Talk:Transcendental Meditation/Archive 41

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Misrepresentations of sources?

I've been catching up on this discussion and I'm struck by the fact that no one responded to TimidGuy's comment of 23:20 26 April where he listed what look to be a number of serious misrepresentations. We should deal with these. Here are the points he noted:

• Cochrane 2010 doesn't say anything about TM researchers being biased.

• Cochrane 2006 doesn't say TM research is "poor."

• Ospina doesn't characterize all TM research as poor. If you read the AHA report, you'll see that the two highest-quality RCTs in the cardio section of Ospina are on TM. Ospina rated both as high quality.

• If you read the AHA report, you'll see that Ospina's methodology has been criticized. Per NPOV, why wouldn't we also mention that?

• The point about selection of subjects with a favorable opinion toward TM only characterizes four of the RCTs in Canter & Ernst 2003. Yet that statement is generalized to all the research on TM. None of the NIH-funded studies, for example, recruited subjects favorable to TM.

• Further, the research section in this article cites Ospina to support the statement that TM doesn't have a health benefit beyond relaxation. Yet if you look at the AHA review, you'll see that Ospina found just the opposite.

And 10:30, 28 April he added this:

• I am also seriously concerned about the peremptory deletion of a number of research reviews, including systematic reviews/meta-analyses such as Sedlmeier 2012.

On the face of it, there are a lot of serious issues here. Can we begin a systematic discussion of them? Thanks! Spicemix (talk) 12:14, 28 April 2013 (UTC)

Are we looking at the same studies? Cochrane 2010 repeatedly emphasizes the problem of bias (e.g. "As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD.") Cochrane 2006 repeatedly emphasizes the overall poor quality of meditation research (e.g. "The small number of included studies and lack of high quality trials in this review do not permit firm conclusions to be drawn.")

In any case, there is a systematic discussion ongoing, above. I agree that a detailed review of sources, and how we present them, would be useful. In order to bring some semblance of order to the process, I suggested above that we should start by identifying the highest-quality sources and then work on accurately reflecting them. MastCell ^Talk 18:34, 28 April 2013 (UTC)

Cochrane's discussion of bias is specifically referencing four included studies. No TM study was among the studies included in their analysis of those four studies. I don't see that their review says anything about TM researchers being biased. Cochrane 2006 only found one TM study that met their narrow inclusion criterion of subjects with a diagnosed anxiety disorder (as opposed to trait anxiety). It characterizes the quality of that study as moderate. It just bothers me when we use such a narrow source to support a generalization that all TM research is poor.TimidGuy (talk) 19:56, 28 April 2013 (UTC)

Apologies for not responding yet to MastCell's reply above, but I've made my start with the recent AHA Scientific Statement. TimidGuy said, "Further, the research section in this article cites Ospina to support the statement that TM doesn't have a health benefit beyond relaxation. Yet if you look at the AHA review, you'll see that Ospina found just the opposite." This article reads: "Independent systematic reviews have not found health benefits for TM exceeding those of relaxation and health education." The AHA Scientific Statement (p.4) says: TM was found to be superior to progressive muscle relaxation.... I'll look at the actual text of Ospina next, but can we agree so far? Spicemix (talk) 20:47, 28 April 2013 (UTC)

In the section TM versus PMR (p.121) AHRQ 2007/Ospina finds, "Two trials totaling 179 participants … provided data on the effects of TM versus PMR on SBP and DBP. The combined estimate of changes in SBP … indicated a significant improvement (reduction) in favor of TM …. The results of the trials for changes in SBP were homogeneous .... The combined estimate of changes in DBP … indicated a significant improvement (reduction) in favor of TM."

Would it be right, even while the general review of sources is going on, now to rewrite the sentence Independent systematic reviews have not found health benefits for TM exceeding those of relaxation? It does currently look misleading for anyone who comes to visit the article. Spicemix (talk) 17:08, 29 April 2013 (UTC)

Since you have found very clear evidence that a factual error is made in that sentence, referenced both to a recent, authoritative review source (2013 AHA scientific statement) and the Ospina review itself, I agree it should be corrected immediately. EMP (talk 17:24, 29 April 2013 (UTC)

I remain concerned about selective quotation here. It's gotten to the point that when you use an ellipsis, a red flag goes up in my mind, apparently with some justification. The full sentence you're quoting from the AHA report reads: "TM was found to be superior to progressive muscle relaxation with respect to reductions in systolic and diastolic BP but not to health education." (Emphasis on the part of the sentence you chose to omit; I've omitted the HRs, p-values, and CIs from the quote for clarity).

In any case, it would be accurate to change our wording to read: "Independent systematic reviews have found that the health benefits of TM are comparable to those of standard health education." MastCell ^Talk 17:33, 29 April 2013 (UTC)

That quote doesn't say it was comparable, it just says it was not superior to it. It may say elsewhere, but I wouldn't base it off that quote. IRWolfie- (talk) 23:22, 29 April 2013 (UTC)

Point taken; substitute "are not superior to" for "are comparable to" in my suggestion above. MastCell ^Talk 23:30, 29 April 2013 (UTC)

Thanks MastCell, it's good to have consensus that relaxation was a misrepresentation. Per your proposed rewrite, shouldn't we tell people about the benefit over relaxation? After all, the page has been misinforming them all this time that there wasn't one. Otherwise they might get the impression that TM had been found to be inefficacious. Spicemix (talk) 05:46, 30 April 2013 (UTC)

It's not a misrepresentation, nor is it a "factual error"; let's be a little more circumspect. The sentence in question cites three references. One of them (Cochrane 2006) says that TM is "comparable with other kinds of relaxation therapies in reducing anxiety". That's where the language about relaxation comes from, and it's not a misrepresentation. I agree we should strive for greater precision, but please don't over-reach and put words in my mouth.

The cited sources indicate that TM has no benefit over relaxation in treating anxiety, and no benefit over health education in treating hypertension (although in the latter case it does appear superior to relaxation). As a suggestion, we could generalize these findings by saying that "TM has benefits comparable to other standard non-pharmacologic treatments, such as relaxation therapy for anxiety or health education for hypertension." MastCell ^Talk 06:01, 30 April 2013 (UTC)

Thanks MastCell, I appreciate anyway that we're gaining more common ground. The history of these pages is that there have been a lot of unilateral deletions. I think though we have to agree that when the article says "Independent systematic reviews have not found health benefits for TM exceeding those of relaxation and health education" and there is indeed an independent systematic review that found a benefit for TM exceeding relaxation, and that review is cited in support of the text, that is a factual error and a misrepresentation. I get the impression that the Ospina finding for TM over relaxation is being underplayed a little: a month ago we had this deletion at TMR. I'm considering your rewrite proposal, thanks again. Spicemix (talk) 14:17, 30 April 2013 (UTC)

The Ospina article is a complex and lengthy document, and it's hard to boil it down concisely and effectively. However, the central thrust of the Ospina article is evident from its conclusions:

A few studies of poor methodologic quality were available for each comparison, mostly reporting nonsignificant results... A few statistically significant results favoring meditation practices were found [including TM vs. relaxation]... The positive results from these meta-analyses need to be interpreted with caution, as biases, such as expectancy bias, cannot be excluded.

So Ospina makes three central points: a) the overall scientific quality of meditation research is quite poor, limiting the ability to draw sound inferences; b) most studies of meditation practices report non-significant results; and c) the few positive findings should be treated with caution given the above limitations and risk of bias.

We seem dedicated to ignoring each of these three points (particularly the last one, urging caution in interpreting positive findings) and instead simply mining the Ospina article for positive mentions of TM which can be highlighted. MastCell ^Talk 17:53, 30 April 2013 (UTC)

Mining: then why you didn't also remove the health education finding? It was derived from a group of five studies. The two highest quality studies in that group of five are the very same studies used in the TM/relaxation meta-analysis.... Spicemix (talk) 20:44, 30 April 2013 (UTC)

By editing one portion of the paragraph, I didn't mean to imply I endorsed the remainder. If you think the health-education finding should be removed as well in favor of a clearer presentation of the Ospina report's bottom line, that would be fine with me. MastCell ^Talk 21:06, 30 April 2013 (UTC)

Thanks MastCell. It's important we have consistency in the article. It's been like the Wild West here in the past. One editor (rightly) deleted all the primary sources, but then used a blog post. It's important though that the article be not just internally consistent, but consistent with policy too.

It seems a little odd that if one accurately represents the weight and conclusion of a source, one wouldn't be able to summarize various facets of that source. Conclusions can be highly summary and abstract accounts of, as you said, complex and lengthy documents. There's also the matter of section summaries. They clearly represent the authors' views and are more concrete than a final summing up. Could you point me to the WP policy that underpins what you've been advocating in this discussion? Spicemix (talk) 04:48, 2 May 2013 (UTC)

I think it's pretty simple, and perhaps you're over-complicating it. If we want to briefly summarize an article's conclusions, then we look at how the authors have summarized their findings, rather than selecting quotes from somewhere in the middle of the article. Moreover, the central point of the Ospina article is clear: the scientific evidence on meditation is of such poor quality that no firm conclusions can be drawn about its efficacy. If we cite this source to suggest that TM "works", then we're misusing it. If you'd like chapter and verse of policy, then WP:NOR states: Best practice is to research the most reliable sources on the topic and summarize what they say in your own words... Source material should be carefully summarized or rephrased without changing its meaning or implication. Take care not to go beyond what is expressed in the sources, or to use them in ways inconsistent with the intention of the source, such as using material out of context. MastCell ^Talk 05:38, 2 May 2013 (UTC)

Thanks for that policy, MastCell: follow the sources and don't mislead. We can live with that. I didn't mean to over-complicate, but we've been told so many times at TMR that only concluding statements can be used, I was starting to believe it.

If you feel that a review clearly concludes that no conclusions can be drawn, and it's wrong then to report an individual finding, are we right to report the individual finding in Cochrane 2006? This review had a narrow scope (diagnosed anxiety disorder) and only found a single small study, with 31 subjects divided among three groups. We seem to be giving it a lot of weight, would you say? Spicemix (talk) 08:33, 3 May 2013 (UTC)

If you look at Cochrane 2006, the authors' conclusions read, in part: "Transcendental meditation is comparable with other kinds of relaxation therapies in reducing anxiety." We're conveying the authors' conclusion, not selectively mining an individual finding from the middle of the article. I think we're being consistent in using the authors' conclusions; if you disagree, could you elaborate? MastCell ^Talk 16:37, 3 May 2013 (UTC)

I hope something can be agreed. I just want to make sure I clearly understand. Is it correct you feel that a meta-analysis of two studies TM/relaxation assessed as high quality and totaling 179 subjects should not be mentioned in Wikipedia and that it's acceptable to mention the results of a single 1980 study on TM/relaxation of moderate quality totaling 31 subjects?

