Mindfulness meditation research and evidence-based medicine

Leading researchers have criticized the pace at which mindfulness meditation has become adopted as a clinical intervention, warning that its benefits have not been adequately established and potential harms not ruled out (e.g., Van Dam et al. 2018). Their abundance of caution stems from an undue reliance on the evidence-based medicine (EBM) hierarchy of evidence, according to which randomized controlled trials (RCTs) and meta-analyses are superior to other evidence. I argue that, plausibly, meditation is effective not because of a single “active ingredient,” but also due to its embeddedness in a rich context. Yet RCT methodology precludes discovering that this is the case and meta-analyses typically exclude non-RCT evidence. I instead propose the inductive reward principle for weighing evidence: However we conceive of evidence quality, we should relax our standard if the prima facie risk of harm is low and the potential to benefit many people is high.