Open science practices in traditional, complementary, and integrative medicine research: A path to enhanced transparency and collaboration.

This educational article explores the convergence of open science practices and traditional, complementary, and integrative medicine (TCIM), shedding light on the potential benefits and challenges of open science for the development, dissemination, and implementation of evidence-based TCIM. We emphasize the transformative shift in medical science towards open and collaborative practices, highlighting the limited application of open science in TCIM research despite its growing acceptance among patients. We define open science practices and discuss those that are applicable to TCIM, including: study registration; reporting guidelines; data, code and material sharing; preprinting; publishing open access; and reproducibility/replication studies. We explore the benefits of open science in TCIM, spanning improved research quality, increased public trust, accelerated innovation, and enhanced evidence-based decision-making. We also acknowledge challenges such as data privacy concerns, limited resources, and resistance to cultural change. We propose strategies to overcome these challenges, including ethical guidelines, education programs, funding advocacy, interdisciplinary dialogue, and patient engagement. Looking to the future, we envision the maturation of open science in TCIM, the development of TCIM-specific guidelines for open science practices, advancements in data sharing platforms, the integration of open data and artificial intelligence in TCIM research, and changes in the context of policy and regulation. We foresee a future where open science in TCIM leads to a better evidence base, informed decision-making, interdisciplinary collaboration, and transformative impacts on healthcare and research methodologies, highlighting the promising synergy between open science and TCIM for holistic, evidence-based healthcare solutions.

Investigating the nature of open science practices across complementary, alternative, and integrative medicine journals: An audit.

BACKGROUND: Open science practices are implemented across many scientific fields to improve transparency and reproducibility in research. Complementary, alternative, and integrative medicine (CAIM) is a growing field that may benefit from adoption of open science practices. The efficacy and safety of CAIM practices, a popular concern with the field, can be validated or refuted through transparent and reliable research. Investigating open science practices across CAIM journals by using the Transparency and Openness Promotion (TOP) guidelines can potentially promote open science practices across CAIM journals. The purpose of this study is to conduct an audit that compares and ranks open science practices adopted by CAIM journals against TOP guidelines laid out by the Center for Open Science (COS). METHODS: CAIM-specific journals with titles containing the words "complementary", "alternative" and/or "integrative" were included in this audit. Each of the eight TOP criteria were used to extract open science practices from each of the CAIM journals. Data was summarized by the TOP guideline and ranked using the TOP Factor to identify commonalities and differences in practices across the included journals. RESULTS: A total of 19 CAIM journals were included in this audit. Across all journals, the mean TOP Factor was 2.95 with a median score of 2. The findings of this study reveal high variability among the open science practices required by journals in this field. Four journals (21%) had a final TOP score of 0, while the total scores of the remaining 15 (79%) ranged from 1 to 8. CONCLUSION: While several studies have audited open science practices across discipline-specific journals, none have focused on CAIM journals. The results of this study indicate that CAIM journals provide minimal guidelines to encourage or require authors to adhere to open science practices and there is an opportunity to improve the use of open science practices in the field.

Complementary, alternative, and integrative medicine researchers' practices and perceived barriers related to open science: An international, cross-sectional survey.

