Talk:Transcendental Meditation

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Research on PTSD is a big new field of research for TM[edit]

The TM university is getting about $2.4 million in research funding from the US Military and the US Office of Veterans' Affairs. Several studies on TM's effects on PTSD have been published. The latest was announced today (10 Feb): Transcendental Meditation Significantly Reduces PTSD in African Refugees Within 10 Days (Journal of Traumatic Stress (Volume 27, Issue 1, 112–115)). This non-controlled study was conducted in the same country on a group of refugees similar to a previous single-blind, controlled study, pubmed ref: Reduction in posttraumatic stress symptoms in Congolese refugees practicing transcendental meditation and the full text of that other study in .doc file format is found here. These two studies both document that TM, at least on civilian refugees living in refugee camps in Uganda, has an exceedingly dramatic effect on PTSD: the controlled study found that 90% of the meditating subjects became non-symptomatic within 30 days, while the control group continued to show extremely high levels of PTSD on a standard test. This new study found that only one week of TM practice drastically reduced PTSD symptoms, but the 30 and 90-day post-tests showed some marginal PTSD symptoms lingering (35.3 average score where 35.0 is counted as non-symptomatic). A third study, from more than 20 years ago, showed that amongst Vietnam veterans, there was a 50% drop in PTSD symptoms over the course of the study. Here's the Full text in pdf format and the WIley journal abstract (not cited in pubmed). As an aside, note that none of these studies, despite their dramatic findings and effect sizes as large as 1.2, qualified for that recent AHRQ meta-analysis on anxiety. Sparaig2 (talk) 23:49, 10 February 2014 (UTC)

Please do not use this page as a soap box for promoting TM. This page is for article suggestions. Thanks, IRWolfie- (talk) 00:53, 11 February 2014 (UTC)
Are you aware that you come across as slightly biased, even hostile, at least to me? When David Spectre mentioned a new study, you shot him down because it was only a single study published in a not-so-reputatable journal. When I mention a new series of studies that are coming out about TM research, rather than addressing whether or not such a series should be included in the research section on TM, you accuse me of soapboxing about TM. So... Here's my pitch: as I said above, PTSD research is turning out to be a big thing in TM research. $2.4 million has explicitly been granted, as I understand it, by relevant US government agencies, to investigate TM's effects on PTSD. Given that you don't want ANY research that isn't mentioned in a "secondary source" to be mentioned, how should an on-going, multi-study research project such as the effects of TM on PTSD be handled by Wikipedia when there aren't enough studies yet to inspire a new "secondary source" meta-analysis? Sparaig2 (talk) 02:54, 11 February 2014 (UTC)
We don't interpret primary studies, we look to the secondary sources. I've no interest in looking through more methodologically weak studies and picking them apart. Trivially to see is that the first has an embarrassingly low 11 subjects and the third has 18 people split between psychotherapy and TM (I don't even know why you mention them at all; those numbers are embarassing) and the second doesn't have an adequate control group to account for placebo effects. But we don't do original research here. I'd be happy to include a study if I can pick through every fault and mention them all explicitly, but that would be against policy. You find them exciting, good for you. I don't share your enthusiasm. Wait until the secondary sources get there, if they didn't qualify for a relevant meta-analysis as you point out its because they were methodologically shit. Regards, IRWolfie- (talk) 00:24, 12 February 2014 (UTC)
So you're saying that a robustly done, large, head-to-head study is trumped by meta-analyses of numerous smaller studies that are not head-to-head? I'm not asserting that such studies exist, but in fact, that is what the American Heart Association is calling for. Such a study isn't a "secondary source" and yet, I've always understood that a single, large, well-done study is thought to automatically trump a meta-analysis that doesn't include it. 24.251.37.236 (talk) 13:42, 19 February 2014 (UTC)
No. Read WP:MEDRS, Second Quantization (talk) 00:51, 20 February 2014 (UTC)

Especially considering all of the contributors to the paper appear to be connected to the TM organization. Zambelo; talk 01:02, 20 February 2014 (UTC)

Virtually all meditation research is connected to practitioners of the specific practice being studied. Sparaig2 (talk) 14:16, 23 February 2014 (UTC)

"square root of 1 percent"[edit]

In the second paragraph under maharishi effect, "the square root of 1 percent" is used as a figure. Just from a mathematical POV, this needs clarification.

Is it intended to mean [ (SQRT(1)/100)*population ] or [ (SQRT(1/100))*population ]? If the former, then somebody is an idiot. If the latter, then it should say "one hundredth of one percent". If we don't know what it means, then this phrase needs to cite its own source and be in quotation marks so we know who originally said it. If there is no source to cite and somebody just wrote it here to sound dumb, then we should remove it.