The key is that this is in a context in which both reviews clearly say no conclusions can be drawn. Cochrane 2006, p.10, says: "The small number of included studies and lack of high quality trials in this review do not permit firm conclusions to be drawn. In one moderate quality trial, the use of meditation therapy in anxiety disorder was associated with some reduction of anxiety symptoms in general, which was comparable to another form of relaxation therapy." I'm thinking if everyone wants this article reviewed to GA, the decisions need to be defensible throughout, and inconsistency here would be tricky. Thanks! Spicemix (talk) 16:18, 4 May 2013 (UTC)

You appear to be conflating the results of a systematic review with the results of individual studies included within that systematic review, IRWolfie- (talk) 00:16, 5 May 2013 (UTC)

• So I'm sensing that several editors believe that the research section (as it exists currently) should be revised. How should it be changed? The abstract says "it is the consensus of the writing group that it is reasonable for all individuals with blood pressure levels >120/80 mm Hg to consider trials of alternative approaches as adjuvant methods to help lower blood pressure when clinically appropriate" while the conclusion, as noted above, is more negative on alternative approaches as a general clinical practice. It seems that there should be a way to compromise so that the argument can be settled. II | (t - c) 04:15, 5 May 2013 (UTC)

Thanks for coming II. The state of play on this thread is that MastCell has proposed the deletion of a finding on the ground of the review authors' low valuation of it, and MastCell has further agreed that the same treatment should be given to another finding from the same review. We are nearly at consensus, because another review of a relatively weak primary source has been identified, where the review authors similarly conclude it is of low value. If those two weaker review sources come out it'll be a notable step in strengthening the science of the article. MastCell has said our guiding policy is "we look at how the authors have summarized their findings", and there is consensus on that. Spicemix (talk) 15:44, 5 May 2013 (UTC)

Is consensus emerging on the post above? It would be good to hear from anyone who disagrees. WP:CON says "consensus is determined by the quality of arguments". The principle of not using findings where review authors explicitly say no conclusions can be drawn is agreed, it's only a matter of applying it. Thanks! Spicemix (talk) 15:32, 8 May 2013 (UTC)

I'm afraid I don't quite understand what's being proposed in your post (even though much of it is attributed to me). Could you clarify what specific content changes you're seeking consensus for? MastCell ^Talk 16:55, 8 May 2013 (UTC)

We've both agreed that the results of the meta-analyses in Ospina can't be used because the authors say conclusions can't be drawn; I have identified another review where the authors say, of a finding from a small 1980 study, that conclusions can't be drawn. Should the authors' conclusions be applied consistently in the way first proposed by you for Ospina, and the specific findings excluded from the article? Or is there a case for making an exception? We should have agreement because discussion of the text of the article can only follow from that. Spicemix (talk) 20:11, 9 May 2013 (UTC)

I'm concerned that you're not accurately paraphrasing my points, or else I'm simply not following your writing. I think we should clearly convey the conclusions of the Ospina review: that the overall scientific quality of meditation research is quite poor, limiting the ability to draw sound inferences; that most studies of meditation practices report non-significant results; and that the few positive findings should be treated with caution given methodologic limitations and potential bias. If we boil this down to one point, it would be that the scientific quality of evidence on TM is too poor to draw firm conclusions about its efficacy. I'm not sure which other reviews you're referring to; it would help if you could cite the first author and year, or at least provide some link to help keep them straight. MastCell ^Talk 21:21, 9 May 2013 (UTC)

Thanks MastCell. We're discussing sources for the text in the Research section of this article that reads: "Independent systematic reviews have not found health benefits for TM exceeding those of relaxation and health education." One source for this text, currently ref. 83, is Ospina et al (2007). You pointed out that the authors' conclusions indicate that it would be unwise to give weight to the finding of TM/relaxation, and agreed "the health-education finding should be removed as well in favor of a clearer presentation of the Ospina report's bottom line". That means we have agreed that Ospina's support, currently ref. 83, for the article content "Independent systematic reviews have not found health benefits for TM exceeding those of relaxation and health education" should be removed.

I then requested that the status of another source for that line of text, Cochrane 2006, currently ref. 77, be considered. In this case, where there is one small study reviewed, the authors' conclusion, p.10, is: "The small number of included studies and lack of high quality trials in this review do not permit firm conclusions to be drawn."

I hope you will see the consistency in my proposal that when it is agreed that Ospina 2007 should not be used to support this text, Cochrane 2006 should not either. Spicemix (talk) 11:06, 11 May 2013 (UTC)

• Does anyone feel the Cochrane authors' conclusion that their data "do not permit any conclusions to be drawn" (p.4) should be discounted and that their review should continue to support the article content, "Independent systematic reviews have not found health benefits for TM exceeding those of relaxation"?

  Specifically of the single 1980 study reviewed, the Cochrane authors say: "The precision of the results could not be determined … and could not be calculated due to lack of data." (p.8) Spicemix (talk) 21:13, 16 May 2013 (UTC)

  • But it's correct to say that the Cochrane review didn't find any health benefits for TM beyond those of relaxation. They didn't find any clear evidence of any health benefits at all, because the state of the literature was too poor to support any such finding. Now, the current wording may not be the best way to convey the authors' conclusion - it's probably not. But it's not really wrong, either. I'd be fine with replacing the current wording with something else that accurately conveys the authors' conclusion. Would you like to propose something? MastCell ^Talk 21:51, 16 May 2013 (UTC)
    • The current content has been defended as the language of science, but I agree it can be improved.

      We could have an involved text detailing the findings and the authors' cautions, but for this summary section I think a simpler sentence would be better, and in fact something similar to the content of a while ago: "Research reviews of the effects of the Transcendental Meditation technique show results ranging from inconclusive (Ospina 2007, Cochrane 2006, Canter 2004, Canter 2003) to suggesting beneficial effects (Carter 2011, Chen 2012, Sinatra 2011, Sedlmeier 2012, Brook 2013)."

      This text would also serve to summarize the findings of Brook 2013, presently treated further down this section. Spicemix (talk) 18:51, 19 May 2013 (UTC)

    • For clarity, several sources supporting the content proposal above were removed from the article by User:Jmh649, but can be seen in this version prior to his deletion.

      If no further discussion arises this content could be added. Spicemix (talk) 09:04, 24 May 2013 (UTC)

      • While there was a RfC a while back. As this addition is controversial maybe you could draft another RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:04, 24 May 2013 (UTC)

Thanks for coming. As you see, we've been having a good discussion here and we've found common ground on two sources. There's no question of a dispute about the remaining sources used in the text proposal, because we haven't yet had a discussion. WP:RFC specifically says, at section "Before starting the Request for Comment process": "Before using the RfC process to get opinions from outside editors, it always helps to first discuss the matter with the other parties on the related talk page." And WP:TALK says:

How to use article talk pages

Communicate: If in doubt, make the extra effort so that other people understand you. Being friendly is a great help. It is always a good idea to explain your views; it is less helpful for you to voice an opinion on something and not explain why you hold it. Explaining why you have a certain opinion helps to demonstrate its validity to others and reach consensus.

You are a Wikipedia Administrator: you understand the sound reasons behind these principles. The good news is that everyone is fully in agreement on one fundamental point: the sources must be correctly represented in the article. MastCell and I have already had an in-depth discussion of how two sources should be used — and we have cordially agreed. That's progress. This is a subject that requires patient discussion over time by editors who are prepared to familiarize themselves with the research and argue its merits. Anthony recently posted that he is hoping to come back soon, and that will be a great asset for the discussion. If you too will come and explain the rationale for your proposed changes to content, it will be a really positive and progressive step. Thank you. Spicemix (talk) 19:36, 24 May 2013 (UTC)

Lead

The lead just has one positive sentence on the research and misses the point entirely. Thus tagged. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:46, 20 May 2013 (UTC)

Please feel free to join the ongoing discussion here on this issue.(olive (talk) 03:25, 20 May 2013 (UTC))

• You are unilaterally changing content that is under discussion. Your edit summary is not an accurate representation of what you are doing. Again, please join the several editors on this page who are doing their best to come to agreement on this content rather than stepping over them and editing, then reverting, to your own version.(olive (talk) 03:57, 20 May 2013 (UTC))

Your revert did not cite any specific objection with the edit, nor does your comment here. IRWolfie- (talk) 15:59, 21 May 2013 (UTC)

Wolfie, did you read Olive's comment? She clearly states that what she is objecting to is the "unilaterally changing [of] content that is under discussion". Doc James deleted contentious content that has been under extensive review and discussion by multiple editors over a period of several weeks and during which text was being crafted in a collaborative manner. By making undiscussed, unilateral changes, Doc James is disrupting the collaborative editing process. Something he has done here on this article multiple times and has been asked not to do on multiple occasions[1] (more diffs available upon request) and the fact that he continues despite multiple warnings is deeply troubling. -- — Keithbob • Talk • 16:39, 21 May 2013 (UTC)

"unilaterally changing [of] content that is under discussion" amounts to complaining that someone made an edit, but it doesn't highlight any issue with that edit. You appear to have some warped view of how editing works; unilateral and undiscussed changes is how wikipedia works, it's called editing normally. Read WP:BRD. Objecting on the grounds that someone made a bold edit without discussing it is a non-reason (complain at ANI that someone made a bold edit and await the laughter). I also see no prior discussion about this specific sentence, so what discussion are you talking about? Your diff [2] which links to you rather than where the quote comes from appears to fail to mention that the "uninvolved" person is a strong supporter of alternative medicine with only 10 article edits. Obviously a simple oversight on your part? Can you also please focus on content issues rather than attacking other editors with very dubious diffs, thank you, IRWolfie- (talk) 16:24, 22 May 2013 (UTC)