INTRODUCTION AND OBJECTIVE: Open science (OS) aims to make the dissemination of knowledge and the research process transparent and accessible to everyone. With the increasing popularity of complementary, alternative, and integrative medicine (CAIM), our goal was to explore what are CAIM researchers' practices and perceived barriers related to OS. METHODS: We conducted an anonymous online survey of researchers who published in journals listed in Scopus containing the words "complementary", "alternative", or "integrative" medicine in their names. We emailed 6040 researchers our purpose-built electronic survey after extracting their email address from one of their publications in our sample of journals. We questioned their familiarity with different OS concepts, along with their experiences and challenges engaging in these practices over the last 12 months. RESULTS: The survey was completed by 392 researchers (6.5% response rate, 97.1% completion rate). Most respondents were CAIM researchers familiar with the overall concept of OS, indicated by those actively publishing open access (OA) (n = 244, 76.0%), registering a study protocol (n = 148, 48.0%), and using reporting guidelines (n = 181, 59.0%) in the past 12 months. Preprinting, sharing raw data, and sharing study materials were less popular. A lack of funding was reported as the greatest barrier to publishing OA by most respondents (n = 252, 79.0%), and that additional funding is the most significant incentive in applying more OS practices to their research (n = 229,72.2%). With respect to preprinting barriers, 36.3% (n = 110) participants believed there are potential harms in sharing non-peer-reviewed work and 37.0% (n = 112) feared preprinting would reduce the likelihood of their manuscript being accepted by a journal. Respondents were also concerned about intellectual property control regarding sharing data (n = 94, 31.7%) and research study materials (n = 80, 28.7%). CONCLUSIONS: Although many participants were familiar with and practiced aspects of OS, many reported facing barriers relating to lack of funding to enable OS and perceived risks of revealing research ideas and data prior to publication. Future research should monitor the adoption and implementation of OS interventions in CAIM.

Traditional, complementary, and integrative medicine and artificial intelligence: Novel opportunities in healthcare.

The convergence of traditional, complementary, and integrative medicine (TCIM) with artificial intelligence (AI) is a promising frontier in healthcare. TCIM is a patient-centric approach that combines conventional medicine with complementary therapies, emphasizing holistic well-being. AI can revolutionize healthcare through data-driven decision-making and personalized treatment plans. This article explores how AI technologies can complement and enhance TCIM, aligning with the shared objectives of researchers from both fields in improving patient outcomes, enhancing care quality, and promoting holistic wellness. This integration of TCIM and AI introduces exciting opportunities but also noteworthy challenges. AI may augment TCIM by assisting in early disease detection, providing personalized treatment plans, predicting health trends, and enhancing patient engagement. Challenges at the intersection of AI and TCIM include data privacy and security, regulatory complexities, maintaining the human touch in patient-provider relationships, and mitigating bias in AI algorithms. Patients' trust, informed consent, and legal accountability are all essential considerations. Future directions in AI-enhanced TCIM include advanced personalized medicine, understanding the efficacy of herbal remedies, and studying patient-provider interactions. Research on bias mitigation, patient acceptance, and trust in AI-driven TCIM healthcare is crucial. In this article, we outlined that the merging of TCIM and AI holds great promise in enhancing healthcare delivery, personalizing treatment plans, preventive care, and patient engagement. Addressing challenges and fostering collaboration between AI experts, TCIM practitioners, and policymakers, however, is vital to harnessing the full potential of this integration.

Dietary and herbal supplement consumer health information for pain: A cross-sectional survey and quality assessment of online content.

Background: Patients are increasingly utilizing the internet to learn about dietary and herbal supplements (DHSs) for various diseases/conditions, including pain management. Online health information has been found to be inconsistent and of poor quality in prior studies, which may have detrimental effects on patient health. This study assessed the quality of online DHSs consumer health information for pain. Methods: Six search items related to DHSs and pain were used to generate the first 20 websites on Google across four English-speaking countries. The identified 480 webpages produced 68 eligible websites, which were then evaluated using the DISCERN tool. The mean scores and standard deviations (SD) of the reviewers' ratings on each of the 15 DISCERN instrument items as well as the overall total score were calculated. Results: The mean summed score for the 68 eligible websites was 46.6 (SD = 10.1), and the mean overall rating was 3.3 (SD = 0.8). Websites lacked information regarding areas of uncertainty, the effects of no treatment being used, and how treatments affect the overall quality of life. These shortcomings were especially apparent across commercial websites, which frequently displayed bias, failed to report the risks of DHS products, and lacked support for shared decision-making regarding the use of DHSs. Conclusion: Variability exists in the quality of online consumer health information regarding DHS use for pain. Healthcare providers should be aware of and provide guidance to patients regarding the identification of reliable online resources so that they can make informed decisions about DHS use for pain management.

