I think it was like a little bit of
Speaker 2: a dirty bird.
Speaker 1: Okay, do you think I think a little bit. You know,
Speaker 1: they probably all were.
Speaker 3: The other thing that I thought was interesting from this
Speaker 3: study is when people fart, they fart at night.
Speaker 2: So you far like the majority of it, but you're
Speaker 2: not tracking at night.
Speaker 3: Between seatween six and ten pm after dinner, when people
Speaker 3: have consumed a larger meal, more fiber, that's when the
Speaker 3: farts get going.
Speaker 2: I mean, that's certainly when my dog is farting them, right.
Speaker 3: No comment on yourself. Okay, all right, that's it for
Speaker 3: the health news of the week. After the break, what's
Speaker 3: the deal with cupping and dry needling?
Speaker 2: And we're back. We are going to talk about cupping
Speaker 2: and dry needling. Today is a two for one episode.
Speaker 2: We'll start with We'll start with cupping. Smash your past cupping,
Speaker 2: then move on to dry needling, do the same thing.
Speaker 2: So I want to start with cupping, and I'm going
Speaker 2: to play you a clip from a science y talking
Speaker 2: influencer online, you know, saying like, what is this cupping
Speaker 2: stuff that people are talking about?
Speaker 4: For over three thousand years, Cupping was an ancient practice
Speaker 4: that helped people accelerate their bodies healing. The practice was
Speaker 4: documented in ancient Egypt and China, and it was also
Speaker 4: endorsed by Hippocrates, and so how cupping works is that
Speaker 4: it applies a gentle vacuum pressure upon the surface of
Speaker 4: the skin and tissues, and it's more than just pulling
Speaker 4: on your skin. Studies have shown that cupping dilates your
Speaker 4: blood vessels to improve circulation, removes metabolic waste by improving
Speaker 4: your lymphatic drainage, and supports the local immune function in
Speaker 4: that area. And past randomized control trials show that cupping
Speaker 4: is an amazing complementary therapy, helping people with chronic lower
Speaker 4: back or neck pain, fibromyalgia, and even migraines. And even better,
Speaker 4: cupping helps you fight stress by improving your body's parasympathetic
Speaker 4: tone and also regulating the stress hormone called cortisol. Key
Speaker 4: takeaway here is don't judge a book by its cruise cover.
Speaker 4: Cupping is one of those agent practices fused with modern
Speaker 4: science that shows it accelerates your body's healing.
Speaker 2: Walk me through, what do you think when you hear
Speaker 2: that off the top?
Speaker 1: This is ridiculous.
Speaker 3: It's the same thing I think when I see I mean,
Speaker 3: I just like that is my first REACTIONA my brother
Speaker 3: has this done?
Speaker 1: Actually?
Speaker 3: Oh, and he's always showing up to family vacations with
Speaker 3: these like bruises, not bruises, but these things all over.
Speaker 2: Oh no, they're bruises.
Speaker 1: Okay, He's always showing.
Speaker 3: Up with all of these things all over himself, and
Speaker 3: I always just think, I think it's ridiculous, and I
Speaker 3: make fun of him, as one does with one siblings.
Speaker 2: Yeah, I mean, you should always make fun of your siblings.
Speaker 2: But we do need to check what the evidence actually shows.
Speaker 2: I mean, one of the things when our listeners are
Speaker 2: hearing that there are things that often show up in
Speaker 2: this space that sound legitimate and kind of aren't. One
Speaker 2: is called the argument from antiquity, which you know, he said,
Speaker 2: you know, from the over the for at least three
Speaker 2: thousand years, people have been doing this, and they're implicit
Speaker 2: in that statement is like, well it must work if
Speaker 2: people have been doing it for three thousand years. And
Speaker 2: of course there's countless counterexamples of things that people have
Speaker 2: done for a very long time, like bleeding people for disease.
Speaker 2: They have ideas, you know, crushing which is under large stones,
Speaker 2: and other things that they did for an awfully long
Speaker 2: time that probably weren't a good idea. So I always
Speaker 2: kind of when I hear the argument from antiquity, I
Speaker 2: kind of roll my eyes and like, all right, but
Speaker 2: we can do.
Speaker 1: Better than that. Yeah, I agree with that.
Speaker 3: I also I want to take a step back on
Speaker 3: both cupping and try anything, because I think this is
Speaker 3: a place where we are going to have to engage
Speaker 3: aggressively with the placebo effect.
Speaker 1: So we talked about the placebo effect a lot.
Speaker 3: Just to be clear, the placebo effects refers to the
Speaker 3: fact that when you do something to someone or have
Speaker 3: somebody take something or tell them in some way something
Speaker 3: might make them better, even if you did nothing, even
Speaker 3: if the pill you give them is a sugar pill.
Speaker 3: Even if the cups are not effective and do nothing
Speaker 3: you can, you will are still likely to get people
Speaker 3: to respond because they think something's going to happen.
Speaker 1: And that is a very very powerful effect. And this
Speaker 1: works even better than we think.
Speaker 3: So one piece of this is that placebo effects tend
Speaker 3: to work better when people believe that they're going to work,
Speaker 3: So if you believe in something, it's.
Speaker 1: More likely to show up as a placebo.
Speaker 3: The second thing, and this is I think my most
Speaker 3: interesting fact about placebo effects, is that you can get
Speaker 3: a placebo effect even if.
Speaker 1: You tell someone it's a placebo.
Speaker 3: So if you tell someone I am giving you a
Speaker 3: sugar pill, but a lot of people find that it
Speaker 3: helps even though there's nothing in this pill, you will
Speaker 3: get a placebo effect versus telling them, you know, versus
Speaker 3: not telling them that.
Speaker 1: Like, people can get the placebo.
Speaker 3: Effect even if they know it's fake. And I think, like,
Speaker 3: that's it's crazy that brain. The brain is so interesting.
Speaker 3: But what that means for this stuff is or for
Speaker 3: any kind of any kind of attempt at a causal
Speaker 3: inference of some treatment, is you really need to generate
Speaker 3: a placebo feeling in everyone. So if you give people
Speaker 3: a vaccine, we give everybody a vaccine. We don't just
Speaker 3: give half the people a vaccine and tell the other
Speaker 3: people while you're in the control group, we give them
Speaker 3: a vaccine of something else, so they think that they
Speaker 3: got the vaccine.
Speaker 2: Or yeah, some different, some different we give them like
Speaker 2: that they have to believe.
Speaker 3: It is very difficult to do that kind of placebo
Speaker 3: control trial with something where the result of the treatment
Speaker 3: is to end up with giant welts all of yourself.
Speaker 1: Because it's like, what is the fake welts, you know.
Speaker 3: Yeah, and it comes up in the needling stuff too,
Speaker 3: Like it's people have to know that they did this,
Speaker 3: And we can talk about how how studies try to
Speaker 3: control for this.
Speaker 1: But for me, this whole space is like very wrapped
Speaker 1: up in the fact that it could just be all
Speaker 1: the placebo effect or a huge share of it.
