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Rapid response to:

Editorial

The therapeutic effects of meditation

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7398.1049 (Published 15 May 2003) Cite this as: BMJ 2003;326:1049

Rapid Response:

Research shows that Transcendental Meditation is valuable for health

Canter’s editorial contains a number of omissions, errors, and
misleading assertions regarding research on Transcendental Meditation
(TM), as taught by Maharishi Mahesh Yogi.(1) For example, no mention is
made of a meticulously controlled randomized study conducted at Harvard,
which actively controlled for expectation and time spent with instructor.
Octogenarians living in residential institutions who learned TM showed
significantly greater improvement in mental health, cognitive and
perceptual flexibility, systolic blood pressure, and self-reported well-
being, as well as significantly lower mortality after three years compared
to three control groups who practised either a pseudo-meditation technique
(of the ‘relaxation response’ type claimed to imitate TM) or
‘mindfulness’, or received no treatment.(2) Strikingly, the pseudo-
meditation controls showed no benefit on any measure, refuting Canter’s
assertion that such comparisons have been negative. In terms of competing
interest, the lead author’s known interest in TM was well balanced by the
second author (and departmental professor), a well-known public proponent
of ‘mindfulness’.

In this and many other studies, it is clear that research on TM is
not confined to self-selected, pre-disposed subjects: indeed, study
populations have varied widely in terms of age, gender, ethnicity,
economic status, and social background, with research conducted in diverse
clinical, experimental, educational, occupational, and rehabilitation
settings. For example, in the randomized study cited by Canter showing
benefits from TM in hypertension,(3) subjects were drawn from a high-risk
population of elderly African-Americans attending underserved inner city
hospital clinics (who, incidentally, were predominantly professed
Methodists and Baptists).

Also omitted are studies demonstrating that TM is effective in
reducing substance misuse – one of the most important issues in world
health and a daily challenge for clinicians. Even though TM involves no
advice to modify consumption, a series of meta-analyses found that the
technique led to significantly greater reductions in use of tobacco,
alcohol, and illicit drugs than conventional programmes specifically
directed at these problems.(4) Long-term abstinence rates achieved with
TM are particularly impressive.

Contrary to the editorial’s assertion, in one of two randomized
studies cited, TM alone was shown to significantly reduce carotid artery
atherosclerosis.(5) The other found similar results using a multimodal
natural medicine programme (Maharishi Vedic Medicine), but was not
designed to examine the effect of TM alone.(6)

Occupational health research, including studies from the Japanese
Ministry of Labour, have shown reduced smoking, improved sleep patterns,
and benefits for general health and well-being in employees of both large
and small companies.(7,8,9)

In keeping with these and other results, research on health care
utilization indicates that TM could play an important role in primary
prevention and reduction of health costs. A 14-year retrospective study
of 2836 people enrolled in the Quebec provincial health insurance scheme
found that payments to physicians did not differ between controls and TM
subjects in the years prior to beginning the technique. However, after
commencing TM, payments declined progressively compared to controls. The
average annual difference was 13 percent, leading to a cumulative
reduction of 55 percent after six years. (10)

An earlier study using data from Blue Cross/Blue Shield, a major US
health insurer, found that both hospital admissions and outpatient
consultations were over 50% fewer for subjects practising TM compared to
norms and controls. In the over-40 age group, the reduction was over 70
percent. Admissions were markedly reduced in all 17 disease categories
studied.(11)

TM research now comprises more than 600 studies, conducted at 200
independent universities and research institutions in 30 countries, with
original research published in over 120 peer-reviewed journals and
participation of more than 360 scientists, most of whom are not affiliated
with organizations promoting TM.

As with many useful and innovative medical technologies, some
researchers have dedicated a substantial part of their careers to
elucidating the effects of TM. One such group based at Maharishi
University of Management (a fully-accredited university to PhD level, in
Iowa) has, in collaboration with independent clinicians and researchers at
other institutions, been responsible for some of the most rigorous
research in this field. This in turn has attracted millions of dollars of
research grants from the US National Institutes of Health.(3,4,5,14) In
contrast to much pharmaceutical research, TM research is not funded by
organizations that promote the technique.

It is highly unlikely that journals and their reviewers, not to
mention the NIH, would accept anything less than the highest standards
when dealing with TM research, all the more so if authors are known to be
affiliated with institutions advocating TM. Year after year, these
stringent standards have been met.