The Brief History of Complementary, Alternative, and Integrative Medicine Terminology and the Development and Creation of an Operational Definition.

The definition of complementary, alternative, and integrative medicine (CAIM) remains dynamic and complex despite a steady increase in the popularity/usage of CAIM therapies across the globe. A lack of consistency in how these terms are defined remains a challenge for researchers, clinicians, and national and international organizations (e.g., World Health Organization, National Center for Complementary and Integrative Health) alike. In the present article, we provide a brief history of the use of these terminologies, and then outline the process we took to develop and create an operational definition of complementary, alternative, and integrative medicine. Our operational definition is the first to be informed by a systematic search of four quality-assessed information resource types, ultimately yielding 604 unique CAIM therapies. We then developed a single search string for the most common bibliographic databases using the finalized operational definition list of CAIM therapies. These CAIM therapies were searched against the Therapeutic Research Center's "Natural Medicines" database for all 604 therapies, whereby each item's scientific name and/or synonym was included as a keyword or phrase in the search string. While the current definition is not without limitations and ongoing debates still surround the field, this work is arguably a steppingstone towards enabling increased collaboration and communication amongst healthcare clinicians, researchers, and the public. This operational definition provides a foundation for developing well-coordinated research efforts that will assist in the acceptance and understanding of this field, while also focusing on adopting knowledge translation techniques and efforts for further research advancement and use.

The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review.

BACKGROUND: Telemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM. METHODS: Following Arksey and O'Malley's scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies. RESULTS: Sixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM. CONCLUSIONS: Studies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.

Complementary, alternative, and integrative medicine-specific COVID-19 misinformation on social media: A scoping review.

Background: The sharing of health-related information has become increasingly popular on social media. Unregulated information sharing has led to the spread of misinformation, especially regarding complementary, alternative, and integrative medicine (CAIM). This scoping review synthesized evidence surrounding the spread of CAIM-related misinformation on social media during the COVID-19 pandemic. Methods: This review was informed by a modified version of the Arksey and O'Malley scoping review framework. AMED, EMBASE, PsycINFO and MEDLINE databases were searched systematically from inception to January 2022. Eligible articles explored COVID-19 misinformation on social media and contained sufficient information on CAIM therapies. Common themes were identified using an inductive thematic analysis approach. Results: Twenty-eight articles were included. The following themes were synthesized: 1) misinformation prompts unsafe and harmful behaviours, 2) misinformation can be separated into different categories, 3) individuals are capable of identifying and refuting CAIM misinformation, and 4) studies argue governments and social media companies have a responsibility to resolve the spread of COVID-19 misinformation. Conclusions: Misinformation can spread more easily when shared on social media. Our review suggests that misinformation about COVID-19 related to CAIM that is disseminated online contributes to unsafe health behaviours, however, this may be remedied via public education initiatives and stricter media guidelines. The results of this scoping review are crucial to understanding the behavioural impacts of the spread of COVID-19 misinformation about CAIM therapies, and can inform the development of public health policies to mitigate these issues.

Knowledge and motivations of training in peer review: An international cross-sectional survey.

BACKGROUND: Despite having a crucial role in scholarly publishing, peer reviewers do not typically require any training. The purpose of this study was to conduct an international survey on the current perceptions and motivations of researchers regarding peer review training. METHODS: A cross-sectional online survey was conducted of biomedical researchers. A total of 2000 corresponding authors from 100 randomly selected medical journals were invited via email. Quantitative items were reported using frequencies and percentages or means and SE, as appropriate. A thematic content analysis was conducted for qualitative items in which two researchers independently assigned codes to the responses for each written-text question, and subsequently grouped the codes into themes. A descriptive definition of each category was then created and unique themes-as well as the number and frequency of codes within each theme-were reported. RESULTS: A total of 186 participants completed the survey of which 14 were excluded. The majority of participants indicated they were men (n = 97 of 170, 57.1%), independent researchers (n = 108 of 172, 62.8%), and primarily affiliated with an academic organization (n = 103 of 170, 62.8%). A total of 144 of 171 participants (84.2%) indicated they had never received formal training in peer review. Most participants (n = 128, 75.7%) agreed-of which 41 (32.0%) agreed strongly-that peer reviewers should receive formal training in peer review prior to acting as a peer reviewer. The most preferred training formats were online courses, online lectures, and online modules. Most respondents (n = 111 of 147, 75.5%) stated that difficulty finding and/or accessing training was a barrier to completing training in peer review. CONCLUSION: Despite being desired, most biomedical researchers have not received formal training in peer review and indicated that training was difficult to access or not available.

