- Key questions can help us decide for ourselves whether mindfulness influences a health outcome that we are interested in.
- Knowing these key questions can help support us be lifelong learners about any topic that can be answered by science.
- Questions include whether there a dose-response relationship between the factor of interest (mindfulness training) and disease.
According to the U.S. National Library of Medicine PubMed database, there are now over 22,000 peer-reviewed articles on mindfulness; about half of these were published just in the last five years. The methodological quality varies. How do we know what to believe? What makes outstanding science?
In the field of epidemiology, we often ask key questions to help determine if x causes y. If x is mindfulness and y is a health outcome you are interested in, how can you find out if mindfulness really influences it?
As I finish teaching the last class of Mindfulness Epidemiology (PHP1895) this week at Brown University where we have the first Master of Public Health concentration in mindfulness worldwide, I thought you might appreciate seeing some key questions students are encouraged to ask, often referred to as Hill’s criteria for causal inference.
When you read something about mindfulness in the news, or maybe read a research article yourself, consider asking yourself the following questions (adapted from the U.S. Centers for Disease Control and Prevention, "The Health Consequences of Smoking: A Report of the Surgeon General, 2004").
- Do multiple high-quality studies show a consistent association between the factor of interest (i.e., mindfulness) and disease? In other words, is it just one fancy article that showed an association, or has this finding been replicated several times by different groups of researchers in unique studies?
- Are the measured effects large enough and statistically strong?
- Does the evidence show that the factor of interest (i.e., mindfulness) occurs before the disease occurs (a temporal association)? In other words, did a mindfulness intervention result in a change in a health outcome?
- Is the relationship between the factor of interest (i.e., mindfulness) and disease coherent or plausible in terms of known scientific principles, biologic mechanisms, and observed patterns of disease? Meaning, does it make sense theoretically that mindfulness training would influence that specific health outcome, and are the biological and behavioral mechanisms consistent with what would be expected if the mindfulness training influenced that health outcome of interest?
- Is there a dose-response relationship between the factor of interest (e.g., mindfulness training) and disease? This isn’t done much in the mindfulness field and should be. My Ph.D. is in pharmacology and therapeutics and I performed medication dosing studies as a graduate student. In the mindfulness field, we can do the same, such as by determining whether people randomized to receive a larger amount of mindfulness training have greater effects than those randomized to smaller amounts of mindfulness training. Relatedly, as in the pharmaceutical industry, we can determine if there is a minimum effective dose of a specific mindfulness training, and also if is there a maximum dose beyond which doesn’t help and may even harm on average.
- Is the risk of disease reduced after changing the factor of interest (e.g., changing mindfulness ability)? Meaning, if we provide mindfulness training, does that lower the risk of disease?
With answers to these questions, you can stand on firmer ground knowing more confidently whether mindfulness really influences that health outcome that you are interested in.