In recent years, the number of studies examining the effect of mindfulness meditation on conditions such as depression and anxiety has grown exponentially. However, leading mindfulness researchers have criticized the pace at which mindfulness has become accepted as a clinical intervention, warning that the benefits of meditation have not yet been adequately established and potential harms not ruled out (e.g., Van Dam et al. 2018, Davidson and Dahl 2018). In this paper, I trace the history of mindfulness meditation research to locate the origin of this abundance of caution. I show that it stems from an undue reliance on the evidence-based medicine (EBM) hierarchy, and particularly the idea that RCTs and meta-analyses are superior to other forms of evidence. Plausibly, the benefits of meditation practice are not due to a single “active ingredient,” but from its embeddedness in Buddhist ethics and metaphysics. The reductionism inherent in RCT methodology precludes determining whether this is indeed the case, limiting what we are able to learn about the benefits of meditation. Moreover, these problems are exacerbated when meta-analyses are considered the best possible evidence, since they tend to exclude non-RCT evidence. Instead of the EBM hierarchy, I propose the inductive reward principle for weighing evidence in medicine: However we conceive of quality of evidence, we should relax our standard if the prima facie risk of harm is low and the potential to benefit many people is high.

Humanistic medicine is a growing movement that emphasizes the importance of relational skills and expert judgment in medical practice. Biomedicine, on the other hand, remains the dominant model for medical practice. It emphasizes scientific and technical aspects of medical knowledge, prioritizing randomized controlled trials over expert judgment (e.g., Evidence Based Medicine Working Group 1992).

Humanistic medicine and biomedicine are standardly understood to be in competition with one another. There have, however, been efforts to reconcile them by bringing elements of humanistic medicine, such as empathy, under the banner of biomedicine (e.g., Howick 2018). In this paper, I investigate the conceptual and methodological challenges associated with these attempts at reconciliation. Importantly, empathy and other relational skills are not the sorts of things that come in “doses” or that function as discrete medical interventions. They cannot therefore be evaluated using the randomized controlled trial. I argue that to understand the value of humanistic skills in medicine, we need to move beyond assessment in terms of the tenets of Evidence Based Medicine. I lay out a new path for reconciling humanistic and biomedicine that does not involve subsuming the former under the latter.

References:
Evidence Based Medicine Working Group. (1992) Evidence-based medicine. A new approach to
teaching the practice of medicine. Journal of the American Medical Association, 268, 2420-5.

Howick, J., et al. (2018). Effects of empathic and positive communication in healthcare consultation:
a systematic review and meta-analysis. Journal of the Royal Society of Medicine, 11(7), 240-52.

Grief is a focus of much recent research in philosophy, psychiatry, psychology, and animal ethology. Matthew Ratcliffe’s Grief Worlds (2022) takes a phenomenological approach to explore the humanistic dimensions of grief experiences. Barbara King’s How Animals Grieve (2013) uses the methods of animal ethology to look at grief behavior in a range of animal species. The DSM-5-TR uses factor analysis to distinguish grief from other distressing psychological conditions and regards most grief as a normal (= “non-pathological”) reaction to bereavement. Despite this work distinguishing depression from grief, laboratory models (rats) use maternal or social deprivation to model the neuroscience of human depression and test pharmaceutical interventions. In my own philosophical work (Solomon, 2021), I have developed George Engel’s medical approach to grief (1961), framing it as psychological injury that it is appropriate to medicalize.
These different approaches to studying grief cannot be wholly integrated in any straightforward way: there are deep disagreements between them. Phenomenologists typically take themselves to be exploring uniquely human experiences, imbued with language and meaning, and having little in common with animal grief behavior despite some behavioral similarities. Strong convictions that grief is “normal” (even, sometimes, “profound”) and should not be “medicalized” clash with the presuppositions of laboratory rat models that aim to intervene pharmaceutically and neurologically on reactions to social deprivation. Incommensurability between perspectives prevents integration and supports continued pluralism.