Complementary and alternative medicine mention and recommendations in inflammatory bowel disease guidelines: systematic review and assessment using AGREE II.

BACKGROUND: Many patients with inflammatory bowel disease (IBD) use complementary and alternative medicine (CAM) for disease management. There is, however, a communication gap between patients and healthcare professionals regarding CAM use, where patients are hesitant to disclose CAM use to providers. The purpose of this study was to identify the quantity and assess the quality of CAM recommendations in IBD clinical practice guidelines (CPGs) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. METHODS: MEDLINE, EMBASE, and CINAHL were systematically searched from 2011 to 2022 to find CPGs for the treatment and/or management of IBD. The Guidelines International Network (GIN) and National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs were assessed using the AGREE II instrument. RESULTS: Nineteen CPGs made CAM recommendations for IBD and were included in this review. Average scaled domain percentages of CPGs were as follows (overall CPG, CAM section): scope and purpose (91.5%, 91.5%), clarity of presentation (90.3%, 64.0%), editorial independence (57.0%, 57.0%), stakeholder involvement (56.7%, 27.8%), rigour of development (54.7%, 45.9%), and applicability (14.6%, 2.1%). CONCLUSIONS: The majority of CPGs with CAM recommendations were of low quality and their CAM sections scored substantially lower relative to other therapies in the overall CPG. In future updates, CPGs with low scaled-domain percentages could be improved in accordance with AGREE II and other guideline development resources. Further research investigating how CAM therapies can best be incorporated into IBD CPGs is warranted.

Limited online training opportunities exist for scholarly peer reviewers.

OBJECTIVES: To create a comprehensive list of all openly available online trainings in scholarly peer review and to analyze their characteristics. STUDY DESIGN AND SETTING: A systematic review of online training material in scholarly peer review openly accessible between 2012 and 2022. Training characteristics were presented in evidence tables and summarized narratively. A risk of bias tool was purpose-built for this study to evaluate the included training material as evidence-based. RESULTS: Fourty-two training opportunities in manuscript peer review were identified, of which only twenty were openly accessible. Most were online modules (n = 12, 60%) with an estimated completion time of less than 1 hour (n = 13, 65%). Using our ad hoc risk of bias tool, four sources (20%) met our criteria of evidence-based. CONCLUSION: Our comprehensive search of the literature identified 20 openly accessible online training materials in manuscript peer review. For such a crucial step in the dissemination of literature, a lack of training could potentially explain disparities in the quality of scholarly publishing.

Recommendations and guidelines for creating scholarly biomedical journals: A scoping review.

BACKGROUND: Scholarly journals play a key role in the dissemination of research findings. However, little focus is given to the process of establishing new, credible journals and the obstacles faced in achieving this. This scoping review aimed to identify and describe existing recommendations for starting a biomedical scholarly journal. METHODS: We searched five bibliographic databases: OVID Medline + Medline in Process, Embase Classic + Embase, ERIC, APA PsycINFO, and Web of Science on January 14, 2022. A related grey literature search was conducted on March 19, 2022. Eligible sources were those published in English in any year, of any format, and that described guidance for starting a biomedical journal. Titles and abstracts of obtained sources were screened. We extracted descriptive characteristics including author name, year and country of publication, journal name, and source type, and any recommendations from the included sources discussing guidance for starting a biomedical journal. These recommendations were categorized and thematically grouped. RESULTS: A total of 5626 unique sources were obtained. Thirty-three sources met our inclusion criteria. Most sources were blog posts (10/33; 30.30%), and only 10 sources were supported by evidence. We extracted 51 unique recommendations from these 33 sources, which we thematically classified into nine themes which were: journal operations, editorial review processes, peer review processes, open access publishing, copyediting/typesetting, production, archiving/indexing/metrics, marketing/promotion, and funding. CONCLUSIONS: There is little formal guidance regarding how to start a scholarly journal. The development of an evidence-based guideline may help uphold scholarly publishing quality, provide insight into obstacles new journals will face, and equip novice publishers with the tools to meet best practices.