An editor with a pattern of unilaterally changing edits, walking over other editors who are in discussion on those edits, on articles that fall under an arbitration, whose edits in this case reasonably appear to be retaliatory, and who is an admin may meet more than laughter at an AE. I suggest you reread the threads on this talk page since you seem to have missed the pertinent discussion. I think you are mistaken in thinking that WP:BOLD trumps good and respectful collaborative editing skills which include respecting editors who are in discussion on content.(olive (talk) 18:06, 22 May 2013 (UTC))

Wolfie, from what I've seen of your editing style, the person with the "warped view" is in fact someone other than me. My diff was to a post I made on James page warning him about TM ArbCom discretionary sanctions and cautioning him about his repeated deletion of sourced content and apparent disregard for collaboration and talk page discussion on a contentious article. My post included several diffs such as James past issues with ArbCom for edit warring, which you failed to mention. Obviously a simple oversight on your part? If you took the time to look at all the diffs in my post you would see that James did not follow WP:BRD and was edit warring on his content change as he has done before on this topic area. So don't lecture me on policy or try to defend Jame's behavior with inaccurate and incomplete information. Meanwhile, can you please focus on content issues rather than attacking other editors with very dubious comments? Thank you, -- — Keithbob • Talk • 21:05, 22 May 2013 (UTC)

Can I focus on content? You have attacked James in both comments in this thread, I merely called you up on your misrepresentation. Do you agree with any part of my analysis of the particular diff (the diff you linked to only contains a single other link)? Do you disagree that the editor who made your quote only has 10 article edits? You don't appear to disagree with the substance of my comment, merely that I didn't look at the diffs that you didn't put in the diff, IRWolfie- (talk) 09:28, 23 May 2013 (UTC)

(Yawn) anything else Wolfie? Are you ready to discuss the article content now? -- — Keithbob • Talk • 12:29, 23 May 2013 (UTC)

Edit conflict

The edit is secondary to a fundamental problem. Doc James made an unilateral edit to content which was under discussion on the talk page. This is disruptive especially given he came directly from my talk page where he, an highly involved editor and admin threatened to block me which would be a grave misuse of his admin tools, and where I then clearly informed him not to threaten me. This by any standard looks like retaliation. Further as to the edit: He removed less significant but important minor details, but he is also in error on significant content. He deleted text which he claimed was a duplicate, but clearly was not, the summary of the study itself is not the same as a clinical recommendation

• The heading of that section of the AHA report reads: Summary and Clinical Recommendations.

• The first quote represents the AHA summary: overall evidence supports that TM modestly lowers BP"

• The second quote represents the AHA clinical recommendation: "TM may be considered in clinical practice to lower BP."

He deleted the latter.

The edit he made should be reverted given his error.(olive (talk) 17:18, 21 May 2013 (UTC))

We do not need to state the same thing three times. I have suggested that people try a RfC a number of times to get wider and outside input on this matter. However it seems only I have attempted this. Now that new evidence is out it may be worth trying another one. Also probably more productive to comment on content rather than other editors and speculation of their motivation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:29, 23 May 2013 (UTC)

I agree, however, perhaps reread the post above, surely as an MD you'd know a clinical recommendation is different than the summary of the report as a whole. I suggest that if you don't agree with the content you discuss that point rather than add an incorrect comment on what that content is, which seems to be a moot point anyway since you've reverted and are edit warring in your preferred version. Perhaps join the discussion above. (olive (talk) 19:17, 23 May 2013 (UTC))

Summary of evidence

I think that something all the literature agrees on is that the quality of evidence is poor regarding TM and thus no concrete conclusions can be drawn. As this is the generally summary and all other conclusions are in light of this it should go first. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:33, 23 May 2013 (UTC)

Yes, I’m sure anyone reading the article now would agree — since on March 23 you, User:Jmh649, deleted [3] all the sources that tell a different story! EMP (talk 01:01, 27 May 2013 (UTC)

Ah so you have high quality sources which draw definitive conclusions about the health benefits of TM? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:00, 27 May 2013 (UTC)

Now, now. Let's let go of a specific edit from 2 months ago and have a serious conversation. James appears to be correct in that the highest-quality medical sources seem to agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything defininitve about TM's efficacy. Do we agree on that much? MastCell ^Talk 22:02, 29 May 2013 (UTC)

This is a serious conversation and I don't think we can minimize Jame's unilateral removal of several WP:MEDRS compliant sources, three times, in one day. When editors on this page have attempted to discuss those sources, which report on TM's efficacy, James has responded by calling for an RfC, as a diversionary tactic. What is he afraid of? Since James won't discuss each individual source, are other editors willing to examine them individually and decide through consensus, which sources can be placed back in the article, without James reverting them? Once appropriate sources have been reinstated, then we can have a discussion about how to best summarize the research in total. One of the removed sources (Seidlmeier) has been presented for discussion below. Does anyone feel it is should be disallowed from the article? -- — Keithbob • Talk • 14:14, 30 May 2013 (UTC)

Any comments on the subject of this section? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:26, 30 May 2013 (UTC)

The subject of this thread is the research. An editor's opinion and or suggestion on the research cannot define the research and cannot be discussed in anyway with out looking at the sources and the research itself. A peremptory deletion of sources under discussion cripples the discussion since it removes the very content information we should be talking about. It seems somewhat disingenuous to me for an editor to first selectively delete content that is part of what we should be discussing, then to open a supposedly comprehensive discussion on the research based on the content that remains. If you want a discussion on the research and how to present it in the article, unilateral edits should be reversed, and the totality of sources to be discussed should then be noted. Further, general statements of opinion on the research are just that. Agreement with an editor opinion gets us nowhere. If we want to be serious about this discussion we need to look at and summarize the multiple sources that inform about the quality of the research. I'll leave this discussion to others, but suggest a more objective approach than what I see in this thread. And I note the TM arbitration and concerns about peremptory deletion of RS content. (olive (talk) 19:12, 30 May 2013 (UTC))

Okay so no comments on the topic at hand either. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:29, 30 May 2013 (UTC)

(edit conflict) I'm not quite following. We can discuss any research here, whether it's found in the current version of the article or not, so I don't see how a single article edit from 2 months ago cripples discussion. You and Keithbob seem to be saying that we need to restore your preferred version of content as a precondition for any further discussion. Now that seems sort of crippling. I'm sure it's not your intention to hold the article hostage, but it certainly comes across that way.

Furthermore, while I share the view that RfC's are often disappointingly inconclusive, they are not a "diversionary tactic". They are Wikipedia's prescribed method of resolving content disputes, so it's inappropriate to attack an editor for proposing one here.

In any event, it's probably a better use of our time to discuss how to move forward. Above, I proposed a starting point: the highest-quality medical sources seem to agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything defininitve about TM's efficacy. Do we agree on that point? MastCell ^Talk 19:33, 30 May 2013 (UTC)

• Mastcell: Let me clarify what I am saying. A summary of the research, and my "preferred" version, indeed the only Wikipedia complaint version, must contain content that is based on scrutiny of all of the research whether it is presently in the article or not. Any other actions that have either left the article with slanted content or will leave the article non NPOV is unacceptable. Statements about the research must be sourced and the source must clearly support what we are adding to the article. If I happen to see an editor or editors acting unilaterally I suspect I'll comment. I've said what I have to say about and to James. He's been through this before. Now back to our regularly scheduled programming.(olive (talk) 21:35, 30 May 2013 (UTC))

By the way this ref http://psycnet.apa.org/psycinfo/2012-12792-001/ did not support "clinically significant" improvement as it does not look at people with diseases (it looked at a non clinical population). Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:29, 30 May 2013 (UTC)

Do you agree that in light of the 2012 AHRQ protocol [4] (see Background— Previous Systematic Reviews on This Topic) that Ospina/AHRQ's conclusion on meditation research should now be discounted? Or should we continue in this article to promote the use of an unmodified Jadad scale, and ignore this most recent thinking from AHRQ authors? EMP (talk 20:40, 30 May 2013 (UTC)

I think your question is phrased in a curious and leading way. We should continue to use the current AHRQ review until a new AHRQ review supersedes it, at which point we should update our coverage. Presumably an updated AHRQ review will be forthcoming soon, since the protocol has been published. And while I'm happy to discuss a specific paper, it might be more useful to start with broad overviews, to see whether we're speaking the same language. I've asked a couple of times without getting an answer, so I'll try once more: the highest-quality medical sources seem to agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything definitive about TM's efficacy. Do we agree on that point? MastCell ^Talk 17:27, 31 May 2013 (UTC)

There are two issues here that we need to look at: 1) that Ospina 2007 has been archived by AHRQ. Every page is now stamped "ARCHIVE: For Historical Reference Only." AHRQ says the findings are "no longer considered current." 2) The latest AHRQ authors have concluded that Ospina's methodology of quality assessment was inappropriate, and in an important way ― the Jadad scale was misused. This leads to the question: should we continue to present findings from Ospina in the article? If we do, it's clear they should be set in the framework now current at AHRQ. EMP (talk 05:39, 3 June 2013 (UTC)

The AHRQ report is going to be updated soon; the draft of the new report is already circulating. In the meantime, I suppose we could clarify in our article that the AHRQ is in the process of updating their guidance, although that seems like an excessive level of detail for the overview presented in this article. No doubt the AHRQ update will account for the "misuse" of the Jadad scale along with other changes in methodology.

Now, I've asked several times about where we stand on a clear overview of TM research, but every time you or other editors have steered away into discussing specific papers. I'm sure you're not intentionally avoiding the question, but could we please make an effort (in this thread, at least) to establish whether we have some common ground at the overview level? Do you agree with my summary above that the highest-quality medical sources agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything definitive about TM's efficacy? MastCell ^Talk 21:48, 3 June 2013 (UTC)

Given that this is a summary section is it better that we leave the flawed Ospina quality assessment out of the article? Perhaps a fuller treatment could be in the main article. It's good progress anyway if we agree this assessment no longer has authority. In this case we are not actually waiting for an update: we are responding to AHRQ's current criticism of the methodology of one of its earlier reviews. And the forthcoming review will be on a largely different research area, so it will not be an update as such.

I welcome your call for consensus on a broad statement describing the research and I thank you for your help in determining one. I'm sure you're not saying we should put content in the article without examining the components of that content. Isn't the best way forward to continue to examine any claims and counter-claims for the quality of the research? If we're now discounting AHRQ 2007 we've already taken a great practical step forward to agreement.

