Cupping therapy is a form of alternative medicine in which a local suction is created on the skin with the application of heated cups. Its practice mainly occurs in Asia but also in Eastern Europe, the Middle East, and Latin America. Cupping has been characterized as a pseudoscience and its practice as quackery. Cupping practitioners attempt to use cupping therapy for a wide array of medical conditions including fevers, chronic low back pain, poor appetite, indigestion, high blood pressure, acne, atopic dermatitis, psoriasis, anemia, stroke rehabilitation, nasal congestion, infertility, and menstrual period cramping. Despite the numerous ailments for which practitioners claim cupping therapy is useful, there is insufficient evidence it has any health benefits, and there are some risks of harm, especially from wet cupping and fire cupping. Bruising and skin discoloration are among the adverse effects of cupping and are sometimes mistaken for child abuse. In rare instances, the presence of these marks on children has led to legal action against parents who had their children receive cupping therapy. Scientific evaluation The American Cancer Society notes that "available scientific evidence does not support claims that cupping has any health benefits" and also that the treatment carries a small risk of burns. A review of literature in 2011 determined that "the effectiveness of cupping is currently not well-documented for most conditions", and that systematic reviews showing efficacy for the treatment of pain "were based mostly on poor quality primary studies." This was further supported by a review in 2014 which demonstrated that previous evidence supporting cupping has resulted from "unreasonable design and poor research quality". There is a lack of evidence to support the use of cupping therapy for acne. Additionally, cupping is often practiced along with other acupuncture therapies and therefore cannot exclusively account for resultant positive benefits. Many reviews suggest that there is insufficient scientific evidence to support the use of cupping techniques to combat relevant diseases and chronic pain. Cupping has been characterized as quackery. The lack of apparent benefits of cupping treatments are discussed by Simon Singh and Edzard Ernst in their 2008 book Trick or Treatment. As a pseudoscientific detoxification ritual, proponents of cupping falsely claim that it can remove unspecified toxins from the body. Proponents also falsely claim that cupping "improves blood flow" to help sore muscles. James Hamblin notes that a bruise caused by cupping "is a blood clot, though, and clotted blood