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Comment & Response |

Meditation Intervention Reviews

Harald Walach, PhD1; Stefan Schmidt, PhD1,2; Tobias Esch, MD3,4,5
[+] Author Affiliations
1Institute for Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany
2Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
3Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
4Neuroscience Research Institute, State University of New York College at Old Westbury, Old Westbury
5Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
JAMA Intern Med. 2014;174(7):1193-1194. doi:10.1001/jamainternmed.2014.1422.
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To the Editor A recent publication on the effects of meditation programs against stress1 reviews rigorously randomized clinical trials (RCTs) with active control groups. We would like to point out a couple of unsolved issues that may arise when discussing the impact of these findings.

The review has only collated evidence from RCTs with active control groups. Randomized clinical trials can only be done, by definition, with patients and individuals who are willing to be randomized. Thereby such trials are excluding the potentially most beneficial therapeutic agent: conscious choice and active engagement. Thus, by default, RCTs can only test and describe what is the minimum effect on people who use a certain intervention, as if it were delivered to them as a passive recipient, like a medication. But meditation is no medication. It requires active involvement and the decision to dedicate regularly a specific amount of time, over a larger period in order to change one's habits and attitudes. This can only be assessed in long-term comparative cohort studies that in other conditions and occasions have shown reliable results comparable to RCTs.2


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July 1, 2014
Madhav Goyal, MD, MPH; Eric B. Bass, MD, MPH; Jennifer A. Haythornthwaite, PhD
1Department of Medicine, Johns Hopkins University, Baltimore, Maryland
1Department of Medicine, Johns Hopkins University, Baltimore, Maryland2Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
3Department of Psychiatry and Behavioral Services, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2014;174(7):1195. doi:10.1001/jamainternmed.2014.1393.
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