EMP (talk 23:34, 4 June 2013 (UTC)

I have to say that I find your focus on discrediting the 2007 AHRQ review a bit puzzling and off-putting. A study is not "flawed" simply because a subsequent paper criticizes its methodology; if that were the case, then much of the medical literature could be called "flawed". In any case, even if one sets aside the 2007 AHRQ review entirely, it still seems that the highest-quality medical sources agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything definitive about TM's efficacy. Do you agree with that summary? MastCell ^Talk 00:09, 5 June 2013 (UTC)

The statement appears to reflect what the most reliable sources say, IRWolfie- (talk) 19:16, 5 June 2013 (UTC)

MastCell, Five times now in this thread you have repeated the same sentence: Do you agree with my summary above that the highest-quality medical sources agree that the literature on TM, while voluminous, is of poor scientific quality, making it difficult or impossible to say anything definitive about TM's efficacy? My answer: I’m not sure. I have been attempting here to examine the sources in detail in order to achieve a consensus. In the meantime, you have been repeating this same sentence, demanding of me a yes or no answer to a complicated question involving dozens of sources. I find this ominous. You are a powerful Wikpedia Administrator. I am frankly apprehensive. I understand that other editors have gotten in trouble for their participation in detailed discussions on these articles. I am feeling that it is not in my best interest to continue here as I fear the consequences. EMP (talk 21:47, 5 June 2013 (UTC)

In this section MastCell was asking a straightforward question. The response was not necessarily straightforward each time; other issues were raised unrelated to the question. Read the sources, come back and give your answer, there are no apparent time limits. MastCell and Doc James are both admins, and are also just editors see WP:INVOLVED, there are no consequences to replying to a straightforward question. I do not understand the sudden apprehension to this direct question since you have been arguing with said admins for at least the last few months about these issues. good luck, IRWolfie- (talk) 21:57, 5 June 2013 (UTC)

@EMP: "I'm not sure" is a totally fine answer to my question. Any answer is totally fine. What's frustrating is to have the question consistently and completely ignored. I've made an effort to answer your questions, and in return you've ignored mine, which makes this interaction feel very one-sided. You are obviously quite familiar with these sources, so I think it's fair to ask how you would summarize them. It's fair to ask you to actually engage with other editors, rather than simply following your talking points and ignoring their input.

As for being a "powerful Wikipedia Administrator", you should know that I would not use my administrative tools in this setting, nor would I be permitted to. I'm here as an editor, like you. You shouldn't be afraid of me, but you should be willing to engage in an actual discussion with me. Like IRWolfie, I don't quite understand your sudden recourse to claiming victim status here. I'm asking you for your thoughts on the central question we've been wrestling with; if a straightforward question about interpreting sources makes you too fearful to continue, then I'm not sure what to tell you. MastCell ^Talk 23:57, 5 June 2013 (UTC)

Psychological Bulletin

One of the sources I'm proposing be restored is Sedlmeier 2012. This systematic review was published in Psychological Bulletin. The journal has an Impact Factor of 14 and ranks 2 of 125 in the category Psychology ― Multidisciplinary. It ranks 10th at Core Psychology Journals. It appears to me a high quality and reputable source. If there is no disagreement on that, we could discuss the merits of Sedlmeier's findings. Spicemix (talk) 17:23, 27 May 2013 (UTC)

I've been taking a bit of time to read that article, because it's quite thorough, detail-heavy, and well-written, and makes some subtle and very interesting points. To move the conversation forward, what do you see as the paper's findings, and how would you propose to present them in our article? MastCell ^Talk 22:05, 29 May 2013 (UTC)

Thanks for coming. It'll be good to have a detailed discussion of Sedlmeier's findings, and you can understand why I put the initial focus on the journal itself. You've said recently that presenting a review's findings and then assessing the quality of the journal is back-to-front, and while I agree too that we should avoid inflexible prescriptions for assessing weight, it's important we get our procedure broadly right. You'll be aware of the history here: by being deleted several times[5][6][7] this source has effectively been ascribed zero weight, so can we be clear in our initial agreement that Psychological Bulletin is reliable enough to support content on the subject areas presented in Sedlmeier ― negative emotions, trait anxiety, neuroticism, learning and memory, and self-realization? Thanks again. Spicemix (talk) 21:00, 30 May 2013 (UTC)

I don't think the source has been "ascribed zero weight"; I think there was concern that it was quoted selectively and misleadingly, which is a recurring theme in this topic area. Thus, I'd like to understand how you propose to convey this paper's findings. MastCell ^Talk 17:19, 31 May 2013 (UTC)

In the opening sentence of this thread I link to a text proposal that arose in our previous conversation, but I'd like the purpose here to be to justify any content.

You have made strongly worded criticisms of sourcing procedure for this article, both on this page and prominently elsewhere. I agree with you that it's teleological to argue for the inclusion of any finding in an article if the source is without sufficient merit. For the content itself, I welcome the chance here to hammer something out with you, and I'm looking forward to hearing your readings of the findings. But of the three primary conclusions available to us, inconclusive, works, doesn't work, none can be included if the source is insufficiently reliable. The phrasing of the content is a matter of how we read Sedlmeier: I'm sure you understand that the quality of the source is a different question ― and the first we should address. Spicemix (talk) 15:17, 2 June 2013 (UTC)

This paper seems to qualify as a reliable source. How would you propose to use it? MastCell ^Talk 21:51, 3 June 2013 (UTC)

I can draft a RfC. I guess the question should we do them sentence by sentence or as a summary? Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:56, 4 June 2013 (UTC)

Why are you pushing for an RfC when the editors here are discussing amicably and seem to be moving towards understanding each other. RfC is for resolution of disputes after talk page discussion fails. Talk page discussion here is ongoing and editors are engaged. Why not join the discussion? (olive (talk) 02:07, 4 June 2013 (UTC))

Meant to post this one section above. There seems to be an avoidance of dealing with the topic under discussion, which sort of means that things are not really moving forwards, which of course is fine. Consensus does not mean universal agreement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:11, 4 June 2013 (UTC)

In reading the thread above what I see is that editors are approaching the discussion from different angles. Both are legitimate approaches. I guess that's what you're saying. OMG! Doc and Olive are agreeing!(olive (talk) 03:17, 4 June 2013 (UTC))

Thanks. Perhaps it's best to look first at the initial summary and final concluding statements. Though there is nothing in either specific to TM, on p.1 the authors say, "We conclude that to arrive at a comprehensive understanding of why and how meditation works, emphasis should be placed on the development of more precise theories and measurement devices." The implication is that "meditation works", and this reading is confirmed on p.25 in the Conclusion: "The effects found in the current analyses show that meditation affects people in important ways." They also say, p.1, "specific findings varied across different approaches to meditation". Have I fairly represented the authors so far? If so, we could look at those findings specific to TM. Spicemix (talk) 11:02, 5 June 2013 (UTC)

Yes, I think we agree so far. Let's get a bit more specific. In the abstract, the authors reiterate the universally appreciated fact that the vast majority of research on meditation is methodologically and scientifically unsound: "Mostly because of methodologic problems, almost 3/4 of an initially identified 595 studies had to be excluded. Most studies appear to have been conducted without sufficient theoretical background."

In the discussion, the authors describe the effects of meditation as broadly comparable to those of other educational and behavioral approaches: "Thus, the impact of meditation on (healthy) practitioners is quite comparable to the impact of behavioral treatments and psychotherapy on patients."

With regard to TM in particular, the authors' findings were quite interesting. On a superficial first pass, results with TM seemed superior to those with other meditation techniques. However, on deeper analysis, TM's apparent superiority was driven by large positive effects reported in non-peer-reviewed book chapters and other less scientifically rigorous outlets, and disappeared when the analysis was restricted to the more rigorous category of peer-reviewed journal articles. There was also evidence of publication bias for TM (and TM alone) which might lead to a further over-estimation of its effectiveness: "If only the journal results are compared, TM does no better than the other approaches. In addition, the funnel plots of the TM studies... indicate that even these results for TM might be slightly overestimated. So, it seems that the three categories we identified for the sake of comparison—TM, mindfulness meditation, and the heterogeneous category we termed other meditation techniques—do not differ in their overall effects."

So I would summarize the article's key points as follows:

• A substantial majority of the published research on meditation techniques is methodologically flawed and lacks a suitable scientific background.
• Meditation techniques, taken as a whole, appear to have benefits similar to those seen with other behavioral, educational, or psychotherapeutic approaches.
• TM does not appear to be superior to other forms of meditation, and there is evidence of publication bias which results in a potential overestimation of its benefit.

Does that seem reasonable? MastCell ^Talk 18:31, 5 June 2013 (UTC)

Sums it up well and put it into context.Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:47, 5 June 2013 (UTC)

Yes, it also appears consistent with what the other reliable sources have reported, IRWolfie- (talk) 19:18, 5 June 2013 (UTC)

Thanks MastCell: I'm going to take a little time looking at the findings before I respond. Spicemix (talk) 09:53, 6 June 2013 (UTC)

Thanks for your patience. Are you reading Sedlmeier as saying that meditation doesn't deliver important benefits? Or could such a phrase be added to your summary list? Spicemix (talk) 19:20, 7 June 2013 (UTC)

The term "important" lacks a clear or agreed-upon scientific definition, a point which the authors themselves make. They therefore define the benefits of meditation more meaningfully, by comparing them to the benefits seen with other behavioral, educational, or psychotherapeutic approaches ("As for the overall size of the effect, is it practically meaningful? This question is hard to answer, but a comparison with other fields of study might be of some help here... Thus, the impact of meditation on (healthy) practitioners is quite comparable to the impact of behavioral treatments and psychotherapy on patients.") To the extent that the benefits of health education and psychotherapy are "important", the benefits of meditation are "important". As an aside, that finding applies to meditation programs across the board, not uniquely to TM. MastCell ^Talk 04:52, 8 June 2013 (UTC)

Thanks. We've agreed that the authors' abstract says "meditation works" (p.1) and that their conclusion is that "The effects found in the current analyses show that meditation affects people in important ways." (p.25) The Conclusion contains no statements that nuance or compromise that broad appraisal.

Within the body of the review the authors say "meditation has a substantial impact on psychological variables" (p.21), and in answer to the question, "Does meditation work in principle, that is, does it have positive effects?", say "The evidence accumulated in the present meta-analysis yields a clear answer: yes." (p.20)

When we check their meta-analysis to be sure that TM specifically is included in that assessment, we see that TM is noted for "Comparatively strong effects … in reducing negative emotions, trait anxiety, and neuroticism and being helpful in learning and memory and in self-realization." (p.19) The authors further say, "This finding is consistent with prior meta-analyses that found superior effects of TM in trait anxiety and measures of self-realization."