Speaker 2: Yeah, when we talk about the studies, we'll try to
Speaker 2: flag when studies are quote sham controlled, which is the
Speaker 2: idea being that they do something to you. It's the
Speaker 2: equivalent of a placebo. But as you're pointing out, this
Speaker 2: is a case where that's very like how do you
Speaker 2: do that right? And what we'll talk about that and
Speaker 2: whether it's adequately controlled. The other thing I want to
Speaker 2: say about placebo effects is that there are certain outcomes
Speaker 2: that are more amenable to placebo and some that are
Speaker 2: less so. Subjective outcomes things like pain, mood, energy, fatigue,
Speaker 2: things that you kind of self report are quite susceptible
Speaker 2: to placebo effects, you know, things like death, LDL, cholesterol stuff.
Speaker 1: Like that you get this infectious disease YEA.
Speaker 2: Those are more objective, and although there are actually some
Speaker 2: studies that even show placebo effects in those areas, they
Speaker 2: generally are not as strong as we'll see in this area.
Speaker 2: And so when you come to wellness things like cupping
Speaker 2: and dry needling, it's like a perfect storm of Okay,
Speaker 2: is this placebo? Is something biological actually happening? And there's
Speaker 2: one other whole set of things that we'll hit on
Speaker 2: here as long as we're taking a fifty thousand foot
Speaker 2: view before we really dive in. And that's thing called
Speaker 2: co intervention bias. So a classic example of co intervention bias.
Speaker 2: Let's say I have a new blood pressure drug and
Speaker 2: I'm going to test it against placebo. So I got
Speaker 2: a sugar pill and a new blood pressure drug, and
Speaker 2: I split my group in half and half get the
Speaker 2: blood PRESSU drug, half get the placebo. But you know,
Speaker 2: in the group that gets the blood pressure drug, I
Speaker 2: call them once weak to check in to see if
Speaker 2: they're having any side effects. I know the placebo people
Speaker 2: aren't having side effects. It's a sugar pill. But I'm
Speaker 2: a little worried, So I'm going to call once a
Speaker 2: week and be like, hey, like, how you doing. You
Speaker 2: feel lightheaded? What's going on? That interaction is another intervention,
Speaker 2: a co intervention that is being applied just to one group,
Speaker 2: And so when you design these studies you have to
Speaker 2: really careful that you're not testing other things, right, So
Speaker 2: you actually need to call the Placbo group and be like,
Speaker 2: are you having any side effects?
Speaker 1: But you've got to do the whole thing, and then
Speaker 1: they probably are.
Speaker 5: Yes.
Speaker 1: Actually, I found is very.
Speaker 2: I've been under one hundred percent. When it comes to
Speaker 2: practices like cupping and try kneeling and acupuncture and kiro
Speaker 2: practice and everything, there's a set of co interventions that
Speaker 2: aren't just the cups going on you. You're in a
Speaker 2: nice dark room, there's like calm music playing, another human
Speaker 2: is there and like talking to you and putting their
Speaker 2: hands on your body, And these in and of themselves
Speaker 2: can have powerful biologic effects and psychological effects. And so
Speaker 2: we really have our work cut out for us to
Speaker 2: try to tease out the unique marginal benefit of you know,
Speaker 2: adding a cup to this lovely, lovely other fireroom.
Speaker 3: All right, So let's start with for the for the uninitiated,
Speaker 3: there are basically three kinds of.
Speaker 1: Cupping, So please tell me what these are and why
Speaker 1: you don't want the one called.
Speaker 2: Fire You don't want fire company sounds awesome. I don't
Speaker 2: want wet cup all right, let's start. Okay, most of
Speaker 2: the cupan you're going to see online is dry cupping,
Speaker 2: and what this is is you it's it is literally
Speaker 2: a cup like a suction cup. You put it on
Speaker 2: a part of your body. You'll see people with on
Speaker 2: their back like any place of the little stick, and
Speaker 2: you suck the air out, typically with a little vacuum
Speaker 2: pump in. It sucks the skin up into it. Usually
Speaker 2: the vacuum is quite strong, in fact, strong enough to
Speaker 2: break the capillaries under the skin, which causes bleeding under
Speaker 2: the skin. That's bruising.
Speaker 1: That's a bruise.
Speaker 2: That's what it is, those cup marks or bruises. That's
Speaker 2: called dry cupping. Wet cupping is the same thing, but
Speaker 2: the practitioner nicks the skin before they put the suction
Speaker 2: cup on, so it actually.
Speaker 1: Isn't this just bleeding?
Speaker 2: Isn't this just do we have a thing called we're
Speaker 2: getting real close?
Speaker 1: Could you put leaches on and then put the cup
Speaker 1: on top of the leach and then.
Speaker 2: I mean that would not be good for the leech.
Speaker 2: I'm sure if we go yeah, I don't think the
Speaker 2: leech likes that. But but yeah, so that's that's now
Speaker 2: you're like sucking the blood out a little bit, and
Speaker 2: as you're as you're sucking fire cupping is just kind
Speaker 2: of a cool and more dangerous way of creating the vacuum.
Speaker 2: So instead of a vacuum pump, what you do is
Speaker 2: you you light a little piece of paper or like
Speaker 2: a I think he's a cotton swap soaked in alcohol,
Speaker 2: you know, and you so you light it, you put
Speaker 2: it under the under the cup before it's on the
Speaker 2: person's body, so hot air gets inside, and then you
Speaker 2: stick the cup on the person and as the hot
Speaker 2: air cools, it contracts, right, and that creates the.
Speaker 3: Case like a low tech it's just like lower lower
Speaker 3: tech version, lower tech version.
Speaker 1: Why are people doing this? What is the point of
Speaker 1: this activity?
Speaker 2: Here's the argument you see, and I've seen this many
Speaker 2: many times. It's like massage is good. I agree with that.
Speaker 2: But in massage, we push on you, okay, and it
Speaker 2: compresses things. And this is like massage, but the opposite,
Speaker 2: like we pull. It's gonna open up your muscle. It's
Speaker 2: gonna like stretch things out and let things kind of
Speaker 2: flow around and stuff like that. Okay, Yeah, yeah, what
Speaker 2: do you think.
Speaker 3: I mean, I think it seems ridiculous, like but you know,
Speaker 3: I guess that's what data is for. I mean, this
Speaker 3: feels I'm I might have said the same about massage,
Speaker 3: and I think we again, well we can talk about
Speaker 3: that another episode. But I guess this is a place
Speaker 3: where I'm not totally clear on the biological plausibility. And
Speaker 3: I think part of the issue is it's in a
Speaker 3: lot of these discussions, it's actually not at all clear,
Speaker 3: like what is the outcome we're looking at? Right, So
Speaker 3: it's a lot of these is like with toxins, we're
Speaker 3: doing We're gonna put this on, it's going to pull
Speaker 3: out the toxins. Like that's not how First of all,
Speaker 3: that's what your kidneys are, liver, you have all these organs,
Speaker 3: internal organs for dealing with the toxins. But also just
Speaker 3: like pulling on your skin is it's not like pulling
Speaker 3: out that doesn't make any sense. It's a stupid idea,
Speaker 3: really dumb for toxins.
