The marketing of mindfulness and why that matters

Alan Cassels is a drug policy researcher and regular contributor to the blog. He is also the author, most recently, of The Cochrane Collaboration: Medicine’s Best-Kept Secret. He tweets as @akecassels.  


mindfulnessIs it possible to use our minds to create a better sense of physical well-being? Can we use meditative breathing, non-judgmental “mindfulness” techniques and so on to reduce anxiety and depression, hone social skills, and improve learning? The short answer is “probably,” but when you look at the body of scientific study and reporting of mindfulness research, you can’t help but feel pushed toward a more conclusive frame of mind.

There are undoubtedly many health-related claims attributed to mindfulness, plugged as the cure for pain, chronic fatigue, mental distress and other afflictions.  And the media has been quick to report on those claims. This NPR report covers research claiming mindfulness works better than opioids for lower back pain. The New York Times said the practice might cause beneficial changes in the brain.

It can’t be that flaky because even the business world is catching the mindfulness vibe. Business.com asserts that CEOs must learn to embrace mindfulness if they want to improve their performance and well-being. This Forbes column says that mindfulness can help businesses dealing with anxious, stressed out and unengaged employees. The Huffington Post adds that adopting mindfulness is a good way to deal with difficult people. US News and World Report says it can even help prevent overspending and reduce consumer debt.

Is mindfulness, then, the new blockbuster Super Drug that we should all be taking?

Mindfulness as marketing tool

That’s hard to say, but if you haven’t absorbed this yet, let me plant one undeniable seed: mindfulness has an influence that is BIG and growing. This New York Times piece reveals there are incredible efforts to commercialize it, to make it grow even bigger and more mainstream than yoga. You can flip through Mindful Magazine, pick up a copy of one of an estimated 8,000 mindfulness books on the market, or peruse the growing list of peer-reviewed journal publications on the topic. Hungry? Why not spread a dollop of Mindfulness Mayo on your BLT, have a Mindful burger in a chain of Chicago burger joints, drink mindful tea, or go on a mindful diet, according to the Washington Post?

prod-mayo-originalPromoters of mindfulness-based approaches claim that there’s plenty of solid research showing that the practice improves attention, emotional regulation, compassion, and sense of calmness. But how do those claims square up against a dispassionate review of the evidence?   

Researchers at Montreal’s McGill University just released a publication in PLOS One looking closely at how randomized controlled trials of mindfulness-based mental health interventions are reported. One of the authors of this report, McGill psychiatry professor Dr. Brett Thombs told me that there is a “massive push to support and propagate it [the mindfulness message],” adding that “it isn’t dissimilar to [the drug industry] pushing cures that don’t work like they say they do.”  

Thombs believes that people certainly have some ability to control their bodies with their minds, but he and his team wanted to find some “real evidence” to support the health claims. He said: “While I’d agree that those selling wares carry out all sorts of shenanigans to promote their work, could this be happening with mindfulness?”

Systematic review finds biased reporting of benefits

His team looked at 124 published trials of mindfulness, finding that 87% of them reported at least one positive outcome in the abstract, and 88% that said mindfulness-based therapy was effective. Based on the effect size they found, the number of positive trials was much larger than they would have expected. Of the trials reviewed, only 21 had been registered (as required by the International Committee of Medical Journal Editors), and most of those — 13 (62%) — remained unpublished 30 months after the trial was completed. (Note to reader: This is what we call publication bias.)

Thomb’s team also found that of all of the 36 systematic reviews and meta-analyses of mindfulness they looked at, none gave sufficient attention to important caveats and limitations as you’d expect with any meta-analysis. In other words, by failing to acknowledge reporting biases, those reviews are likely overestimating the effects of mindfulness.  

What’s one to conclude from all of this? That researchers in mindfulness, like almost anywhere, are capable of cherry-picking studies, some of which may make outrageous claims, including real nose-stretchers that mindfulness can “change the brain” in a short period of time.  

Bear in mind: It’s unlikely to do harm 

So, what’s the take-away, Alan?

As Thombs says: “I don’t believe that mindfulness training is completely ineffective or is harmful. I do believe–and I am supported by the evidence that we are publishing–that we don’t have a very good idea of how effective it is.”