I appreciate your close attention to some of the detail, but do you feel that in light of these statements, we should reflect the authors' overall conclusion "that meditation affects people in important ways"? Spicemix (talk) 16:46, 10 June 2013 (UTC)

Of course. Hence my second bullet point, above, indicating that meditation is comparable to other approaches which affect people in important ways (e.g. psychotherapy, health education). More generally, I sense that you're looking for the vaguest possible favorable statement that can be excerpted from the Sedlmeier paper. The paper doesn't just say that "meditation works" - the authors went into great detail about how well meditation works, how it compares to other similar interventions, how strong the literature is, etc. I think that boiling it down to "meditation works" is a disservice, because the authors clearly use that statement as a starting point for a serious, scholarly analysis of the topic.

As for specific findings with regard to TM, please don't cherry-pick the positive sentences from the paper. The authors make it extremely clear that TM is not superior to other forms of meditation ("the three categories we identified for the sake of comparison—TM, mindfulness meditation, and the heterogeneous category we termed other meditation techniques—do not differ in their overall effects.") They elaborate that any apparent superiority of TM is driven by positive results in non-peer-reviewed and less rigorous publication venues, and that there is further evidence of publication bias (that is, selective publication of only positive results) in the TM literature such that even the finding of equivalence may be over-estimated. So if you're trying to use this paper to argue that TM is somehow superior to other forms of meditation, then you are clearly mis-using it in a way directly at odds with the authors' actual findings. MastCell ^Talk 18:50, 10 June 2013 (UTC)

I enjoy rational dialogue, and often our discussion is just that. But also it often feels as if your tone is accusatory and that you are assuming bad faith. I have in fact suggested that discussion move towards looking collaboratively at very specific aspects of the sources so we could decide together what should go into the article. Were I cherry picking I would not be opening the door for scrutiny of the specific sources and joint decisions.

Further, you have selectively discounted items in your analysis: for example, when the authors say (p.20), "the impact of meditation on (healthy) practitioners is quite comparable to the impact of behavioral treatments and psychotherapy on patients", they seem to be saying that meditation is effective as it matches the effect sizes seen in other types of intervention.

And when you say "there is further evidence of publication bias (that is, selective publication of only positive results) in the TM literature such that even the finding of equivalence may be over-estimated", please consider the authors' statement, (p.16), "we still find unlikely susceptibility". If my reading is correct, their fail-safe analysis indicates there would need to have been 2,246 unpublished studies to change their results. So I am beginning to wonder how neutral you are.

I came to this TM topic because I had witnessed the bullying and edit warring of Doc James and the assumption of bad faith and false narratives put forth by others. I have tried to be patient, but working in this kind of biased and aggressive environment is unpleasant and fatiguing and I'm going to step away from this page. Spicemix (talk) 20:20, 12 June 2013 (UTC)

Regarding publication bias, the fail-safe analysis is a single test (among several) to look at the question. The authors also used funnel plots and population variance. When the authors summarize their findings on publication bias in the article's discussion, they do so by writing: "If only the journal results are compared, TM does no better than other approaches. In addition, the funnel plots for the TM studies (for both chapters and articles together—not shown—and for articles alone—see Figure 4) indicate that even these results for TM might be slightly overestimated."

This example illustrates why I've tried to emphasize looking to the authors' conclusions for their interpretations of their own data, rather than selectively quoting a single finding in a multi-part analysis. One individual test (the fail-safe analysis) showed no evidence of publication bias, but several others did. The authors summarized these test results as suggesting publication bias. It is inappropriate for us to select the one test which failed to find publication bias and highlight it in isolation, and in contradiction to the authors' synthesis of their own data. MastCell ^Talk 22:57, 12 June 2013 (UTC)

Ignoring attempt to compromise

To Doc James: Its unfortunate that you chose to ignore an attempt to compromise on the research section. The section should open with the historical perspective which logically should lead the paragraph.(olive (talk) 13:31, 16 August 2013 (UTC))

This section should open with the current situation and understanding and end with the history. This is how medical content is typically presented per WP:MEDMOS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:24, 16 August 2013 (UTC)

Olive, that's a tautology. You've merely restated your position without advancing any policy based argument, IRWolfie- (talk) 23:25, 16 August 2013 (UTC)

Also this moving of content is promotional in nature. It is an effort to emphasis how long research has been taking place and were it has been conducted over what it has found. Neither of the former says anything about the effectiveness of the methods in question or the quality of said research. As this was Olive's 5th revert within 24 hours and she has been warned about these sorts of issues in the past I have brought the matter to the noticeboard Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:48, 16 August 2013 (UTC)

Doc, I removed three promotional edits made by a new user, and then attempted to compromise on this content with you. How is this promotional. Further nothing in the text emphasises anything, but its a couple of short sentences laying out simple statements of fact per the sources. That you regard this simple content as promotional says a lot about your POV. I did not revet you a third time because you are clearly intractable on this content, nor will I discuss further. You are welcome to your version. While I misjudged my edits today in trying to keep promotional content out of this article, nothing you did after that leaves me with the sense that your actions had integrity.(olive (talk) 00:58, 17 August 2013 (UTC))

Can you please comment on the specific issue rather than other editors. Are we all agreed that it is important to emphasise the current state of research? IRWolfie- (talk) 01:17, 17 August 2013 (UTC)

To me this looked like trying to emphasis the amount of research and who did it rather than the results. This is common practice by the TM movement as can easily be seen at TM.org. The organization love to comment on how many studies have be done and who has done them rather than the fact that they have been generally poorly conducted. I do not see any effort to compromise. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:10, 17 August 2013 (UTC)

I'm finished with this discussion; the issue is resolved and I have stated my position. Thanks.(olive (talk) 01:45, 17 August 2013 (UTC))

• Note that I've just protected for a week to stop the edit warring. Please try to reach a consensus here on the talk page. Mark Arsten (talk) 00:24, 17 August 2013 (UTC)

Rewriting an American Heart Association scientific report in the name of accuracy

This is a revisit of something that most of you no doubt believe was settled months ago. To wit, the scientific statement of the American Heart Association with respect to alternative treatments for hypertension, is quoted in the main article on Transcendental Meditation as saying 'A 2013 statement from the American Heart Association described the evidence supporting TM as a treatment for hypertension as Level IIB, meaning that TM "may be considered" but that its effectiveness is "unknown/unclear/uncertain or not well-established".'

The words "unknown/unclear/uncertain or not well-established" do not appear as searchable text anywhere in the body of the statement, but are part of a graphic of the "writing guidelines" for the writing team which had several choices in what wording to use in describing TM and any/all other treatment modalities discussed in the report but chose not to use those particular words anywhere at all in the paper despite the use of quotation marks in the wikipedia article. The specific words chosen were a consensus of the entire committee as indicated below in Dr. Brook's response to Dr. Schneider's letter.

In a private e-mail, Robert Brook's response to that alleged quote was: "They did not use our words" and that he disagreed with the second part of the sentence.

Now, since it was a private e-mail, I won't quote the rest of his response, but I can be reasonably certain that Robert Brook isn't planning on referring his colleagues to Wikipedia any time soon to find out what he and the rest of the writing team said in a formal scientific statement released by the American Heart Association as he believes that the statement was misquoted and I suspect he, like myself, is appalled at the incredible liberty in inventing quotes that don't exist in something he helped write ('wikipedia's lack-of-reputation with the scientific community is obviously well-deserved' is my impression of the sense of his response). Instead, I give you the public exchange between Robert Schneider and Robert Brook concerning the raising of the classification of TM in the report found in the Letters to the Editor. Note that at no time are the words in question used or even hinted at with respect to TM. They are discussing raising the rating of TM:

Response to AHA Scientific Statement on Alternative Methods and BP: Evidence for Upgrading the Ratings for Transcendental Meditation'

To the Editor:

The AHA Statement on alternative approaches to lowering blood pressure (BP) is a groundbreaking effort to inform physicians and public of their options. As principal investigator on several randomized controlled trials (RCTs) on the Transcendental Meditation (TM) technique and other alternative interventions for BP and cardiovascular disease, I suggest 5 points for consideration.

First, an alert reader notices a discrepancy between the level of evidence (LOE) of B for research on TM and the published evidence. The Statement defines LOE B as “Data derived from a single randomized controlled trial or nonrandomized studies.” However, the Statement surveys 11 RCTs with >1200 subjects and 2 well-conducted meta-analyses on TM and BP. Moreover, there are multiple hard event outcome trials on TM that are not available for other nonpharmacologic approaches.

Most of the RCTs published in the past 20 years have been competitively reviewed and externally funded, rigorously conducted in collaboration with leading academic medical centers, blinded, independently monitored, published in peer-reviewed journals, and replicated. The 2012 cardiovascular disease event trial was analyzed independently. BP effects of TM have been confirmed by numerous investigators, in multiple populations and with ambulatory monitoring.

Second, on page 18, it was suggested that TM is less practical, and on page 19, TM was omitted from the conclusion although it received a IIb recommendation (classification of recommendation [COR]), the same or higher than other methods in the list. Practicality has not been an issue in RCTs on TM conducted at 10 clinical sites with diverse sex, race/ethnicity, socioeconomic status, age, and geographic populations. Subjects generally report the practice is easy, relaxing, enjoyable, and convenient. Certified TM instructors are available widely. In the trials, the standard TM course of 1.5 hours/d over 5 or 6 days was implemented.

My impression is that both the LOE B and the COR IIb ratings were based only partially on objective evidence and that additional, nonprespecified judgments were applied. Ideally, the Statement would be transparent about subjective input and systematically apply prespecified criteria.

Third, page 6 reads: “As a result of the paucity of data, we are unable to recommend a specific method of practice when TM is used for the treatment of high BP.” This implies there is >1 method of TM, but there is only 1. As with other behavioral therapies, there is consideration of individual patient characteristics. However, instruction is protocolized and standardized.

Fourth, the summary states that TM "modestly lowers BP"; however, the effect is the same order of magnitude as aerobic exercise and other nonpharmacologic methods recommended by the Statement.