Speaker 2: Absolutely, so that's just bullsh that's straight up bullsh Nothing
Speaker 2: is coming out of your skin, even the wet needling
Speaker 2: when like a little bit of blood is coming out
Speaker 2: of your skin like blood. It's it's blood. Your kidneys
Speaker 2: are gonna filter way more blood. I've said this before,
Speaker 2: but I'll say it again. The kidneys filter one hundred
Speaker 2: milliliters of blood per minute right all day long.
Speaker 1: That's a lot the whole job.
Speaker 2: That's a lot of blood that cycles through your entire
Speaker 2: blood volume, like twenty five times a day. You're not
Speaker 2: getting that much out from from wet cupping. And also
Speaker 2: it's not like it gets cleaned and.
Speaker 1: It's just like you just lose it. And it's like
Speaker 1: and how wouldn't know to take out the bad blood anyway?
Speaker 6: Right?
Speaker 4: Whatever?
Speaker 1: This is stupid, but.
Speaker 2: Okay, so let's just put toxins aside. I want to
Speaker 2: go to muscular skeletal because I think that's where like
Speaker 2: the most biologic plausibility is. And one of the videos
Speaker 2: I saw felt more like massage than the others. So
Speaker 2: you'll see videos where there's just like cups, cups, cups,
Speaker 2: cup cups, Like someone's entire back is just lined with
Speaker 2: these suction cups and yeah, there, I'm like, that's what
Speaker 2: my brother does. That's what your brother does, okay, And
Speaker 2: also like Michael Phelps does right, like you see athletes
Speaker 2: that are doing this, et cetera. Then I saw a
Speaker 2: video where a person took a cup they had kind
Speaker 2: of I guess they had like lathered up the skin
Speaker 2: a little bit so they could make a seal. I
Speaker 2: think it was on the guy's leg and they were
Speaker 2: moving the cup up and down the leg, so it
Speaker 2: was sucking and they were kind of moving it, And
Speaker 2: I was like, Okay, that's massage with extra Like.
Speaker 3: It feels a little bit like the arguments for foam
Speaker 3: rolling or something like basically some kind of like a
Speaker 3: fairly aggressive like muscle interaction that sort of causes some
Speaker 3: muscle breakdown which then should come back better, which I
Speaker 3: think is the idea behind foam rolling.
Speaker 2: Yeah, I understand. Yeah, you know, I was thinking about
Speaker 2: massage versus cupping two and like this argument that a
Speaker 2: massage is compressing and cupping is whatever. The opposite of
Speaker 2: compressing is tensing. But then I was like, actually, you
Speaker 2: know what massage also like stretches, Like you're not just
Speaker 2: pushing straight down right, you're moving, which means like you're
Speaker 2: obviously you are pulling tissue aside and like letting stuff
Speaker 2: flow and whatnot.
Speaker 1: So is this just a kind of massage.
Speaker 2: I think there are ways to do this that it's
Speaker 2: just a kind of massage, and that's probably fine. Like
Speaker 2: if you're taking the cup and moving it around and
Speaker 2: not causing the like capillaries to break in the skin
Speaker 2: and causing big bruises, then maybe it's just a kind
Speaker 2: of fancy massage. And if it feels good, that's okay.
Speaker 1: Do we have any data that will suggest that this
Speaker 1: is good? Sure, there's always data, there's always data.
Speaker 2: Yeah, I want to talk I think about chronic nonspecific
Speaker 2: low back pain.
Speaker 3: Everybody loves chronic non specific low back pain. I mean
Speaker 3: this is like a very common problem that people.
Speaker 2: Have a hugely common problem. And you know that trope
Speaker 2: that's like doctors hate this, Okay, that's a way actors
Speaker 2: hate that. I hate this. Yeah, And the reason I
Speaker 2: hate it is because I have no great treatments for
Speaker 2: chronic non specific low back pain. I mean I have
Speaker 2: like physical therapy and exercise and weight loss, but it's
Speaker 2: just those things are hard for people to do, and
Speaker 2: it goes on and on and on. Okay. So I
Speaker 2: have a study here from the Journal Physiotherapy twenty twenty one.
Speaker 2: Dry cupping versus sham for chronic nonspecific low back pain.
Speaker 2: We've got ninety people. Forty five got dry cup being
Speaker 2: forty five got shammed sham cupping for four weeks, and
Speaker 2: they followed up it eight weeks, and both groups had
Speaker 2: a modest improvement in chronic not specific low back pain
Speaker 2: in the end, including the sham cupping group.
Speaker 4: Right.
Speaker 3: And I will say this is there was no significant
Speaker 3: difference in that study. And it's actually quite difficult to
Speaker 3: sham cup someone because just like people know if you
Speaker 3: are putting a cup on and sucking things out and
Speaker 3: they're ending up with like giant bruises versus just like
Speaker 3: someone put a cup on you.
Speaker 1: Like, people are not idiots, you know.
Speaker 3: It's like so unless you're putting the cup on and
Speaker 3: then like coloring it in or something or like, I
Speaker 3: don't know what is the thing you do to make
Speaker 3: people think that you gave them a somewhat painful bruising.
Speaker 1: This is I don't think this is comfortable. It's not
Speaker 1: like a no FUSI. It hurts.
Speaker 2: It hurts absolutely, like it's really sucking up.
Speaker 3: This is an example where I don't even know why
Speaker 3: sham I mean, I guess you had a little bit
Speaker 3: of the sha totaled it. Maybe you told people like
Speaker 3: maybe if you never have this before and you had
Speaker 3: is that maybe that's the case. You never had this
Speaker 3: before and you don't know it's a thing to expect,
Speaker 3: and so you just think it's someone waving cups around
Speaker 3: over you, like maybe then that's still I mean, And anyway,
Speaker 3: didn't find anything, so fine sham.
Speaker 2: What they did here, just to give them some credit,
Speaker 2: is they they had special cups that had a little
Speaker 2: like valve in it, and so it would suck like
Speaker 2: they would put it on and they would apply the
Speaker 2: suction EI and then like a few seconds later, all
Speaker 2: the air would like leap back in, so you did
Speaker 2: feel a little bit like and then it would like deflate.
Speaker 1: So maybe that's why I didn't it didn't work.
Speaker 3: This is also not in a very good I mean,
Speaker 3: a lot of these papers that try to talk about
Speaker 3: this aren't actually not in very good journals, and I
Speaker 3: think that can be hard for people to tease out,
Speaker 3: tease out like why is the journal of you know this?
Speaker 3: And the more I feel something, the more words are
Speaker 3: in the title of the journal, the worst it is.
Speaker 3: It's not always true, but it can be difficult to
Speaker 3: figure out is this really something where it got aggressive
Speaker 3: peer review and some real experts looked at it, or
Speaker 3: is it just you know, you paid the journal one
Speaker 3: thousand dollars and they publish your paper, which definitely there
Speaker 3: are many journals like that.
Speaker 2: Yeah, yeah, absolutely, I guess.
Speaker 3: I mean my feeling on this whole space is like,
Speaker 3: it's very very unlikely that this has anything but a
Speaker 3: tiny marginal impact. But if it is something that people
Speaker 3: like and they feel like it helps them, then maybe
Speaker 3: that's maybe that's fine. Well that's what we always come
Speaker 3: down with placebo, right, I know, it's like if it's
Speaker 3: just if it's just fine, I.
