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Comment & Response |

Meditation Intervention Reviews—Reply

Madhav Goyal, MD, MPH1; Eric B. Bass, MD, MPH1,2; Jennifer A. Haythornthwaite, PhD3
[+] Author Affiliations
1Department of Medicine, Johns Hopkins University, Baltimore, Maryland
2Department 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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In Reply Walach et al suggest that randomized clinical trials (RCTs) should not be used to evaluate meditation programs. While we agree that cohort studies provide valuable information, we disagree with the rationale that conscious choice and active engagement are eliminated in RCTs. Individuals make a conscious choice to join meditation trials, and since meditation requires engagement by the participant, it cannot become a passive activity merely by the act of randomization any more than exercise could. Both cohort studies and RCTs have inherent strengths and weaknesses in terms of generalizability and the extent to which “causal” conclusions can be drawn. Cohort studies are useful early in establishing short- and long-term outcomes of a risk or risk reduction factor. Randomized clinical trials then provide evidence as to the “causal” role of this factor through manipulating, ideally, only the factor of interest. The Institute of Medicine report cited by Dr Loucks makes a point of this value of RCTs.1 Following high-quality RCTs, cohort studies can further establish the circumstances that optimize and promote engagement over long periods.

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July 1, 2014
Thomas Rutledge, PhD; Paul Mills, PhD; Robert Schneider, MD
1Psychology Service, Department of Veterans Affairs San Diego Healthcare System, San Diego2Department of Psychiatry, University of California, San Diego
2Department of Psychiatry, University of California, San Diego
3Maharishi University of Management, Institute for Natural Medicine and Prevention, Maharishi Vedic City, Iowa
JAMA Intern Med. 2014;174(7):1193. doi:10.1001/jamainternmed.2014.1419.
July 1, 2014
Harald Walach, PhD; Stefan Schmidt, PhD; Tobias Esch, MD
1Institute for Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany
1Institute for Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany2Department 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, Massachusetts4Neuroscience Research Institute, State University of New York College at Old Westbury, Old Westbury5Division 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.
July 1, 2014
Eric B. Loucks, PhD
1Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
JAMA Intern Med. 2014;174(7):1194-1195. doi:10.1001/jamainternmed.2014.1924.
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