Fifth, Table I indicates that COR is based on size of treatment effect, whereas the text suggests that LOE and clinical practicality are also considered. Given that the magnitude of treatment effect is similar to other recommended methods, that LOE meets criteria for level A, and the TM techniques demonstrated practicality and generalizability, it seems that COR of IIa should be considered as a more appropriate clinical rating.

Overall, the AHA Statement is to be commended. We think that these clarifications will further enhance its veracity and clinical use.

Disclosures

Dr Schneider is a consultant to Maharishi Foundation USA, a non- profit educational organization.

.

Robert H. Schneider

Institute for Natural Medicine and Prevention

Maharishi University of Management

Fairfield, IA

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 highlight 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 presence 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 breathing 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 among 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 (although few direct comparisons are available). We clearly 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

Waiting to see how the oh-so-careful team that writes the TM section responds to this.70.190.21.22 (talk) 22:49, 12 November 2013 (UTC)

Didn't notice that I had not logged in.Sparaig2 (talk) 22:54, 12 November 2013 (UTC)

• The 2013 AHA statement describes the evidence supporting TM as Level IIB, which is defined in Table 1 of the article as meaning that it "may/might be considered" but that its effectiveness is "unknown/unclear/uncertain or not well-established". Presumably this table was included in order to define the levels of evidence cited in the paper. You object, first, because this quote doesn't appear in "searchable text"—an objection which has no bearing on anything besides the software search function on your PDF reader. You move on to claim that the quotes don't appear "anywhere at all in the paper"—an obvious falsehood, since the tables are part of the paper. You amplify on that falsehood by describing these as "invented quotes" when they are, in fact, taken verbatim from the paper. You're dishonestly accusing people of fabricating quotes, which makes me less willing to bother engaging with you.

  As I'm not in a position to comment on private email correspondence between yourself and Dr. Brook, I am left to base my reading on what the paper actually says. Moreover, it appears from the authors' response you quote above that Brook et al. resisted the pressure to "bump up" the evidence rating for TM, instead affirming the limitations of existing evidence. I'm open to alternate interpretations and summaries of these sources, but not to the string of misrepresentations and outright falsehoods in your post.

  Finally, since you bring up Wikipedia's scientific reputation, that reputation is most likely to suffer from the reality that our medical content on TM is controlled by accounts with undisclosed conflicts of interest and affiliations with the TM movement. That sort of hidden conflict is a much bigger threat to the integrity of our medical coverage than the specific quotes we choose to represent a source. MastCell ^Talk 00:03, 13 November 2013 (UTC)

LOL. The text doesn't appear as searchable text because it is only found in the graphic of the writing guide table as a possible alternate phrasing that could be chosen by the writing committee but, in fact, it wasn't. The writing committee chose the exact wording --throughout the statement and specifically with respect to TM-- that they did after "spirited discussions," to quote Dr Brook above. The words of the report were chosen with extreme care, as the letter by Dr. Brook indicates. You are continuing to defend the use of quotation marks around words that were not used in the report. In a very real and obvious sense, you are defending the rewriting of the report. To reiterate what Dr Brook said with regards to the second half of that sentence: "They did not use our words." That you continue to defend the rewriting of the report speaks volumes. Sparaig2 (talk) 02:06, 13 November 2013 (UTC)

Anyone can verify that the quoted text does, in fact, appear in the cited source. I'm at a loss to explain your insistence to the contrary. You're relying heavily on what you represent as the content of a private email you received from one of the study authors—which no one else is in a position to verify. In my view, your track record of honesty is fairly poor thus far, as you've falsely described the content of the published paper. Therefore I'm not willing to extend much credibility to your private email correspondence as a basis for article content decisions, although perhaps others will be more charitable. MastCell ^Talk 05:55, 13 November 2013 (UTC)

The phrase you quote is found only in a graphic, not in the text. It is identified in the graphic as one of several phrases that the writing committee could chose from. They chose to use the first phrase, not the last. Quoting the last phrase as though it is used in the paper when in fact the first phrase is used, is deceptive.Sparaig2 (talk) 06:54, 13 November 2013 (UTC)

These "graphics" are called "tables and figures" in the context a scientific publication. They are an integral part of any publication, and in fact are often used to highlight the publication's key points more effectively. At least you've moved on from the accusation that these quotes were "invented" or otherwise fabricated, though. MastCell ^Talk 17:18, 13 November 2013 (UTC)

What I said originally was:

The words "unknown/unclear/uncertain or not well-established" do not appear as searchable text anywhere in the body of the statement, but are part of a graphic of the "writing guidelines" for the writing team which had several choices in what wording to use in describing TM and any/all other treatment modalities discussed in the report but chose not to use those particular words anywhere at all in the paper despite the use of quotation marks in the wikipedia article.

I haven't changed what I said in the slightest. I just restated my point, almost exactly as I said it before. And the "Table" you refer to is the "writing guide table" used by the writing committee as guidelines on how to word their commentary for what they decided was the evaluation. They had three choices of "Suggested phrases for writing recommendations" to use to describe a Level IIb evaluation:

1) may/might be considered

2) may/might be reasonable

3) usefulness/effectiveness is unknown/unclear/uncertain or not well established

They chose option (1). You chose to add in a "but" followed by option (3) in quotes, as though that is what they actually said. They didn't say that. Their exact words were "may be considered" followed by a period. YOU chose to edit their words and pretend that they added a clause that doesn't even make sense by preceding it with a "but." There's no way that that "but" is justified as it doesn't occur in the writing guide. The three options are given equal level as "Suggested phrases for writing recommendations" for the Level IIb recommendation. As Dr Brook said, and is quite obvious, "They [the editors of Wikipedia] did not use our [the writing committee's] words."Sparaig2 (talk) 20:25, 13 November 2013 (UTC)

I think we've both re-stated our views several times, so I'll wait for additional input at this point. I would ask you to stop citing an unverifiable private email you purport to have received from Dr. Brook. It carries no weight in determining article content. MastCell ^Talk 22:23, 13 November 2013 (UTC)

I'll ask YOU, instead, to email Dr. Brook yourself, rather than persist in suggesting that I am lying.Sparaig2 (talk) 22:43, 13 November 2013 (UTC)

I think you're missing the point. We base article content on published reliable sources, not on personal email correspondence. MastCell ^Talk 00:33, 14 November 2013 (UTC)

So, in your mind, there is no issue inherent in reconciling the claim that the paper says that the effects of TM on BP are "unknown/unclear/uncertain or not well-established" with the explicit statement by Dr Brook that "We do agree that TM is unique in the robustness and quality of evidence among 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" as he says in response to Dr Schneider's Letter to the Editor quoted above? Sparaig2 (talk) 00:57, 14 November 2013 (UTC)

The current level of evidence for TM is "unknown/unclear/uncertain or not well-established". In your green quote, Dr. Brook states that if future studies more consistently show benefit from TM, then the level of evidence might be upgraded. I do not see an inconsistency there, although perhaps you do. Brook goes on to state: "... we believe that existing limitations [in the TM literature] need to be addressed before revisiting a higher class of recommendation concerning TM for the sole purposes of managing high BP" ([8]). It's difficult to spin his statement into an endorsement of TM, although not for lack of trying. MastCell ^Talk 22:01, 14 November 2013 (UTC)

The AHA statement isn't an endorsement of any product, service, technique, etc., but an attempt to clarify the American Heart Association position on what doctors might consider telling their hypertensive patients concerning alternative approaches to treating hypertension. That said, the AHA statement explicitly says the following, and only the following, in their summary of the section on meditation and relaxation:

Summary and Clinical Recommendations

The overall evidence supports that TM modestly lowers BP. It is not certain whether it is truly superior to other meditation techniques in terms of BP lowering because there are few head-to-head studies. As a result of the paucity of data, we are unable to recommend a specific method of practice when TM is used for the treatment of high BP. However, TM (or meditation techniques in general) does not appear to pose significant health risks. Additional and higher-quality studies are required to provide conclusions on the BP-lowering efficacy of meditation forms other than TM.

The writing group conferred to TM a Class IIB, Level of Evidence B recommendation in regard to BP-lowering efficacy. TM may be considered in clinical practice to lower BP. Because of many negative studies or mixed results and a pau- city of available trials, all other meditation techniques (including MBSR) received a Class III, no benefit, Level of Evidence C recommendation Thus, other meditation techniques are not recommended in clinical practice to lower BP at this time.

They do NOT add any other phrase from the writing table to qualify the ClassIIB rating, other than "may be considered". Adding an additional phrase, in quotes, implies that such a phrase is found somewhere in the body of the statement. The writing group, after "spirited discussion" chose to use the exact wording I quoted above, reflecting "the full consensus of the writing group." Editors in Wikipedia chose to use additional wording that is not found anywhere in the body of the statement, but only as part of the writing guide showing how the writing group might chose to word their recommendation. The wikipedia editors are NOT the writing group, and have no right to use additional phrases placed in quotes to imply that they are clarifying what the full consensus of the writing group actually was.Sparaig2 (talk) 14:35, 15 November 2013 (UTC)

Needless to say, I agree with MastCell. The document lists several wordings that correspond to IIB, but clearly TM has been classified as such and the basic gist of IIB is that the evidence isn't super-clear, which the article shows in a fair manner. I also think the accusations and relentlessness here (from Sparaig2) are overly aggressive and off-putting. II | (t - c) 08:05, 15 November 2013 (UTC)

So you disagree with the lead-author of the AHA report when he said, in response to my requesting his reaction to the current Wikipedia sentence, 'A 2013 statement from the American Heart Association described the evidence supporting TM as a treatment for hypertension as Level IIB, meaning that TM "may be considered" but that its effectiveness is "unknown/unclear/uncertain or not well-established"' that "They did not use our words" and "I do not agree with the last part of that sentence."? Are you calling me a liar or questioning Dr Brook's authority to comment on what the paper he helped write actually said? Or are you merely refusing to email him and ask him to verify what he said?Sparaig2 (talk) 13:26, 15 November 2013 (UTC)

circular reference to Transcendental Meditation research

There's no "main article" any more.