Canter mentions a meta-analysis which found that TM had twice the
treatment effect in reducing anxiety as other forms of meditation and
relaxation.(12) Misleadingly, his previous sentence implies that this was
‘carried out by researchers directly involved in the organization offering
transcendental meditation’. In fact, the senior author was a physicist at
Stanford University who had not previously published research on TM, and
although both junior authors had longstanding interests in the technique,
neither was directly involved with a TM related institution at the time.

TM’s effect was specifically found superior to methods claimed by
their originators to imitate TM, including both pseudo-meditation (like
Benson’s relaxation response) and ‘mantra meditation’.(12) Canter
questions the clinical relevance of these results because the studies did
not include patients ‘with psychiatric illness’. As a GP, I would suggest
that only a little of the massive burden that general anxiety places on
individual quality of life, the health service, and the economy comes
under the remit of ‘psychiatric illness’. All studies included in this
meta-analysis used an inventory that has been shown to correlate well with
both physiological and clinical aspects of anxiety.

Contrary to Canter’s assertion of no data, further analyses (Table 4,
p.967) do indeed show that the superiority of TM in reducing anxiety was
maintained or increased when confined to randomized studies with low
attrition; to published studies alone; or to randomized studies conducted
by authors with a neutral or negative attitude to TM.(12) These results
are consistent with a subsequent meta-analysis showing that TM was more
than three times as effective as other meditation and relaxation
procedures in improving a measure of overall mental well-being.(13)

The description of ‘Benson’s relaxation response’ as a ‘non-cultic
form of transcendental meditation’ is curious and unexplained. TM
requires no belief, nor any change in life-style, attitudes, or diet, and
can be easily learned by anyone regardless of age, education, or culture.
TM is a simple, effortless technique practised on an entirely voluntary
basis for 15-20 minutes twice daily and is taught by qualified teachers
who have completed an extensive training programme. More than five
million people from very diverse social, cultural, ethnic, religious, and
economic backgrounds have learned the technique in over 100 countries.
The ‘relaxation response’ method is not a ‘form of transcendental
meditation’: claims by its proponents that it replicates TM’s effects fail
to stand up to scrutiny.(2,4,12,13)

Exploring the effects of different techniques is an on-going
challenge, but to start from the a priori assumption that all
meditation/relaxation methods, and even all ‘cognitive-behavioural’
techniques, are the same because of a few superficial similarities not
only flies in the face of research evidence but is as misleading as
claiming that morphine and aspirin are essentially the same because both
are analgesics.

Canter’s conclusion, repeated in the headline, that ‘conditions
treated are stress related’ is not explained but is presumably intended to
suggest only relatively minor medical significance. It is, however,
virtually meaningless given the lack of agreement on which conditions can
be properly described as stress related: do they include hypertension,
angina pectoris, atherosclerosis, and longevity to name but a few
clinically important end-points shown to improve with TM? (2,3,5,14,15)

TM certainly provides an exceptionally effective and much needed
method of reducing stress (4,1216), but its effects are not limited to
highly stressed individuals: planned subgroup analysis of a randomized
trial showed that TM significantly reduced systolic and diastolic blood
pressure in both high and low risk subgroups on a measure of psychosocial
stress, in contrast to groups who practiced progressive muscular
relaxation or received health education. Interestingly, TM was similarly
effective for both sexes and for high and low risk subjects on four other
dimensions – obesity, alcohol intake, physical inactivity, and dietary
sodium-potassium ratio.(14) Cost-effectiveness compared favourably with
drug treatment.(17)

Finally, the BMJ has rightly highlighted the massive medical impact
of war. At this critical time in world affairs, concerned clinicians may
wish to know that more than 40 controlled studies (including prospective
projects) published in peer-reviewed journals have found that collective
practice of TM and the advanced TM-Sidhi programme by a specific small
fraction of the total population consistently reduces crime, violence, war
casualties, and conflict intensity, and enhances international
harmony.(18,19,20,21)

In an era in which health care is increasingly dominated by
management (as opposed to prevention or cure) of chronic disease, anything
that truly promotes health and contributes to genuine primary prevention
is refreshing. Having observed the comprehensive benefits of TM for
health and quality of life in over 3000 individuals, I can wholeheartedly
recommend this valuable technique to both patients and colleagues.

