Acupuncture and Oppositional Defiant Disorder
Recently there has been some degree of outrage about a 14 year old “asbo yob” receiving taxpayer funded acupuncture treatment in an attempt to moderate his behaviour. One senses that some of the outrage may stem from the belief that “yobs” should be punished, not given what may be perceived as “feel-good” treatments, but this misses the point completely – if the treatment works and the boy in question stops causing such mayhem, then everybody wins.
However, opposition to the acupuncture treatment also comes from the belief that there is no evidence that acupuncture works for “Oppositional Defiant Disorder” which is – apparently – the diagnosis which has been made in this case. My colleague Sean Barkes was recently asked to discuss this case on BBC Radio Humberside. The debate became one of research availability. Whilst the detractors argue there is no evidence to suggest that traditional acupuncture might be helpful for ODD, Sean argued that there was. My colleague’s point was that there is an abundance of research to show that acupuncture is helpful in improving health in humans, including mental health. Inevitably, physical and mental health status affects behaviour. The other point he was trying to make was that, even if positive research evidence were available relating to the acupuncture treatment of ODD, it would not be relevant for this specific case as it is the cost to society that is the key point here.
There is a lot of research to show that acupuncture has a positive effect on people both mentally and physically; for example, it is at least as effective as anti-depressant medication in treating depression (1), it is more effective than hypnotic drugs (sleeping tablets) at treating insomnia (2), and is at least as effective as drug-therapy for managing migraines (3). Therefore we can say that it is likely to have a beneficial effect in this case. If orthodox solutions have been tried and not been effective, something needs to be done. If we know that acupuncture may have a positive effect on this individual’s mental states, it may well be that acupuncture is worth trying. What, after all, is the alternative? The alternative is probably to lock him up. This, I don’t doubt, would be a whole lot of a bigger financial burden on the tax-payer than a mere £40 a week acupuncture treatment. So there is a case to be made that trying acupuncture may well save the tax-payer a lot of money; furthermore, if it is successful, it may encourage further research in the area, which might just mean that the tax-payer saves an awful lot of money.
It is too simplistic to argue that there is no research to support the use of acupuncture in this case. Evidence for the efficacy or otherwise of any treatment for any condition does not just appear. If you have a condition for which you do not have an effective treatment, you have to try something. If you have positive results, and you can repeat these in a few other cases, you can start thinking about doing some proper research. I would think that the people responsible for trying acupuncture here deserve some credit for a bit of initiative, and in fact for looking for a solution which is much more economical than most.
A further relevant point here is the way that research is done on the effectiveness of a holistic treatment such as traditional acupuncture. Such treatment is targeted at the individual patient, rather than at the specific condition, such as ODD. However, the usual research methodology, epitomized by the Randomized Controlled Trial, focuses down onto the condition, and pretty much ignores the larger context of the patient’s general health. An RCT investigating the effectiveness of a drug to counteract high blood cholesterol, for instance, may conclude that the drug in question is effective in lowering cholesterol levels, but it does not measure or take into account such things as the side effects of that drug. The question such a trial should really address is, do people live longer when they are on the drug in question – and, perhaps, do they have a better quality of life. If people’s life expectancy is not improved by the drug, and if their quality of life is impoverished, then the fact that their cholesterol levels are lowered is of little consequence. This example illustrates the main weakness of modern western medicine, which all too easily falls into the trap of treating the condition rather than the person. It is no good improving one isolated aspect of the person’s health if their overall health suffers.
So similarly in a case like this, one would want some research which investigated, say, whether traditional acupuncture treatment reduces the cost to society of young offenders, rather than whether it helps with ODD specifically. After all, it would be of little consolation to anyone if the lad in question displayed improvement in the symptoms of ODD, such as fewer angry outbursts and less resentment, but continued with a life of crime anyway.
So, far from outrage, a more reasonable response to this story would be to welcome the possibility that a very economical holistic therapy such as acupuncture may have an important part to play in managing these kinds of anti-social behaviours in a cost-effective way. But the research which needs to be done to find out whether this indeed may be a viable approach needs to avoid over-focusing on conditions such as ODD and measure whether there is a reduction in violent and anti-social behaviour.
Written by Vimalaprabha