Speaker 2: Know, what's the harm? You know, you're spending some money.
Speaker 2: We'll go through some harms. There are some actually interesting
Speaker 2: case reports of harms. But I do want to give
Speaker 2: one more potential positive for cupping, which is in blood flow. Okay,
Speaker 2: so it would make sense maybe that if you like
Speaker 2: suction a lot that like more blood would flow to
Speaker 2: that area, and that has been shown with laser flowometry,
Speaker 2: which is a technique to measure blood flow, and pretty
Speaker 2: significant increases in blood flow like ten to fifteenfold increases.
Speaker 2: That does sound obviously like a lot, like, oh my god,
Speaker 2: I'm increasing blood flow by ten to fifteen times in
Speaker 2: this local area of the skin. That's actually pretty similar
Speaker 2: to what happens if you were to like burn your
Speaker 2: skin or get a sunburn or any other injury. Like
Speaker 2: your body is pretty good at recognizing when injury happens
Speaker 2: and directing a lot of blood flow to that area.
Speaker 2: You know, maybe injuring an area of skin is good,
Speaker 2: like in the long run, maybe it, you know, I
Speaker 2: don't know for what, well, for what for Yeah, I
Speaker 2: got nothing, I don't know.
Speaker 3: I mean, yeah, I think to say, like this injures you,
Speaker 3: and then blood goes there to treat the injury.
Speaker 1: Okay, sure, yeah, where we're super system.
Speaker 3: Yeah, but I'm not sure, Like I think we would
Speaker 3: want to see the second phase of okay and then
Speaker 3: you feel better later, which is the part that's that's missing, right,
Speaker 3: and when.
Speaker 2: We talk about that injury. The other thing I saw
Speaker 2: online about cupping is people interpreting the bruising like as
Speaker 2: if it means something, right, So like this color bruising
Speaker 2: means your blood has more toxins, and this means less
Speaker 2: toxins and and like you can enter.
Speaker 1: It's like if it's green, if the it's a green bruise,
Speaker 1: like just forget it.
Speaker 2: Yeah yeah, or you're a vulcan Hello tomorrow Hello. So
Speaker 2: uh yeah. These are just these are bruce, Like you
Speaker 2: can do this to yourself. You probably did.
Speaker 1: You ever can like sucked on your absolutely, so you
Speaker 1: get a hickey. These are about a hickey. It's a hickey.
Speaker 1: It's like a it's like an adult. It's like a
Speaker 1: doctor hickey. Basically, it's a doctor doctor.
Speaker 2: All right, should we talk about risks.
Speaker 1: Yeah, there are some risks.
Speaker 3: I think the first thing to say is it was
Speaker 3: when you cut into your skin you could get infected.
Speaker 3: So wet something where you cut your skin and then
Speaker 3: you pull some of the blood out, like this is
Speaker 3: always a risk for infection, and so there are cases
Speaker 3: of infection. And also just like anytime you're injured, there's
Speaker 3: anytime you cut yourself, there's a risk of infection and
Speaker 3: that is part of the reason you shouldn't do that. Yes,
Speaker 3: you could also burn yourself if there was fire. You
Speaker 3: can burn yourself with fire, and you can get infected
Speaker 3: if you cut yourself.
Speaker 2: So yeah, let's sticky, let's stick with dry at best.
Speaker 1: Yep, and then there are there. You can get a hematoma,
Speaker 1: which doctor Perry is.
Speaker 2: Well, okay, so hematoma is a bruise, but what this
Speaker 2: type of hematoma is a subdural hematoma, which is a
Speaker 2: bleed on the outside of your brain. There have been
Speaker 2: three case reports I found in the literature of subdural
Speaker 2: hematoma from cupping. These were people who are getting cupping
Speaker 2: on their necks. So like right at the base of
Speaker 2: the occipital bone here in the bottom of your skull
Speaker 2: and your neck for chronic neck pain. There are some
Speaker 2: very delicate blood vessels in there that go up into
Speaker 2: your brain. And you know, I guess what had happened
Speaker 2: here is that when they sucked that up, they damage
Speaker 2: those blood vessels. Again, that's what the marks are. It's
Speaker 2: broken capillaries. But in this case these would have been
Speaker 2: veins probably that broke and that bled under the skull
Speaker 2: and above the brain, which can compress the brain and
Speaker 2: is generally a bad thing.
Speaker 1: So don't want to be careful, all right. And if
Speaker 1: it's just bruises, are bruises dangerous?
Speaker 2: I mean not really, Although you can get iron deposit
Speaker 2: like permanent staining of the skin from the iron and
Speaker 2: blood if bruises are bad enough. So there's some aesthetic
Speaker 2: risk there. Some people who are very prone to scar formation,
Speaker 2: like keloid formation, can get keloids from repeated cupping, which
Speaker 2: is also you know, aesthetic, but like probably not, probably
Speaker 2: not right And certainly if you're talking about wet cupping right, scarring.
Speaker 1: Yes, it's scaring. You don't call yourself.
Speaker 3: You can get infection to go scar Okay, Perry, are
Speaker 3: you smash your pass on the cupping.
Speaker 2: I am passing on the cupping. Just get a massage, folks. Sorry.
Speaker 3: I am also a strong pass on hot cups and
Speaker 3: all the cups, all the cups, high tops, gold cups.
Speaker 1: No, forget it, No, no bruising.
Speaker 2: But it's okay to be in your cups from time
Speaker 2: to time. That's an old time drunk.
Speaker 1: I thrunk.
Speaker 3: Yeah.
Speaker 1: Yeah, we can cut out.
Speaker 2: From Whenry and I were in college and people were
Speaker 2: necking and giving each other.
Speaker 1: Yeah, that's what we remember. Kids, remember hickeys from the nineties.
Speaker 2: They're coming back.
Speaker 1: They're coming back on your back.
Speaker 2: Let's move on to dry needling. So I'm going to
Speaker 2: show you a video. Now, there's no audio here Emily,
Speaker 2: but I wanted to. I just want you to describe
Speaker 2: what you're seeing. We'll put this on the YouTube, but
Speaker 2: like for people who are listening n audio, just talk
Speaker 2: me through what you're seeing here, all right.
Speaker 1: So there's a guy.
Speaker 3: He's laying on his face and someone is putting a
Speaker 3: needle into him. They're pushing it really far into his ah,
Speaker 3: into his like a shoulder muscle, and just moving it
Speaker 3: up and down like like a stab with a stabbing motion.
Speaker 3: It just keeps going. The caption on this thing says
Speaker 3: still going, Okay, I'm done. Okay, now they're taking it out.
Speaker 3: I'm done with this video.
Speaker 2: Yeah, that's dry needling.
Speaker 1: Okay, So dry needling. Yes, it's a place you put
Speaker 1: you stick the needle in.