This link: https://en.wikipedia.org/wiki/Transcendental_Meditation_research#Research

points to a section which says: Main article: Transcendental Meditation research

which points to: https://en.wikipedia.org/wiki/Transcendental_Meditation_research

Transcendental Meditation From Wikipedia, the free encyclopedia

 (Redirected from Transcendental Meditation research)

Given that TM is among the "most researched" (to quote Wikipedia) of all meditation practices, and the first modern study on meditation was about TM, isn't it a bit odd that there's no article? Sparaig2 (talk) 08:32, 25 December 2013 (UTC)

did these guys ever get off the ground?

i posted a link straight from them. deal with it, they said they were going to levitate and fly! lol — Preceding unsigned comment added by 72.130.168.139 (talk) 11:35, 16 October 2013 (UTC)

http://www.youtube.com/watch?v=NHwhGUo90jw

Amusing, but this is not a forum. WP:NOT#FORUM
i know they were trying to fly their bodies through space, any luck with that yet? — Preceding unsigned comment added by 108.184.252.247 (talk) 10:27, 13 June 2013 (UTC) Youtube video, where a TM executive claims "the 3d stage is full levitation and flying": http://www.youtube.com/watch?v=NHwhGUo90jw — Preceding unsigned comment added by 72.130.171.79 (talk) 06:17, 1 July 2013 (UTC)

Yogic Flying is part of the TM-Sidhi program, not the Transcendental Meditation program. This off-topic discussion belongs in some forum, not on WP. I suggest deleting this Talk section entirely. David Spector (talk) 22:28, 29 December 2013 (UTC)

Cochrane Reviews out of date

Cochrane Reviews as a scholarly source - as in reference number 77 and 84 - should be removed, since the review is far behind published research, and systemically out of date, as noted here: http://blog.tripdatabase.com/2013/04/a-critique-of-cochrane-collaboration.html — Preceding unsigned comment added by Two Wrongs (talk • contribs) 22:30, 14 January 2014 (UTC)

The Cochrane Reviews are generally recognized as among the highest-quality systematic reviews in the medical literature. If you're suggesting we disqualify them because of something someone wrote on his/her blog, then I think you'll have an uphill battle. The first stop would probably be the reliable sources noticeboard. MastCell ^Talk 23:57, 15 January 2014 (UTC)

Citation not about Transcendental Meditation

Reference number 78 should be removed since it is not about Transcendental Meditation - Ospina MB, Bond K, Karkhaneh M, et al. (June 2007). "Meditation practices for health: state of the research". Evid Rep Technol Assess (Full Rep) (155): 1–263. PMID 17764203. "Scientific research on meditation practices does not appear to have a common theoretical perspective and is characterized by poor methodological quality. Firm conclusions on the effects of meditation practices in healthcare cannot be drawn based on the available evidence." — Preceding unsigned comment added by Two Wrongs (talk • contribs) 22:34, 14 January 2014 (UTC)

Of course it's about Transcendental Meditation (among other forms of meditation). What an odd comment. I'm not sure what you're getting at by quoting the sentence in question - could you clarify? MastCell ^Talk 00:11, 16 January 2014 (UTC)

Consistency of coverage

Since this article gets more attention than any other meditation article, I would like to ask those watching this page to also consider how to summarize the AHA position statement and the AHRQ systematic review in the following articles on mindfulness meditation:

• Mindfulness (psychology)#Scientific research
• Mindfulness-based stress reduction#Evaluation of effectiveness
• Research on meditation and its summary in Meditation#Scientific studies.

Just to be clear: I am not hinting or implying that this article is biased. I am worried that mindfulness meditation, which is receiving much more media attention these days, is not held to the same high standards of sourcing. Vesal (talk) 01:15, 18 January 2014 (UTC)

As somebody who revamped the Mindfulness-based stress reduction article a few months ago, I know there are strong sources commenting on its effectiveness so there was little question what Wikipedia should relay. What's the issue exactly? Alexbrn ^{talk|contribs|COI} 06:33, 18 January 2014 (UTC)

Well, if you compare this article and the MBSR article, it comes as a completely surprise that the AHA would consider the evidence in favor of TM to be more solid than that of MBSR. What causes this discrepancy between our assessment and theirs? Vesal (talk) 23:19, 18 January 2014 (UTC)

The MBSR article makes no mention of any effect on hypertension. We could (and should) add the AHA findings to the MBSR article, and generally improve and expand it. The MBSR article does note, correctly, that meta-analyses have consistently found MBSR to have statistically significant (albeit small) effects on various metrics of psychological stress. In any case, I think we agree that the MBSR article would benefit from more editorial attention (and it's on my to-do list). Was your intent in raising the issue here simply to attract more eyes, or is there a point you're making about our coverage of TM specifically? MastCell ^Talk 23:47, 18 January 2014 (UTC)

Well, MastCell, I think what you do here is admirable, but this article is receiving an unfair amount of attention from competent admins. As a result, other meditation articles are naively buying into the claims of proponents. These very same meta-reviews that say MBSR has a moderate effect on improving stress also say the effect is indistinguishable from active controls and CBT. So, it seems that refuting your negative thoughts is just as effective as acceptance. Anyway, I'm glad to hear mindfulness articles are on your to-do list, and I will take any further complaints to the relevant pages. Thank you, Vesal (talk) 01:27, 19 January 2014 (UTC)

Books are not considered scholarly research

When referring to scientific "Research", books are not considered peer-reviewed journals, therefore the reference number 79, which does not lead to any scientific or scholarly paper, nor a reference to one, should be removed, since citing a book under scientific research is unethical and mis-leading the public. — Preceding unsigned comment added by Two Wrongs (talk • contribs) 22:37, 14 January 2014 (UTC)

The citation I think you're referring to (currently #76) goes to Braunwald's Heart Disease, possibly the most respected cardiology textbook in existence. I am completely incapable of following your reasoning here - why is it "unethical and misleading" to cite a leading medical textbook to describe the current medical understanding of TM? MastCell ^Talk 00:14, 16 January 2014 (UTC)

Agree. In this circumstance, Two Wrongs, doesn't make a right, :> IRWolfie- (talk) 23:57, 4 February 2014 (UTC)

New AHRQ-funded systematic review

PMID 24395196 is a newly published systematic review and meta-analysis of meditation's effect on stress and well-being, funded by AHRQ and conducted by a team at Johns Hopkins. One of its central findings is that "mantra meditation programs did not improve any of the outcomes examined". (In contrast, there was some evidence that mindfulness-based meditation was superior to non-specific controls, although not superior to specific active controls like exercise). The lack of evidence for mantra meditations persisted when TM was considered in isolation. How should we reflect this new secondary source in our article? MastCell ^Talk 01:26, 9 January 2014 (UTC)

Note that the way the review was done, ONLY studies that evaluated psychological effects were cited, and even in those studies, ONLY psychological effects were counted. For example, the review referred to Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease.. Since the psychological test for anxiety revealed that none of the TM subjects were anxious at the beginning of the study, or at the end, the study was counted as showing that TM had no effect on anxiety. The study also reported that the TM group showed beneficial changes on measures of heart-rate variability, adjusted systolic BP and insulin resistance, but since none of these were psychological measures of anxiety, the review counted this as "no effect," leading to the report that only mindfulness practices had ANY effect on "well being." As to how to cite it, note that of 17,000+ meditation citations examined by the reviewers, only 47 of them made the cut, and despite one of the TM researcher participants submitting 50 TM studies for use in the review, the reviewers only used 8 of them (Orme-Johnson, personal communication, but I'm sure he'll put it up on his blog soon)Sparaig2 (talk) —Preceding undated comment added 19:28, 15 January 2014 (UTC)

A key part of any meta-analysis or systematic review is to assess the quality of the literature and high-quality studies. If you include low-quality studies, then you get garbage in, garbage out. The fact that very few TM studies qualified is not an indication of a problem with the systematic review. It's an indication of the flaws and weaknesses of the TM literature (as other systematic reviews have routinely noted).

The vast majority of TM studies are methodologically flawed to the point that they can't be meaningfully interpreted, and are thus excluded from any well-conducted systematic review. You seem very focused on the raw quantity of TM studies, but piling up huge numbers of flawed studies is like multiplying zeroes. It's important to understand that 50 flawed studies are no more useful than 1 flawed study, at least in science (obviously, in marketing the equation may be substantially different). MastCell ^Talk 23:49, 15 January 2014 (UTC)

I like it how you only responded to Sparaig2 last sentence. Also I had a quick look at the review and doesn't it only look at stress and well-being in a clinical setting?--Uncreated (talk) 19:33, 17 January 2014 (UTC)

I didn't see much else in Sparaig2's post to respond to. I understand that a pseudonymous Wikipedia editor disagrees with the paper's methodology, but that carries zero weight when it comes to our content policies. His main objection seemed to be based on a fundamentally faulty understanding of how systematic reviews work, so I tried to clarify that. I'm not sure what you mean by "only" looking at "clinical settings"; could you clarify? MastCell ^Talk 23:32, 17 January 2014 (UTC)

By Clinical Setting I mean the review only looked at studies in which the subjects had been diagnosed with a medical or psychiatric problem. --Uncreated (talk) 07:47, 8 February 2014 (UTC)

You said: "The fact that very few TM studies qualified is not an indication of a problem with the systematic review. It's an indication of the flaws and weaknesses of the TM literature (as other systematic reviews have routinely noted." This statement suggests a bit of bias on your part for several reasons: firstly, in most of the reviews I have seen, reviewers don't single out TM research as the worst of all worlds, which your statement implies; secondly, in reference to the most recent review from the American Heart Association, lead author Robert Brook said that studies on TM were unique in the quality of research on hypertension, which goes against the general implication of your comment; finally, on a purely numerical level, the pubmed search string, "transcendental meditation" ("well being" OR anxiety OR depression) yields 50 hits, while the search string, mindfulness meditation ("well being" OR anxiety OR depression) yields 320 hits. 8 out of 50 TM studies made the grade, while 20 out of 320 mindfulness studies made the grade. That's 16% of the TM studies were sufficiently high quality to be included, while only 6.25% of the mindfulness studies were sufficiently high quality to be included, assuming that only pubmed citations were used. Surely you can see that singling out TM studies the way you appear to be is not warranted? 14:44, 23 January 2014 (UTC) — Preceding unsigned comment added by Sparaig2 (talk • contribs)

I added 5 tildes by accident and it said I didn't sign the commentSparaig2 (talk) 14:48, 23 January 2014 (UTC)

Test: see?14:49, 23 January 2014 (UTC) — Preceding unsigned comment added by Sparaig2 (talk • contribs)