Roger A. Chalmers

1 Canter P. The therapeutic effects of meditation. BMJ 2003;326:1049
-50.
2 Alexander CN, Langer EJ, Davies JL, Chandler HM, Newman RI.
Transcendental Meditation, mindfulness, and longevity: An experimental
study with the elderly. J Personality and Social Psychol 1989;57(6):950-
64.
3 Schneider RH, Staggers F, Alexander CN, Sheppard W, Rainforth M,
Kondwani K, et al. A randomized controlled trial of stress reduction for
hypertension in older African Americans. Hypertension 1995;26:820-7.
4 Alexander CN, Robinson P, Rainforth M. Treating and preventing alcohol,
nicotine, and drug abuse through Transcendental Meditation: A review and
statistical meta-analysis. Alcoholism Treatment Quarterly 1994;11:13-87.
5 Castillo-Richmond A, Schneider RH, Alexander CN, Cook R, Myers H, Nidich
S, et al. Effects of stress reduction on carotid atherosclerosis in
hypertensive African Americans. Stroke 2000;31(3):568-73.
6 Fields JZ, Walton KG, Schneider RH, Nidich S, Pomerantz R, Suchdev P, et
al. Effect of a multimodal natural medicine program on carotid
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Medicine. Am J Cardiol 2002;89:952-8.
7 Haratani T, Henmi T. Effects of Transcendental Meditation on health
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Effects of the Transcendental Meditation Program on stress reduction,
health, and employee development: a prospective study in two occupational
settings. Anxiety, Stress, and Coping 1993;6:245-62.
10 Herron R, Hillis S. The impact of the Transcendental Meditation program
on government payments to physicians in Quebec: an update. Am J Health
Promotion 2000;14(5):284-91.
11 Orme-Johnson DW. Medical care utilization and the Transcendental
Meditation program. Psychosomatic Med 1987;49:493-507.
12 Eppley KR, Abrams AI, and Shear J. Differential effects of relaxation
techniques on trait anxiety: a meta-analysis. J Clin Psychol 1989 45:957-
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13 Alexander CN, Gelderloos P, Rainforth MV. Transcendental Meditation,
self-actualization, and psychological health: a conceptual overview and
statistical meta-analysis. J Social Behavior and Personality1991;6(5):189
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14 Alexander CN, Schneider RH, Staggers F, Sheppard W, Clayborne BM,
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African Americans: II. Sex and risk subgroup analysis. Hypertension 1996
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15 Zamarra JW, Schneider RH, Besseghini I, Robinson DK, Salerno JW.
Usefulness of the Transcendental Meditation program in the treatment of
patients with coronary artery disease. Am J Cardiol 1996;77:867-70.
16 Brooks JS, Scarano T. Transcendental Meditation in the treatment of
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17 Herron, R, Schneider RH, Mandarino GV, Alexander CN, Walton KG. Cost-
effective hypertension management: comparison of drug therapies with an
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18 Hagelin JS, Orme-Johnson DW, Rainforth M, Cavanaugh K, Alexander CN.
Results of the National Demonstration Project to Reduce Violent Crime and
Improve Governmental Effectiveness in Washington D.C. Social Indicators
Research 1999;47:153-201.
19 Hatchard GD, Deans AJ, Cavanaugh KL, Orme-Johnson DW. The Maharishi
Effect: a model for social improvement. Time series analysis of a phase
transition to reduced crime in Merseyside metropolitan area. Psychol Crime
and Law 1996;2(3):165-74.
20 Orme-Johnson DW, Alexander CN, Davies JL, Chandler HM, Larimore WE.
International peace project in the Middle East: the effects of the
Maharishi Technology of the Unified Field. J Conflict Resolution
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21 Dillbeck MC. Test of a field hypothesis of consciousness and social
change: Time series analysis of participation in the TM-Sidhi program and
reduction of violent death in the United States. Social Indicators
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Competing interests:  
Roger Chalmers is a full-time locum general practitioner and has derived more than 99% of his income from NHS clinical work over the past 7 years. He became a teacher of Transcendental Meditation in 1975, and has lectured widely on research and medical applications of this and related techniques over the past 27 years. From 1982-1996 he was directly involved with institutions publicly advocating TM<holding a number of non-salaried academic positions (including co-editing of collected papers on TM research). From 1987-1991, he worked in full-time private medical practice utilizing the complementary system known as Maharishi's Vedic Approach to Health, which includes TM, alongside modern medicine.

Competing interests: No competing interests

29 May 2003
Roger A Chalmers
general practitioner (locum)
Various GP practices in East Anglia