Speaker 3: It looks actually a bit like acupuncture, quite a bit
Speaker 3: like acupuncture, but the needle goes much further in uh
Speaker 3: and is typically sort of or at least in some cases,
Speaker 3: kind of moved around. There are kinds of dry needling
Speaker 3: that involve electronic stimulation where you stick in the needles
Speaker 3: and you hook up that's what you got, that's what
Speaker 3: I got, and you hook up a system to it,
Speaker 3: and you like run some current through it and it
Speaker 3: like the muscles and that is also uncomfortable and so
Speaker 3: so yeah, it's the idea I think is that you
Speaker 3: are damaging the tissue and that that then promotes healing.
Speaker 3: This is my general understanding of this is that it
Speaker 3: is another way to try to in a targeted manner,
Speaker 3: like tell your body come over here and pay attention.
Speaker 3: Shakes this up nice because it's like we're having some
Speaker 3: problems with this, yeah, this area.
Speaker 2: That's my sense. I think that's the generous interpretation generals
Speaker 2: of what's happening here.
Speaker 1: That's what the chiropractor said. Okay, now.
Speaker 2: I want to draw a distinction between wet needling, just
Speaker 2: like what do we why dry needling? And the answer
Speaker 2: is that doctors inject substances into you all the time. Sure,
Speaker 2: and so I don't know, I think you've ever had
Speaker 2: like a cortizone injection into joints.
Speaker 1: Or oddly no, oh okay, yeah, sure it's coming.
Speaker 2: It's coming, you know, or lie to cane injections or whatever.
Speaker 2: And so you have a hollow needle and you stick
Speaker 2: it in somewhere and you inject. That's a wet inject
Speaker 2: But people, I think appropriately asked when it came to
Speaker 2: things like cortizone injections in the needither like is it
Speaker 2: the cortisone that we're injecting or is it just the
Speaker 2: fact that we're sticking a needle in there? And some
Speaker 2: of the sham controlled studies of wet injection, which just
Speaker 2: was like, well we'll stick a needle in and not
Speaker 2: do anything also effects and so either guys, either it's
Speaker 2: a placebo, that's what it is. There's something about the
Speaker 2: needle itself, and so now you have needles that are
Speaker 2: I mean some some dry needling practitioners will use hollow needles,
Speaker 2: but oftentimes it's just a solid needle, like there's not
Speaker 2: even a you're not pretending to inject anything. It's it's
Speaker 2: it's that there's.
Speaker 3: Another piece of this which you sometimes hear, which is
Speaker 3: this idea like we're going to stick it in a muscle.
Speaker 3: Not so a lot of what people like to use
Speaker 3: dry needling for is like you know, releasing trigger points.
Speaker 3: So it's like there's sort of different ways to release
Speaker 3: muscle trigger points, but this is like you stick it in.
Speaker 3: I think it's almost like people have in their mind
Speaker 3: like it's literally like a like a shoelace not and
Speaker 3: if you like got something in there, then that would
Speaker 3: like really essentially and work for shoelaces either.
Speaker 5: But but I think that if you look at the
Speaker 5: AI people are putting up, there's so much AI on
Speaker 5: Instagram of like look what happens and the needle goes
Speaker 5: in and like this like literal not of a muscle dissolves,
Speaker 5: and it's like, okay, wait, if you're showing AI, then
Speaker 5: clearly you don't.
Speaker 2: Have any actual image of this, Yes, Can I tell
Speaker 2: I went on such a deep rabbit hole okay about
Speaker 2: muscle knots, and I honestly don't know if I'm in
Speaker 2: a place where my natural social awkwardness is limiting my
Speaker 2: understanding of this, Okay, Okay. So trigger points is the
Speaker 2: medical term. It's associated with something called myofascial pain syndrome,
Speaker 2: a real syndrome of chronic muscular pain that seems to
Speaker 2: be exacerbated. They are like certain points in the muscle
Speaker 2: that are hypersensitive that are often linked to you know,
Speaker 2: what the lay people would call knots, like when you're
Speaker 2: giving someone massage and you're like, ooh, there's a knot
Speaker 2: and I'm working out the knot.
Speaker 1: Okay.
Speaker 2: I haven't given many massages in my life, okay, or
Speaker 2: receive them. Okay, this is so far the story is
Speaker 2: going good. See social and social. I just don't like
Speaker 2: being touched in that way. Okay. But I will say
Speaker 2: when I was like a theater kid in high school
Speaker 2: and there's just lots of massages going on, people would
Speaker 2: be like, ooh, you've got such a knot here, and
Speaker 2: I was like, I don't know that. I do like
Speaker 2: there were tender parts, like obviously there are parts that
Speaker 2: hurt more hurt less. And then when I was massaging people,
Speaker 2: they'd be like, oh, that's a knot, and like, I
Speaker 2: didn't know that I ever felt it. I was like,
Speaker 2: is this is this a collective hallucination that they're actually
Speaker 2: like physical like I felt bones, you know, you can
Speaker 2: feel like there are bones underneath? Or like is there
Speaker 2: no such thing as muscle nuts? Is what I'm asking?
Speaker 2: Or do I not lack the human contact on this?
Speaker 1: I think they're okay. I don't really know what it
Speaker 1: would mean for it's not like the muscle tied in
Speaker 1: a knot.
Speaker 7: Well, I know that, like there're a lot there, Like, yeah,
Speaker 7: I feel bumps, But I think it's just I don't
Speaker 7: think you're right, because I think it is very clear
Speaker 7: that like you, if you are doing this even on yourself,
Speaker 7: like and you you, there are places where you can
Speaker 7: where I can feel.
Speaker 2: This is the closest Emily and I have ever gotten
Speaker 2: to giving each other massages right here.
Speaker 3: Where there's like a not in my life. I think
Speaker 3: this is a real thing, But I'm not sure what
Speaker 3: I think this is a real thing.
Speaker 2: Okay, I went deep enough in this to look at
Speaker 2: the image science.
Speaker 3: Just you're not just basing your information on well like
Speaker 3: things that happened in my leg last week, which is
Speaker 3: what I'm facing.
Speaker 2: So I was thinking biological if you if you circle
Speaker 2: back to the creatine episode, we were talking about exercising
Speaker 2: to failure, which which is this idea that like muscles
Speaker 2: can only contract until they run out of ATP and
Speaker 2: then they just and you fall down flat in your face.
Speaker 2: So the idea that there's a not in my muscle
Speaker 2: that's like continuously contracting seems by logically implausible to me. Sure,
Speaker 2: And so then I looked at like MRI studies and
Speaker 2: ultrasound studies to see what the imaging correlates of a
Speaker 2: trigger point would be so like if if I, if
Speaker 2: I using my hands feel a trigger point, like how
Speaker 2: what do we see on ultrasound or what do we
Speaker 2: see on ultra on MRI. So there was an MRI study.
Speaker 2: These are small studies. So ten people got an MRI.