Not really following the argument here. What change is being proposed, exactly? Alexbrn ^{talk|contribs|COI} 14:51, 23 January 2014 (UTC)

I was simply noting what appears to be a bug. I suppose I should have tested in a sandbox rather than in public. I've sent an email about it, though its a wiki bug, and the authors of the original software need to be told --not obvious how to go about doing that, however.Sparaig2 (talk) 15:14, 23 January 2014 (UTC)

WP:5TILDES is documented behaviour. I meant: what edit to the article is being proposed, exactly? Alexbrn ^{talk|contribs|COI} 16:08, 23 January 2014 (UTC)

I was pointing out to MastCell that I thought his attitude towards TM research is biased. It is up to MastCell to decide what, if anything, to do about his bias and how it affects his handling of the citation of TM research in wikipedia. Sparaig2 (talk) 16:20, 23 January 2014 (UTC)

I don't think I've ever claimed that TM research was uniquely worse than other meditation research. As you note, meditation research is pretty poor across the board in terms of quality. This page is about TM specifically; hence the focus on TM here. You're welcome to follow up on your concerns about bias on my talkpage or in whatever venue you see fit, although I find it somewhat ironic to be accused of bias on an article dominated by a group of single-purpose TM-affiliated accounts. MastCell ^Talk 18:36, 23 January 2014 (UTC)

And yet, one man's "deeply flawed" can make another man's list of "most important studies published in 2012." Specifically, when the study by Schneider et al was pulled from publication in the journal hypertension just moments before the journal went online, a number of bloggers made note of the incident, and decried it as an awful study. A little over a year later, the study was published in the American Heart Association journal, and is now listed as: "Circulation: Cardiovascular Quality and Outcomes Editors' Picks: Most Important Articles Published in 2012". None of the bloggers or the people who gave impromptu critiques of the study were willing to go on the record by writing a Letter to the Editor of _Circulation_. Which are we to believe, the journal editors or a bunch of bloggers, and why?Sparaig2 (talk) 19:25, 23 January 2014 (UTC)

Actually, a number of people went on record as critical, or at least skeptical, of the way that article was handled (and we've still never gotten an actual explanation for why Archives of Internal Medicine pulled the paper 12 minutes before it was set to go live—an unprecedented occurrence). Independent experts described the study as "too small to be conclusive", and Larry Husten and Sanjay Kaul at CardioBrief have written extensively about the paper's mysterious disappearance and re-appearance, as well as its methodologic quality (e.g. [9], [10]). But we're jumping around a bit here—I initially opened this thread to discuss how we should incorporate the new JAMA Internal Medicine/ARHQ systematic review. MastCell ^Talk 21:41, 23 January 2014 (UTC)

They went on the record in *blogs*, but in the year since it was published, not a single one of them "went on the record" by writing a Letter to the Editor concerning its dubiousness. And, as I said, the editors of the journal went on the record as listing it as one of the most important papers published in the journal in 2012. And, this article in _The Scientist_ provides some explanation of why it was pulled:

According to Jann Ingmire, director of media relations for the Archives journal series as well as the Journal of the American Medical Association (JAMA), the decision was made after the authors informed Archives editors that new, potentially relevant data existed. “At that point, the journal felt it was necessary to review the new data” prior to publishing the study, said Ingmire, adding that it is not yet known whether the new data will affect the study’s findings.

The new data came to light after the study authors invited the National Heart, Lung, and Blood Institute (NHLBI), which funded the study, to comment on the accepted manuscript for a press release. Upon seeing the final paper, project officer Peter Kaufmann reminded the authors of the additional data collected since the original manuscript was submitted, “and the importance of including all available data in publications,” Kaufmann told The Scientist in an email. Though he did not specifically recommend that it be included, the authors decided to send the most recent data to the journal. — Preceding unsigned comment added by Sparaig2 (talk • contribs) Sparaig2 (talk) 06:18, 24 January 2014 (UTC)

They focused on psychological markers of stress and well-being because if a patient is just as depressed after therapy, what good is a chart demonstrating improved heart-rate variability?? However, the authors of the review do acknowledge that leaving out trials that measured biological markers may "disappoint some readers", and they then mention the hypothesis (from the paper cited above) that mantra-meditation may independently influence the body's stress response.

This review should be given primary weight here, but it may be worth asking whether a few sentences should be said about the impact of this restriction on TM, based on the words of the review authors themselves. My own opinion, as an episodic single-purpose account, is that it would probably not hurt to clarify that this review focused on psychological markers only, so that the AHA's relatively more positive evaluation does not seem too contradictory. Vesal (talk) 07:48, 24 January 2014 (UTC)

Fair enough. From a true believer's perspective, however, it is frustrating to see that many/most of the TM research that "made the grade" were studies where the subjects were already rated as "non-anxious" or "non-depressed" on psychological tests so that the lack of change in pre and post-test was counted as "TM has no effect on anxiety or depression." Most TM research in the past few years has focused on physiological changes as that is where the major grant money for MUM (the TM university) is coming from. It is a numbers game that is very hard to play. A pubmed search string on research published on (mindfulness meditation) in the last 10 years yields 704 hits. The same search string for ("Transcendental Meditation") yields 90 hits, and the ratio of published mindfulness meditation studies to published TM studies studies is getting larger every year (I project that more mindfulness studies will be indexed in pubmed in 2014 than are indexed for the 40 years history of TM research: 305). It is a given that an arbitrary review of some arbitrary set of variables will almost certainly yield more mindfulness meditation hits than "transcendental meditation" hits, and meta-analysis is very much a numbers game: the results will tend to favor whichever therapy has the most randomly designed studies to look at, unless those variables happen to be exactly what the limited number of TM studies are looking at, as is the case with the AHA hypertension report. Sparaig2 (talk) 17:19, 24 January 2014 (UTC)

By the way, the claim that they focused on mental health, so any study that wasn't on mental health was eliminated, ignores the fact that what they said was:

We aimed to determine the efficacy and safety of meditation programs on stress-related outcomes (e.g., anxiety, depression, stress, distress, well-being, positive mood, quality of life, attention, health-related behaviors affected by stress, pain, and weight) compared with an active control in diverse adult clinical populations

while Transcendental meditation, mindfulness, and longevity: an experimental study with the elderly. DID a comparison of TM,. mindfulness and "low mindfulness relaxation" (the relaxation response) on:

paired associate learning; 2 measures of cognitive flexibility; mental health; systolic blood pressure; and ratings of behavioral flexibility, aging, and treatment efficacy'

but as this study didn't use an active control group, but instead did a head-to-head comparison of three different treatments and a no-treatment control group, it didn't qualify to be included in the meta-analysis. I just have to ask you, in all seriousness: can you take seriously a meta-analysis that refuses to include the results of head-to-head studies between two of the treatment modalities that it otherwise analyzes? Sparaig2 (talk) 21:49, 3 February 2014 (UTC)

• Does someone want to propose some text based on the systematic review? IRWolfie- (talk) 23:55, 4 February 2014 (UTC)

New research study

No suggested edit

New published research on TM: teacher burnout. David Spector (talk) 21:44, 3 February 2014 (UTC) It's a single study (i.e primary source) of a rather paltry 40 individuals. Let the Secondary sources sort these out. Incidentally, Phys.org is also a rather poor website, IRWolfie- (talk) 00:01, 5 February 2014 (UTC) It's not the place of wikipedia to try to provide balance in the face of this kind of imbalance in number of studies for opposing practices/treatments but the typical methodology used in science to compare treatment modalities assumes there the number of studies for each modality is within an order of magnitude or 2. That is no longer the case with TM vs mindfulness, as that little graph of the number of studies indexed in pubmed shows. I have no idea how anyone can address such an issue. Of course, for those who think TM is worthless (or that all meditation practices are worthless or equivalent), it obviously doesn't matter. But here's a thought: even now, it appears like new research on mindfulness doesn't overturn the AHA's conclusion from last year, despite the avalanche of new research... Sparaig2 (talk) 08:25, 10 February 2014 (UTC) Sorry I have no idea what you are talking about nor do I see the relevance to your initial post. I'm not sure what you are extrapolating from the AHA statement of evidence being "unknown/unclear/uncertain or not well-established". IRWolfie- (talk) 20:12, 10 February 2014 (UTC) As I pointed out before, the lead author of the AHA study. Richard Brook, has commented to me in email that "they did not use our words" when the WIkipedia entry claims that a LOE (Level of Effect) "type IIb" means "unknown/unclear/uncertain or not well-established". That was an alternate form of wording that the AHA writing committee chose NOT to use. It merely appears in the graphic that gives all the possible wordings that could have been used in connection with the LOE designation the writing committee chose to use. Instead, they chose to use the wording "may be used in clinical practice," which gives an entirely different interpretation of the official designation. What the Richard Brook also said in an exchange of Letters to the Editor of the AHA journal (which I also quoted in this talk page) is that We do agree that TM is unique in the robustness and quality of evidence among 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. I typed out the entire letter in a reddit discussion in case you are interested in the context. Sparaig2 (talk) 22:58, 10 February 2014 (UTC) When I said in context I was referring to your initial post. I thought you were suggesting an edit based on it, but your above comment appears to be moving off topic. IRWolfie- (talk) 23:08, 10 February 2014 (UTC) I was merely pointing out a philosophical issue that is probably beyond the scope of Wikipedia to deal with: when you have a publication ratio of 25 to 1 (currently a 41 to 1) for one treatment vs another treatment, typical scientific protocols like meta-analysis, start to fall apart. There's been about 100 studies on TM published in the past 10 years, as indexed by pubmed. There's been over 1000 studies on mindfulness practices published, and the number is growing possibly more than exponentially, every year, while the growth in the number of TM studies published per year has been flat. Without any ill-intent, it is almost certainly the case that there will be hundreds of mindfulness studies published in the next few years that meet criteria for inclusion in some arbitrary meta-analysis, while the TM research pool will simply be lacking. The recent meta-analysis on anxiety is a good example: There's almost no TM studies that qualified, and of those that did, at least a few were on populations that were not anxious or depressed in the first place, so of course, a test on anxiety or depression would show "no effect" simply because there was no possible way to show an effect: zero minus zero = zero. and when you average in such studies, the calculated TM effect-size, whatever it might actually be, becomes meaningless. Sparaig2 (talk) 23:22, 10 February 2014 (UTC)

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

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"

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). 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

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 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)