Mindfulness is about being open and receptive, focusing on breathing and being intentionally nonjudgmental. Certainly anything that can reduce stress, bring peace and help focus our attention can’t be that bad, can it?  We are surrounded by so many demands on our attention, and it seems to me that the resulting chaos, stress and potentially harmful impact to our psyche demands some sort of effective antidote. Does it matter that vested interests may be exaggerating the evidence base underlying mindfulness?  Sure, but it’s surely not worth tossing the baby out with the bathwater.

I would conclude here — and I consider myself, as I write this, to be as “in the moment” as one can be while staring at a computer screen — that probably the truest thing that you can say about mindfulness or meditation is that it is unlikely to ever be harmful–a sentiment you could apply to almost no health care intervention in the modern world. If it’s a Super Drug, it’s probably beneficial in small doses and very unlikely to lead to a harmful overdose.

And that might be something worth meditating on.

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Comments (7)

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Robert Burney MD

April 12, 2016 at 5:10 pm

I ran a pain clinic at a university hospital where a new Mindfulness Meditation began. We sent him our failures–people who didn’t get better. His program was intense. Intake was a session every day for a month, and you had to agree to return for evaluations up to 12 months. Results were beyond belief. The typical patient had back pain for 2+ years and took prodigious amounts of medications. At the end of 12 months, the typical story was: “I still have the pain, but it doesn’t bother me as much now. I’m working and not taking any medications.” I went from serious skeptic to believer. This is real. Not 100% but more than half. And the starting point was patients who had failed everything else.

    Gary Schwitzer

    April 16, 2016 at 8:53 am

    On the other hand, on Twitter, Dr. Sharmila Dissanaike, chair of surgery at Texas Tech, wrote:

    “As someone who teaches mindfulness & sees its benefits, excess exposure & commercialization worry me”

    Which was really the point of Alan Cassels’ blog post.

    Gary Schwitzer
    Publisher

Maia Szalavitz

April 14, 2016 at 3:36 pm

Actually, there’s evidence that meditation, when done by depressed people or when done too intensely by distressed people, *can* be harmful. There’s a whole research project being done looking at this, called the Dark Night project http://www.theatlantic.com/health/archive/2014/06/the-dark-knight-of-the-souls/372766/

Mark Hunyor

April 16, 2016 at 10:50 pm

Consumerism creeping into mindfulness is incredibly ironic but not surprising. If anything, mindfulness is the ultimate anti-consumerist movement. It’s an alternative to “retail therapy” and and antidote to mindless consumerism in general. But it requires discipline to practice so maybe in our consumerist world many people would like to think you can buy it in a tub and put it on your salad. That type of promotion is quite scandalous and really letting the mindfulness movement down but enough people are out there doing it right, teaching mindfulness and its benefits, so I’m sure they will prevail.

    Cynthia H. Craft

    April 18, 2016 at 2:52 am

    What I know about mindfulness is that a) most people think it means taking a few second or minutes seconds out of their stressful workday to sit outside the office building and exclusively focus visually and mentally on something in their environment, usually a plant or flower or the weather, and b) mindfulness only works if people practice it daily; it’s main component consists of meditative breathing with eyes closed for at least 20-40 minutes. Like mediation, you must practice it daily or benefits such as reducing stress-induced “brain fog” vanish. The Mindfulness-Based-Stress Reduction (MBSR) program, as designed and instituted at MIT and Harvard decades ago, is really what mindfulness is all about. MBSR combines the practices of meditation, yoga, qui-jong (an ancient Asian art of contemplative, slow movements), group talk therapy and learning not to judge oneself harshly (similar to positive-self-talk, but more subtle). I agree with the author that it is a shame to see willy-nilly product marketing exploiting the meaning of mindfulness. And, if this interests anyone in your organization, a clinical trial at the Palo Alto Veterans’ Administration is now soliciting PTSD sufferers, half of whom will take part in what sounds like MBSR-style breathing techniques training, and half of whom won’t. I’d be interested in whether the VA’s methodology constitutes legitimate study methodology.

Holly Anderson

April 18, 2016 at 6:13 am

On so many levels, this was a wonderful and helpful review. Thank you. And I never thought about publication bias in quite this way. Double thank you.

Patricia Battaglia

April 18, 2016 at 10:20 am

I had to laugh at the mindful mayonnaise. But, like the pink-ribbon marketing of breast cancer, any cause or potentially helpful trend can be marketed in a manner that, at best is ironic, and at worst, sabotages the original idea.. One can only hope that mindful consumers will avoid the hype.