Speaker 2: A practitioner palpated the trigger points and marked them and
Speaker 2: then looked for MRI like not blinded, like knowing where
Speaker 2: the trigger points were. Looked for differences on the MRI
Speaker 2: scan between you know, the trigger point and other parts
Speaker 2: of the muscle, and they found one difference on a
Speaker 2: very specific type of MRI spin called mtrpt two, which
Speaker 2: had a value that's meaningless to me, but was thirty
Speaker 2: three milliseconds versus twenty nine for normal. So it wasn't
Speaker 2: like ooh on MRI, like this part of the muscle
Speaker 2: is bright white and this is black, Like this is
Speaker 2: pretty subtle. Ultrasound did a little better. Nine people with
Speaker 2: my fascial pain syndrome and a known trigger point. The
Speaker 2: ultrasound found local areas of reduced vibration amplitude over the
Speaker 2: trigger point, like I guess it didn't like it didn't
Speaker 2: jiggle as much as it should. I literally don't. I'm like,
Speaker 2: I'm not, I'm not. I'm just trying to like chase
Speaker 2: this dated now. Maybe it's hard, but I guess I'm
Speaker 2: wondering the premise of dry needling is that you're putting
Speaker 2: them in a specific place that matters, similar to acupuncture,
Speaker 2: Like you're looking for the trigger point and you're putting
Speaker 2: the needle there, and maybe it doesn't maybe just need
Speaker 2: to be in the muscle full stuff.
Speaker 3: Yeah, I mean I think that that is my read
Speaker 3: of of the dry needling. I find your deep dive
Speaker 3: on this totally fascinating. I still think there are much
Speaker 3: but that's it's interesting. But I my sense of of
Speaker 3: kind of the the broader picture of the dry needling
Speaker 3: is that a lot of it is you have a
Speaker 3: muscle or something which is sore or like needs attention,
Speaker 3: and this is a way to like bring more attention
Speaker 3: to that. And the thing is, there's a million different
Speaker 3: in the sports spaces, like a million different ways that
Speaker 3: people think about doing this in an effort to like
Speaker 3: address sort of sore muscles in particular, not just points,
Speaker 3: so things like I mean, I would put foam rolling
Speaker 3: in this category, Like you know, there's a thing called
Speaker 3: muscle scrape. There's like a like a muscle scraper, and
Speaker 3: you basically just like scrape, scrape, scrape, scrape, scrape on
Speaker 3: your muscle, over the top of the skin, over the
Speaker 3: top of the scan and that. And the idea is
Speaker 3: like it it like injures it sort of injures it,
Speaker 3: but then it increases the blood flow. And I think
Speaker 3: this is the same kind of space, which is different
Speaker 3: from the idea of I'm sticking a needle in and
Speaker 3: releasing a trigger point, which feels I agree, yeah.
Speaker 2: Like maybe a little. It's it's not quite like we're
Speaker 2: we're finding energy meridians and and but it's it's it's
Speaker 2: it's close.
Speaker 3: Okay as usual, let's go to the data. Is there
Speaker 3: any actual evidence that this, uh, that this improves things?
Speaker 2: Can I give you one more biologically plausible factor aside
Speaker 2: from this increasing like telling your telling your body that
Speaker 2: there's a problem here, is that pain dampens pain. So
Speaker 2: if you like stub your toe, you might find you'll
Speaker 2: feel better if you actually like rub it, squeeze it, right,
Speaker 2: or even if you like rub or squeeze another part
Speaker 2: of your body so you can overcome the pain signals
Speaker 2: in part of your body by like engendering further pain.
Speaker 2: Isn't that just a short term Like it's pretty sure.
Speaker 2: This is like this feels like all these things are
Speaker 2: should be looking for. Like I did this and then
Speaker 2: four days later I feel better.
Speaker 3: Yeah, yeah, and that's not that's not We're hitting someone
Speaker 3: on the head and then they're like, oh yeah, my
Speaker 3: need doesn't hurt that much now that you put me
Speaker 3: in the head of the hammer.
Speaker 2: It's like, yeah, okay, I guess my point is it's
Speaker 2: not just distraction. It literally like the signal doesn't get
Speaker 2: to your brain. Okay, let's talk about the data. We've
Speaker 2: got a lot of studies here. I mean, should we
Speaker 2: do shoulder pain because that's what I'm doing.
Speaker 3: Let's do shoulder pain, and then we can do we
Speaker 3: can do knee pain because that's what I'm in. So
Speaker 3: we can do our different problems.
Speaker 2: All right, talk to me about Let's see. This is
Speaker 2: a study from the journal.
Speaker 3: Pain Reports, Pain Reports, not exactly High Impact factor journal,
Speaker 3: which fine is like, all right, so so you know
Speaker 3: this is a study with active and sham control groups.
Speaker 1: There's twenty people in each group. All these studies are
Speaker 1: super super small.
Speaker 3: There is a dry needling effect which is significantly different
Speaker 3: between the active and the sham and the sham group.
Speaker 3: It's kind of on the I would say, on the
Speaker 3: margin of signaligans it's not you know, it's not our
Speaker 3: most significant thing. But of course it's a very small study,
Speaker 3: so you know, I don't.
Speaker 2: Know, we believe in sham. I feel like sham dry
Speaker 2: needling is easier than sham.
Speaker 1: Cupping because you put the needle in like less, like
Speaker 1: if you.
Speaker 2: Feel a little pinch in your skin, you could convince
Speaker 2: me that you're doing something right.
Speaker 1: Yeah, I think it's it feels easier to do this.
Speaker 3: And also if you think, I mean, there's actually pretty
Speaker 3: good sham acupuncture for example, which is where you like
Speaker 3: acupuncture in the wrong places. Now that's particularly easy because
Speaker 3: acupuncture is supposed to be about a specific vacation here.
Speaker 2: You have to do it generally a sham acupuncture. Uh.
Speaker 2: Studies show that it works as well as definitely nothing.
Speaker 3: Better than nothing, but just the same as Yeah, So yeah,
Speaker 3: I thought this was interesting. Again, the effects are fairly
Speaker 3: they're fairly small, and they're not like wildly significant, they
Speaker 3: know last like forever.
Speaker 1: Yes, So I don't know.
Speaker 2: The knee pain study is quite a bit bigger. It's big, yeah.
Speaker 2: So this is coming to you from the Clinical Journal
Speaker 2: of Pain in twenty eighteen. This is a study of
Speaker 2: two hundred and forty two participants with knee oste arthritis.
Speaker 2: Half of them got six weeks of electrical dry needling
Speaker 2: like the kind that kind of got and manual therapy
Speaker 2: which is just like you know, massage and stuff like that,
Speaker 2: an exercise, and the other group just got manual therapy
Speaker 2: and exercise. This had a pretty dramatic effect actually, so
Speaker 2: in terms of like a significant improvement based on this
Speaker 2: Global Rating of Change scale, seventy five percent in the
Speaker 2: dry needilin group had a successful outcome compared to eighteen
Speaker 2: percent in the just manual therapy and exercise group at
Speaker 2: three months. Of course, the problem here is that it's
Speaker 2: not there's no sham control here, but still a pretty
Speaker 2: big effect size.
Speaker 3: I feel that this was an interesting I mean, I
Speaker 3: think there's an interesting think here which relates to to
Speaker 3: your point about co co intervention, which is like what
Speaker 3: they're doing here is they're doing this and they're doing exercise,
Speaker 3: and they're like they're doing they're sort of layering this
Speaker 3: on top of other things, and so one interpretation of
Speaker 3: what they find, which I'm not sure in the study
Speaker 3: they actually give me enough information to figure this out.