The claim that 1% of a population doing TM would have a noticible effect on that population is called "The Maharishi Effect." The "Extended Maharishi Effect" refers to the claim that group practice of TM and the TM-SIdhis by the square root of 1% of a population would have the same effect and when it was first introduced, the world's population was just under 5,000,000,000, so the required number to effect the world was 7,000 and a logo for the campaign to establish a permanent group of people included that number. The formula used is: sqrt(population * 1/100). [1] Sparaig2 (talk) 08:23, 27 July 2014 (UTC)

The reference to the Maharishi Effect is now worse than it was when I first made the above comments. The Extended Maharishi Effect is NOT 1/100 of 1%. Sparaig2 (talk) 19:01, 30 August 2014 (UTC)

Wording in intro superceded[edit]

The introductory section on TM says, "It is not possible to say if it has any effect on health as the research to date is of poor quality," , but in fact, not only does the American Heart Association giveTM the only passing grade out of all meditation practices studied in their scientific statement on alternate therapies for hypertension, but the lead author, in an exchange of Letters to the Editor, says that "We do agree that TM is unique in the robustness and quality of evidence among meditation technqiues for BP-lowering..."Robert Brook, lead author of AHA scientific statement, in Letters to the Editor exchange. The current wording should either be deleted, or mention should be made of the evaluation made by Brook et al, as TM gets a passing grade for research, while all other forms of meditation are explicitly given a failing grade.Sparaig2 (talk) 02:06, 29 August 2014 (UTC)

Since the Letters to the Editor section is behind a pay-wall, here is the full text of the Letter:


Response to Response to AHA Scientific Statement on Alternative Methods and BP: Evidence for Upgrading the Ratings for Transcendental Meditation
Hypertension October 14, 2013
We thank Dr Schneider for his positive comments and for raising important issues on our recent scientific statement. We highligh that when our conclusions differ it is a result of variances in perspective and not from any bias against Transcendental Meditation (TM). The writing group had spirited discussions on the level of evidence (LOE) and class of recommendation for each modality. Reaching consensus is often not as simple as following the exact wording of the writing-group guidance table. We did indeed review 11 randomized controlled trials and 3 meta-analyses, while acknowledging some limitations of the AHRQ (Agency for Healthcare Research & Quality) report before conferring on TM an LOE of B. This was not intended to be a weak endorsement (nor a questioning of the research integrity) but rather a consensus of the full committee on the strength as well as limitations of the supporting literature. For example, the latter 2 meta-analyses that we cited are largely overlapping in studies, whereas the first reported that TM was not superior to health education. The recent outcome study also did not actually demonstrate a lowering of blood pressure (BP) from baseline. The sole prsence of a published meta-analyses and randomized controlled trials, as such, does not mean there is no discordance among results nor that an LOE of A is universally warranted. For example, meta-analysese of randomized controlled trials also exist for device-guided breathign and isometric handgrip; however, neither received an LOE of A because of other uncertainties. We do agree that TM is unique in the robustness and quality of evidence amgon meditation technqiues for BP-lowering and that a reassessment of the LOE may be warranted should future studies, particularly using home or ambulatory BP monitoring as the primary outcome, more consistently corroborate its efficacy.
About the specific method, this was simply meant to convey that the selected mantra is individualized and might (albeit unlikely) impact BP responses. Although the intruction for practice is uniform, whether differences in each person's actual implementation (eg, compliance) alters the efficacy is also not well known.
We objectively and fairly presented the published data about the lowering of BP from TM. Its efficacy was indeed shown to be on par with some other alternative approaches when cross-comparing summary meta-analyses results (ahought few direct comparisons are available). We clarly stated that most approaches have modest efficacy (not just TM), and that patients requiring >10 mmHg reductions should be monitored closely.
TM was not invented to lower BP. We acknowledge that meditation techniques may offer numerous benefits to people. Nevertheless, we believe that existing limitations need to be addressed before revisting a higher class of recommendation concerning TM for the sole purposes of managing high BP.
Disclaimers
None.
Robert D. Brook
Division of Cardiovascular Medicine
University of Michigan
Ann Arbor, MI
Joel W. Hughes
Department of Psychology
Kent State University
Kent, OH

As I said, the wording should be changed.Sparaig2 (talk) 02:12, 29 August 2014 (UTC)

