When I give public lectures I often ask the crowd to name the most important things we can do for our health. The point is to highlight the simple, obvious, evidence-based truths. Don’t smoke. Exercise. Eat real food. And so on. And this is generally the kind of stuff I hear back from audiences. But over the past year or so, more and more people are shouting something new. They are telling me to be mindful.
It appears that there is a growing perception that mindfulness is now one of the most important things we can do for our health. It has been embraced by celebrities (Oprah), sports stars (Kobe Bryant) and business leaders (Steve Jobs). A 2014 Time magazine cover declared that we are now in the midst of a “mindful revolution.” And mindfulness is a central plank of virtually every integrative, alternative and/or holistic health centre on Planet Earth.
Is this hype justified?
Fear not, mindful masses, I am not about to bash meditation. On the contrary, being more mindful, a meditation practice that focuses on present-moment awareness, has been one of my New Year’s resolutions for the past decade. (I usually fall off the in-the-moment wagon within the first week, mostly because it makes me sleepy. Yes, I know, I’m doing it wrong.)
There is a growing body of evidence to support the idea that mindfulness has health benefits. When advocates of the practice — be they celebrities, motivational speakers or university-based clinicians — write or speak about mindfulness and meditation, there are almost always more than a few research-has-shown phrases.
And this is where the health policy challenge lies. Is mindfulness a science-based approach to health and wellbeing or a philosophy about how we should live? If the former, what does the good science actually say about the benefits? If the latter, does it matter what the science says, and what, then, is its place in an (allegedly) evidence-based health care system? And, perhaps most challenging, can it be both?
Regardless of your personal view about these tensions — and it should be noted that many continue to debate the appropriateness of secularizing and researching this 2,500-year-old Buddhist practice — there is no doubt that meditation and mindfulness has been increasingly presented in popular culture as something that can be studied and that has empirically verified benefits. This is how it is now sold: by practitioners, by funding agencies and by universities seeking to obtain research grants on the topic.
So what does the science actually say? In fact, the available evidence is far less definitive than the Oprahs of the world would have us believe. For example, a rigorous 2014 systematic review of available evidence on the impact of meditation on stress and well-being, published in JAMA Internal Medicine, reviewed over 18,000 citations and found 47 randomized clinical trials worthy of consideration. Using only these high-quality studies, it concluded there is moderate evidence to support the benefits associated with anxiety and depression and either insufficient evidence or evidence of no effect “on positive mood, attention, substance use, eating habits, sleep, and weight.”
More importantly, the study also found no evidence “that meditation programs were better than any active treatment.” Mindfulness was not better than, for example, exercise. In part, this may be because many of the studies on mindfulness and meditation are, from a methodological perspective, less than ideal.
A 2007 review done for the US Department of Health and Human Services by the University of Alberta Evidence-based Practice Center came to a similar conclusion, finding that most studies on meditation were “of a poor methodological quality” and that no “firm conclusions on the effects of meditation practices” can be made.
These are pretty underwhelming conclusions for an approach that has received so much attention.
To be fair, emerging research continues to suggest that the benefits for some conditions are significant and measurable — such as recent work on anxiety and depression. And its applications in other areas, like ADHD and sleep, appear to be promising.
But mindfulness is not magic. As is almost always the case when investigating a health intervention of any kind, the results will vary. It will be found that it works for some conditions and not for others.
And this brings us back to the tension between viewing it as an intervention worthy of study and a philosophy or spiritual approach to life. If we want to embrace a scientific approach, we can’t allow the philosophy to taint the interpretation and presentation of the research. For example, in the context of mindfulness and meditation research, I am certain a phenomenon called “white hat bias” plays at least a small role in the production and interpretation of the relevant data. The white hat bias, which was first articulated in 2010 in relation to obesity research by Mark B. Cope and David B. Allison, leads to a “distortion of information in the service of what might be perceived to be righteous ends.” In other words, when the end is viewed as worthy (such as supporting a philosophy perceived as being socially beneficial), research results tend to be exaggerated and are more likely to be reported in a positive light by the media.
There are also vested interests involved. When a mindfulness practitioner, who works in a mindfulness clinic, writes an article and it is published in a journal called Mindfulness, I tend to read the article with a heightened level of skepticism. The conflicts run deep. Indeed, I did a quick skim of dozens of abstracts in that particular journal. I could find very few, if any, truly negative conclusions about the value of mindfulness. Which, from an academic perspective, is pretty suspicious. The journal’s unwavering support of all things mindful is almost comical but, given the journal’s title and mandate, hardly surprising.
And we should not forget that mindfulness has become a big business. There are mindfulness apps, mindfulness courses and hundreds and hundreds of books. Like it or not, mindfulness is now an industry. And this means that the potential for profit will, inevitably, further twist what we hear about the value of the practice.
Of course, these and other biases and distorting influences exist in other areas of health research. But the growth of mindfulness research is a wonderful example of how the appeal of a philosophy or world view (I’m thinking of you, naturopathy) can colour what we hear about relevant research.
So I say let’s tone down the hype and study mindfulness in a rigorous manner, looking at both benefits and possible harms. We should strive to do it in the same critical and dispassionate manner that good science demands for all areas of research. We should be aware of the potential biases and vested interests. And we should guard against allowing the attractiveness of the broader philosophical approach to distort what we hear about the science.
If we want to use science to justify the use of mindfulness, we must play by the rules of science.