Speaker 3: But like, if I think that the pain that the
Speaker 3: dry needling is going to make it more possible for
Speaker 3: me to exercise, Like if this is going to improve
Speaker 3: my engagement with the exercise because I think I feel better,
Speaker 3: then you like layer on top of this of the
Speaker 3: placebo effect. Also that kind of like, well the exercise
Speaker 3: is more effective because you're doing it more because you
Speaker 3: think it's going to work better, And then it's like
Speaker 3: both more exercise and more needling, right, right, kind of
Speaker 3: shows up. So I think there's a sort of it
Speaker 3: like a like an additive place and we know exercise
Speaker 3: is good.
Speaker 2: Right, Well, it's like we should probably consider this for
Speaker 2: its own episode. But what's that like kinetic tape that
Speaker 2: people KT tape? Yeah yeah, yeah, I haven't looked at
Speaker 2: the data yet, but I'm suspicious that that can do much.
Speaker 2: But you're right, if just having it makes you feel
Speaker 2: like I can work out a little harder, maybe work
Speaker 2: out a little harder, right, and that that actually does
Speaker 2: make you.
Speaker 3: So I I that was my a little bit of
Speaker 3: my read of this because the effects are very the
Speaker 3: effects are very big.
Speaker 1: I mean, knee pain is known to be very, very
Speaker 1: susceptible to placebo effects.
Speaker 3: I mean it's our very best placebo stuff is in
Speaker 3: like even knee surgery, where like you can show that
Speaker 3: that just cutting someone's knee open and telling them that
Speaker 3: they were in knee surgery is like basically as good
Speaker 3: as actual knee surgery, right right, Well.
Speaker 2: What happens after you get fake knee surgery is you
Speaker 2: get physical therapy right regardless.
Speaker 3: Which is probably very good for your Yeah, uh totally yeah.
Speaker 3: So I mean again, I think with all of these things,
Speaker 3: like it's ah, is that the placy like and does
Speaker 3: it matter? That's always always want to ask that with
Speaker 3: like would it like does it matter? Well, the thing
Speaker 3: that is, if it's not doing we can get into harms,
Speaker 3: but if it doesn't matter, if if there's no real harm,
Speaker 3: yeah we'll.
Speaker 2: Talk about harms, and there's costs. But also even in
Speaker 2: a good randomized trial, even with a sham control, what
Speaker 2: you almost never get is an active comparator control, which
Speaker 2: is should I like, given my knee pain, should I
Speaker 2: do dry needling or cupping, or physical therapy or aqua therapy. Right,
Speaker 2: so you know, it's it's actually not hard in a
Speaker 2: lot of the wellness space to find small studies that
Speaker 2: appear to be decently done that might suggest some benefit
Speaker 2: of a given intervention. We've talked about publication bias, like
Speaker 2: you're probably not seeing all the studies that you know
Speaker 2: don't show an effect and all that kind of stuff.
Speaker 2: But you know the real question for you is, Okay,
Speaker 2: I've got this problem, what's the best way to fix it?
Speaker 2: And and some of the I in the end, I
Speaker 2: often come back to biologic plausibility, like I want the
Speaker 2: thing that is the most plausible end has the best data,
Speaker 2: as opposed to just anything that has data is good enough.
Speaker 3: I also think this layers your belief about this layers
Speaker 3: on top of these placebo effects, right because in some sense,
Speaker 3: like the thing you should do if you thought there
Speaker 3: were a ton of things that were vaguely plausible, but
Speaker 3: a lot, probably a lot of it was driven by
Speaker 3: spacebo effects, you should pick the one you believe.
Speaker 1: Oh yeah, that's the one where you're gonna get the best.
Speaker 2: If your faith is strong enough.
Speaker 3: Exactly, So it's like, if you think dry needling is
Speaker 3: the thing that works, that's the one you should pick.
Speaker 3: If you think cupping is the thing that's worked, that's
Speaker 3: what you think. If you think like, you pick the
Speaker 3: one that you think that, I mean, that's how you're
Speaker 3: getting That's how you're getting your most effectively.
Speaker 2: Are you saying that people basically should stop listening to
Speaker 2: this podcast where we're like, I don't know about this
Speaker 2: and just go with their guting's going with your gut.
Speaker 3: No, no, it's like you need to keep listening so
Speaker 3: you have support for your gut, oh guy, for your
Speaker 3: different knee pain problems.
Speaker 2: But you do have to think about risks. So let's
Speaker 2: talk about risks of kneeling.
Speaker 1: Generally, the risks are fairly small.
Speaker 3: I mean again, we sort of talked about cutting yourself
Speaker 3: and pulling blood out here, you are sticking, you are
Speaker 3: sticking needles into yourself. There's you know, there's bleeding. You know,
Speaker 3: major events are pretty rare. There are some neumothorax risks,
Speaker 3: which which are more of a problem.
Speaker 2: So I don't know if you knew this, but TJ. Watt,
Speaker 2: the linebacker from the Pittsburgh follow Stealers, I.
Speaker 3: Don't really follow football other than Taylor Swift related football news.
Speaker 2: I think Taylor's okay. In December of last year, he
Speaker 2: got taken to the hospital for like a lung issue,
Speaker 2: and what it turned out was that he had a
Speaker 2: newmo thorax from dry needling. And so what a new
Speaker 2: moothorax is is a collapsed lung and it's it's actually
Speaker 2: pretty interesting. So the way the lungs work is that
Speaker 2: you know, you've got this diaphragm that sort of moves
Speaker 2: up and down, and the lungs are in the chest
Speaker 2: and there's essentially a vacuum between the outside of the
Speaker 2: lung and the inside of the chest wall. So as
Speaker 2: the diaphragm goes down, the only place air can go
Speaker 2: to fill that vacuum is into the lung. There's no
Speaker 2: path into the inside of the chest wall, okay, But
Speaker 2: if you create a path into the inside the chest
Speaker 2: wall and your diaphragm goes down, then air goes into
Speaker 2: the chest instead of in through your mouth and into
Speaker 2: the lungs, and that has the effect of just collapsing
Speaker 2: the lung as if it were like a balloon. It's
Speaker 2: like a pop pivolan po and we get quite scared
Speaker 2: about this in medicine, because we do stick a lot.
Speaker 2: You are using your lungs all the time, people need them,
Speaker 2: it turns out, and we stick a lot of needles
Speaker 2: in this area, particularly in people who are pretty sick,
Speaker 2: like we'll put in a central venus catheta, for example,
Speaker 2: in the internal jugular vein, which is you know right
Speaker 2: here for those of you listening, just like pointing to
Speaker 2: my neck, but the top of the lung, the top
Speaker 2: of the plor is pretty darn close, and we'll use
Speaker 2: ultrasound and stuff to make sure that we're not violating
Speaker 2: that space, because then you get a new mouthorax you
Speaker 2: can fix, but you have to have the lung. I
Speaker 2: have had this complication, I yep, I like on yourself.
Speaker 2: No no, no, Fortunately on someone I was trying to
Speaker 2: take care of much worse.
Speaker 1: I was dry needling myself.
Speaker 4: And I no I was.