A letter to the editor is not a sufficient source per WP:MEDRS Doc James (talk · contribs ·

email) (if I write on your page reply on mine) 03:26, 29 August 2014 (UTC)

You are missing the point: the author of the study explicitly said something to clarify what was said in the study. That isn't some arbitrary Letter to the Editor, but an official RESPONSE to a Letter to the Editor.Sparaig2 (talk) 18:56, 30 August 2014 (UTC)
The fact that the AHA scientific statement, directed at doctors, says that TM may be used in clinical practice for the treatment of hypertension, directly refutes what is said in the intro section to this page: "It is not possible to say if it has any effect on health...". The AHA very clearly says that it does. Sparaig2 (talk) 19:27, 31 August 2014 (UTC)
Sometimes authors want to get out more than they can get through peer review. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:38, 31 August 2014 (UTC)
AHA clearly states that "The overall evidence supports that TM modestly lowers BP." -A1candidate (talk) 21:56, 31 August 2014 (UTC)
Of course, the lead author of the AHA statement is also lead author of the new article which you cite further down in this discussion. Obviously, the authors are convinced enough of the validity of the statement to say it twice, first in the AHA scientific statement, and then in the new article discussing the AHA scientific statement.Sparaig2 (talk) 15:34, 2 September 2014 (UTC)
  • Please be aware that what Spairag2 has posted is not the full text of Brook & Hughes' response. Some of us actually have access to these journals and are able to double-check these things, so I'm not sure how Spairag2 thought he could get away with this, or why the rest of you take his posts at face value. What he presents as the "full text of the Letter" is in fact missing a paragraph in the middle. (I'm not sure how you "accidentally" omit a paragraph from the middle of a long letter). In the omitted paragraph, Brook and Hughes comment that TM is unlikely to perform as well for unselected patients with hypertension as it did within the confines of randomized clinical trials. Brook & Hughes also comment (in the omitted paragraph) on the exorbitant cost of TM (which they peg at $1,500) compared to other integrative approaches. I await an explanation for why this paragraph was selectively omitted from the "full text" posted by Spairag2 above. MastCell Talk 03:22, 2 September 2014 (UTC)
Hum. That is a huge concern. A topic ban may be in order for this WP:SPA. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:00, 2 September 2014 (UTC)
Someone sent me a scan of the pdf file of the letter and I didn't copy that part. I originally made the copy about 8 months ago and cut and pasted from my comments in reddit.com. Obviously, I should have typed out the entire letter, but didn't. What follows is the section that I omitted from teh reddit.com version, again copied by hand from the scanned version:
About practicality, there is a marked difference between providing a treatment in a randomized controlled trail and referring unselected patients with hypertension for TM training in clincial practice. TM is also more expensive than other approaches ($1500), and access to certified training may be more limited. For example, the Cleveland area only has 2 listed sites covering a population of ~2 million people (http://www.tm.org/transcendental-meditation-cleveland).
Does this actually change the nature of my arguments? Certainly, in order for me to rightfully claim that it was the "full" text, I should have included it, but my reddit.com entry [1] was made 9 months ago, and I, for whatever reason, left it out originally. Rather than going back to the original source and retyping from scratch, I merely cut and paste what I said 9 months ago. I may have decided to deliberately leave that paragraph out 9 months ago, or it may simply have been a copying error. Either way, mea culpa for not double-checking before asserting that I was providing the "complete text."Sparaig2 (talk) 14:43, 2 September 2014 (UTC)
Notice that nowhere do Brook & Hughes assert that "TM is unlikely to perform as well for unselected patients with hypertension as it did within the confines of randomized clinical trials." instead, they say "there is a marked difference between providing a treatment in a randomized controlled trail and referring unselected patients with hypertension for TM training in clinical practice." Does this mean that the person misquoting them should be banned? I assert that there is far more difference between what is actually said in the letter and what they say the letter says, then there is relevance for me leaving out a paragraph talking about a price that is no longer valid (TM now costs $960 for adults, $360 for full-time students of any age (working less than 25? hours per week), and TM centers have scholarships and grants available to lower the cost further. Additionally, I have heard that when a medical doctor formally refers a patient to the TM center, there is an additional discount ($200?) given to that patient, and the doctor is also given a "credit" for TM instruction that he can apply to himself, or pass on as a further discount to his patients --this last is NOT common knowledge, but I heard it recently during a webinar for TM teachers with reference to doctors that I managed to view, and the local TM center chairman verified it as being valid within the past few months).Sparaig2 (talk) 14:57, 2 September 2014 (UTC)
I'm not surprised that the TM movement doesn't publicize the fact that it provides gifts to physicians in exchange for referrals, because it's an unethical practice. In fact, in some circumstances, it's illegal, under the Stark Law or federal anti-kickback statutes. I'm not a lawyer, but I don't think TM is covered by the Stark Laws; nonetheless, the practice of providing kickbacks or other "rewards" to physicians in exchange for referrals is widely considered an abusive and unethical practice. I suspect that the TM insiders you're quoting would be unhappy that you're mentioning this practice in public.