Speaker 2: I was putting a central line in the ICU in
Speaker 2: this uh this guy very skinny, very little tissue above
Speaker 2: his lungs to give myself a little bit of a
Speaker 2: defense here. And you know, this is a known complication.
Speaker 2: We consent people. We tell them that this is something
Speaker 2: that could happen. And we always get an x ray
Speaker 2: right after we put in one of these lines to
Speaker 2: make sure there's a no normal thorax. And it's like
Speaker 2: three am in the ICU and I get the x
Speaker 2: ray and it comes up and I'm like, oh, you know,
Speaker 2: and I had to call. It's embarrassing because you have
Speaker 2: to call surgery and like, I'm a medical doctor and
Speaker 2: I'm like, hi, guys, can you fix my problem? And
Speaker 2: they come and they put in a chest tube and
Speaker 2: it's fine, but it's not great. And so what happened
Speaker 2: to TJ. Wise? He was getting dry needling in the
Speaker 2: trapeziest muscle right here in your neck and you just
Speaker 2: go too deep you hit the lung. That's and of
Speaker 2: there was a report of this of a case series
Speaker 2: of seventeen serious complications from dry needling, and fifteen of
Speaker 2: the seventeen were pneumothorax. So your lungs are closer to
Speaker 2: the surface than you think. You really do have to
Speaker 2: be careful.
Speaker 1: About this, So a little more careful if you're doing
Speaker 1: it up in your neck. Yeah, you smash your pass
Speaker 1: un dry needling Berry.
Speaker 2: I'm you know, I've never had it done. I'm a
Speaker 2: pass on this again. I don't think it's worth the
Speaker 2: potential risks. I still think getting a nice massage in
Speaker 2: a quiet dark room with some nice music playing, it's
Speaker 2: going to make you feel good. Emily, you had this done,
Speaker 2: it made you feel better.
Speaker 3: Yeah, I'm a smash. I'm a smash. I'm a smash
Speaker 3: if you believe in it, and I will say I
Speaker 3: based on my experience, I believe in it. So if
Speaker 3: I if I had a similar related injury, I would.
Speaker 1: Probably do it again. Yeah, right, all right?
Speaker 2: That is it for not in my neck. Not in
Speaker 2: my neck, maybe not your back or anywhere where.
Speaker 1: Just more legs. In my life, I would do it
Speaker 1: in my legs. I'm smashing the legs, not otherwise.
Speaker 2: That's it for cupping and dry kneeling. You're a mailback.
Speaker 2: Question of the week after.
Speaker 4: The break.
Speaker 6: Hi, Emily and Perry. This is Delilah from Detroit. Settle
Speaker 6: a bet between my partner and meat.
Speaker 4: Please.
Speaker 6: She says that it's best to brush your teeth when
Speaker 6: you first wake up in the morning. I say it's
Speaker 6: best to wait until after breakfast. Who's right? Thanks so much.
Speaker 3: It turns out the best time to brush your teeth
Speaker 3: is before breakfast, particularly if you're going to have coffee. Hee.
Speaker 1: Most people brush your after breakfast.
Speaker 3: Actually food starts to like to the acid in your
Speaker 3: food can like affect the enamel, and so then when
Speaker 3: you brush your teeth after breakfast, you like remove more
Speaker 3: of the enamel than if you brush your teeth before breakfast.
Speaker 3: And so I actually think that the dentist recommended thing,
Speaker 3: since of course you don't also want to have food
Speaker 3: in your mouth, like when you eat breakfast and he
Speaker 3: gets in your teeth, and then that's also bad. Is
Speaker 3: you should brush your teeth like when you wake up,
Speaker 3: and then after breakfast you should like rinse your mouth
Speaker 3: with one of those like water velosster things to get
Speaker 3: the food out from between your teeth. Okay, yeah, I
Speaker 3: don't do this, but I think this is the the
Speaker 3: I am recommended thing.
Speaker 2: I'm definitely like a coffee is going to stain my teeth,
Speaker 2: and therefore I should brush my teeth after or I
Speaker 2: have coffee. But maybe I should just like rinse my mouth.
Speaker 1: Yeah, maybe it should ri inside your mouth.
Speaker 3: Yeah, I will say I am my dentist like least
Speaker 3: favorite client because I don't really believe in routine extra
Speaker 3: like I think we over X ray people. I'm not
Speaker 3: afraid of the extra, but I generally think like routine
Speaker 3: dental X rays are unnecessary, and I don't have dental insurance,
Speaker 3: and so it's both a belief about routine dental X
Speaker 3: rays based on some data and also a feeling about.
Speaker 2: The economics of money, and so I'm.
Speaker 3: I'm like always on the edge of like just how
Speaker 3: they will They insist that you have routine X rays
Speaker 3: some number of years to stay in our dental practice,
Speaker 3: which I like very much, but every time I'm trying
Speaker 3: to push them off. So like I've been pushing them
Speaker 3: off and off and off, and finally last time they
Speaker 3: were like, if you don't do it next time, we're
Speaker 3: not going to see you any My god.
Speaker 2: It's like, Okay, kicked out of a practice, like like
Speaker 2: someone yeah, yeah, exactly.
Speaker 3: I'm like, I'm like the anti vaxer of the essential practice,
Speaker 3: and I feel a little bad about it. And my
Speaker 3: husband's always like, I like this dentist, like, don't get
Speaker 3: us kicked out, Like don't get us kicked out by
Speaker 3: being a weirdout, Like just get the X rays.
Speaker 1: So anyway, brush you before breakfast.
Speaker 2: Kids from your teeth to God's ears.
Speaker 1: That's it for us today.
Speaker 3: Stick with us next week when we'll ask what's the
Speaker 3: deal with hypoactive sexual desired disorder?
Speaker 1: Oh, I'm interested to discuss that.
Speaker 2: Okay, let's go.
Speaker 3: Wellness Actually is produced in association with iHeartMedia. Our senior
Speaker 3: producer is Tamar Avishai. Our executive producer at iHeart is
Speaker 3: Jennifer Bassett. Our theme music is by Eric Deutsch, and
Speaker 3: our content is for educational purposes only.
Speaker 2: If you like the show, help other people find us,
Speaker 2: leave a rating and review on Apple Podcasts or your
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Speaker 2: Head over to Wellness Actually dot fm and leave us
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Speaker 2: a future show.
Speaker 1: We'll let the influencers have the last word.
Speaker 2: What is this thing?
Speaker 4: So you know what puppy? Yeah? Like people do it
Speaker 4: with like fire and something. They have digital one and
Speaker 4: it's much user so vibrate up. It's got red light.
Speaker 3: Yeah, what look at Oh my gosh, do you see
Speaker 3: how much that is pulling at a skin.
Speaker 1: Wait, I thought you had to go to a spot
Speaker 1: for one of these.
Speaker 4: So it feels good?
Speaker 5: Oh yeah?
Speaker 1: Does it feel good?
Speaker 2: Is it's finally Yeah?
Speaker 4: The nice thing is, you know, not it's like it's
Speaker 4: in one spot, so now it's actually getting that spot.
Speaker 2: Usually I roll on a ball, but how long do I.
Speaker 1: Can I take it off? I want to see Oh yeah,