As for quoting the letter... I can accept that it was a mistake. But you do understand why it makes it hard to have a constructive dialog? Look at it from my perspective: you presented the "full text" of a letter, and when I go to verify the text I find that a paragraph has been omitted—a paragraph which is relatively "critical" of TM and which mentions the cost of TM, which seems to be a sore subject. Does it change the nature of your arguments? I don't know. I think it does, but perhaps others don't. The point is that the full text of the letter needs to be provided for people to make up their own minds. MastCell Talk 04:55, 3 September 2014 (UTC)

The kickback you refer to is either a discount for the doctor to learn TM, or if he already has learned TM (or has no interest in learning TM), it is a further discount for the patient. What is unethical about that?Sparaig2 (talk) 19:11, 3 September 2014 (UTC)
By teh way, you didn't supply the missing text, I did (with corrections for how the price of TM was wrong, even at the time the letter was written). You also paraphrased the text in a way that may not be what the author intended, rather than quoting the text directly, even though it would have been trivial to do that instead. Why is that, I wonder? Some nefarious plot on your part, perhaps? Or just you didn't care enough to be accurate in a post critical of my own inaccuracy? Sparaig2 (talk) 19:17, 3 September 2014 (UTC)
For every patient a physician refers to TM, the physician is financially rewarded by the TM movement with a discount. In other words, the physician is effectively being paid on a per-referral basis by the TM movement. Paying a physician in kind, through discounts, is functionally no different than paying them cash. Do you really not see how this scheme could be perceived as unethical, or as a kickback? Suppose that every time a physician prescribed a given medication for a patient, the drug company rewarded the physician with free medications for him to use personally or to re-sell at a profit. If the TM movement is so certain that this scheme passes ethical muster, then why are they keeping it under wraps? Shouldn't they advertise it publicly? If I were a physician (hypothetically, of course), I'd want to start referring people as soon as possible and collecting my discounts. MastCell Talk 03:51, 4 September 2014 (UTC)
For every patient referred, the doctor is given a credit towards learning TM. They can either use it for themselves, or give it to their patients. If the doctor already has learned TM, it only can be used on the patients' behalf. Once the doctor learns TM, it can only be used on the patient's behalf. If the doctor has no interest in learning TM, it can only be used on the patient's behalf. Only in 1 out of 4 scenarios, and only for a limited number of patients, can the doctor personally benefit from prescribing TM. Do you not see this as fundamentally different than a kickback? It is primarily, and in the long run, ONLY of benefit to the patient. Sparaig2 (talk) 04:52, 4 September 2014 (UTC)
I should point out that the "sell TM credit for a profit" would only apply if the doctor were to start prescribing TM and accepting payments under the table from his patients who want to get access to that credit. In THAT scenario, that would be selling the discount, so yes, technically that is potential for abuse. But it never occurred to me that a doctor would behave that way. I wouldn't behave that way. Would you REALLY behave that way if you were a physician? I suspect you're just arguing because you don't like TM or anything related to it. Sparaig2 (talk) 05:18, 4 September 2014 (UTC)
I don't have strong feelings about TM one way or the other. I do confess to being bothered by the efforts of TM-affiliated editors to conceal their conflicts of interest (not you; you've always been upfront) and abuse Wikipedia to promote the product. I think that in any situation where the potential for abuse exists, some percentage of people will take advantage of it. That's true whether the people in question are physicians, bankers, priests, police officers, or unemployed. A system where physicians are rewarded on a per-referral basis by the company receiving the referrals is prone to abuse. Really, this is why the Stark law exists, and a number of physicians have been prosecuted under it. As I mentioned, the Stark law almost certainly doesn't apply to TM, but the ethical precepts behind it do apply. If you think I'm motivated by bias against TM, I invite you to seek the opinions of others with experience in medical ethics, and I invite you to ask the TM program to publicize this incentive program rather than keeping it under wraps. MastCell Talk 16:16, 4 September 2014 (UTC)
I understand the reasoning behind your concern that the credit/discount thing could be abused, but I think the intended purpose for it is obvious: encourage people, both patients and doctors, to learn TM and practice TM, which is the primary mandate for the organization (the other mandate being to survive indefinitely while fulfilling the primary mission). I don't know the details of the creditsystem other than what little I heard in the webinar, which was later confirmed by the local TM teacher. It may be that they never considered the potential for abuse since they are the ones offering all the discounts and their motivations are sincere and open, so it never occurred to them that someone else might game what they are doing for financial gain. On the other hand, perhaps they HAVE given thought to the scenario you came up with and either don't care, or have attempted to make it difficult for such a scenario to occur. /Shrug. The TM organization is an interesting mass of contradictions. Privacy and secrecy are very important in the sense that TM instructions are meant to be provided in a certain context in a certain order, and all TM teachers pledge to follow such guidelines and keep private what they learn in private. And yet... everyone and his brother ends up with access to much/most/all of "TM secrets" anyway. Shrug (again)... To finish the thought... just about everything they do is as messy and inefficient as their ability to maintain secrecy... ("We're not a cult: a cult is better organized."). Sparaig2 (talk) 17:00, 4 September 2014 (UTC)

Wikipedia misinterprets scientific consensus[edit]

According to review article PMID 25164965:

Recently, the American Heart Association recently published a scientific statement describing nonpharmacological means of lowering BP. The authors reviewed the efficacy of several approaches directed at reduction of anxiety, including meditation, relaxation, device-guided slow breathing, and biofeedback methods. Transcendental Meditation was found to modestly lower BP (class IIB recommendation, level of evidence B).

This seems to directly contradict Wikipedia's claims. I think editors have misinerpreted AHA's statement. -A1candidate (talk) 21:49, 31 August 2014 (UTC)

This has been discussed. Please read the definition of "class 2B"
See [1] User:MastCell comments at lenght. We can discuss again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:14, 31 August 2014 (UTC)
Byrd and Brook's review article clearly disagrees with MastCell's unpublished comments. -A1candidate (talk) 22:50, 31 August 2014 (UTC)
RD Brook, being the same Robert Brook who was lead author of the AHA scientific statement in the first place, so his characterization of his own writing further clarifies what he meant it to say.Sparaig2 (talk) 15:23, 2 September 2014 (UTC)
I should point out that there is no set "definition" of "class 2B" to be found in the AHA statement. Instead, Table 1 provides guidelines for how to decide which Level of Evidence/Classification of Recommendation (LOE/COR) to use and guidelines for how the writing committee might word clarifications of the LOE/COR. In the case of a COR IIB, the treatment (TM) efficacy is "less well-estabilished" [than treatments receiving a COR of IIA or better]. Table 1 guidelines give three alternate wordings that the writing committee might use with a COR of IIB: 1) may/might be considered; 2) may/might be reasonable; 3) usefulness/effectiveness is unknown/unclear/uncertain or not well established. The writing committee chose to clarify TM's COR of IIB with the phrase "may be considered" and wikipedia editors chose to add the phrase "usefulness/effectiveness is unknown/unclear/uncertain or not well established" in quotes, as though the writing committee actually used those words. When I pointed this out to Robert Brook, lead author, he responded "they did not use our words..." Sparaig2 (talk) 16:42, 2 September 2014 (UTC)

You are joking right? Page three of the AHA statement [2] Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:15, 4 September 2014 (UTC)

As I said: "Table 1 provides guidelines for how to decide which Level of Evidence/Classification of Recommendation (LOE/COR) to use and guidelines for how the writing committee might word clarifications of the LOE/COR." In the case of a COR of IIB, the guidelines say that it is "less well established" [than higher CORs]. Table 1 provides 3 different suggested phrases that COULD be used with a COR of IIb. The writing committee chose to use "May be considered [in clinical practice.]" They did NOT choose "usefulness/effectiveness is unknown/unclear/uncertain or not well established." Table 1 is copied from Table 5. COR/LOE Table of the Methodology Manual and Policies From the ACCF/AHA Task Force on Practice Guidelines[2]and is "always Table 1 in an ACCF/AHA guideline." Authors are to be concise in their wording. The authors of the AHA alternate treatments for hypertension scientific statement chose to use a specific set of words. They did NOT choose to use a alternate set of words, and wikipedia editors who are putting quotes around the alternate wording as though they clarify things are actually rewriting the AHA statement. "They did not use our words..." according to Robert Brook, lead author of the AHA statement. "I thought that section was fairly clear" according to Robert Brook. Sparaig2 (talk) 09:58, 4 September 2014 (UTC)