What are the ways in which social media is used in the context of complementary and alternative medicine in the health and medical scholarly literature? a scoping review.

BACKGROUND: Despite the increased use of social media to share health-related information and the substantial impact that complementary and alternative medicine (CAM) can have on individuals' health and wellbeing, currently, to our knowledge, there is no review that compiles research on how social media is used in the context of CAM. The objective of this study was to summarize what are the ways in which social media is used in the context of CAM. METHODS: A scoping review was conducted, following Arksey and O'Malley's five-stage methodological framework. MEDLINE, EMBASE, PsycINFO, AMED, and CINAHL databases were systematically searched from inception until October 3, 2020, in addition to the Canadian Agency for Drugs and Technology in Health (CADTH) website. Eligible studies had to have investigated how at least one social media platform is used in the context of a single or multiple types of CAM treatments. RESULTS: Searches retrieved 1714 items following deduplication, of which 1687 titles and abstracts were eliminated, leaving 94 full-text articles to be considered. Of those, 65 were not eligible, leaving a total of 29 articles eligible for review. Three themes emerged from our analysis: 1) social media is used to share user/practitioner beliefs, attitudes, and experiences about CAM, 2) social media acts as a vehicle for the spread of misinformation about CAM, and 3) there are unique challenges with social media research in the context of CAM. CONCLUSIONS: In addition to social media being a useful tool to share user/practitioner beliefs, attitudes, and experiences about CAM, it has shown to be accessible, effective, and a viable option in delivering CAM therapies and information. Social media has also been shown to spread a large amount of misleading and false information in the context of CAM. Additionally, this review highlights the challenges with conducting social media research in the context of CAM, particularly in collecting a representative sample.

Complementary and alternative medicine mention and recommendations in pancreatic cancer clinical practice guidelines: A systematic review and quality assessment.

Background: Pancreatic cancer is the third leading cause of cancer death in the United States, which is attributed to limited treatment options. Complementary and alternative medicine (CAM) therapies have been proposed to provide benefits in treating pancreatic cancer. Despite its importance in treatment, clinicians are not generally well equipped to counsel their patients about CAM therapies. This review identified the quantity and assessed the quality of clinical practice guidelines (CPGs) providing CAM recommendations for the treatment and/or management of pancreatic cancer. Methods: A systematic review was conducted to identify pancreatic cancer CPGs. MEDLINE, EMBASE and CINAHL were searched from 2011 to 2022. The Guidelines International Network (GIN) and the National Center for Complementary and Integrative Health (NCCIH) websites were also searched. Eligible CPGs published by non-profit agencies on treatment and/or management of pancreatic cancer for adults were assessed using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument. Results: From 31 eligible search results, 7 CPGs mentioned CAM and 3 CPGs made CAM recommendations. The mean scaled domain percentages of the CPGs in this study (overall, CAM-specific) were as follows: scope and purpose (81.3%, 77.8%), stakeholder involvement (63.9%, 42.6%), rigor-of-development (51.0%, 40.3%), clarity-of-presentation (83.3%, 54.6%), applicability (42.3%, 30.5%), and editorial independence (58.3%, 58.3%). Conclusions: Evaluation of the CPGs demonstrated that quality varied both within and between CPGs. CPGs that scored well could be used by patients and clinicians as the basis for discussion for the use of CAM therapies. Future research should identify other appropriate CAM therapies for further development of CPGs for pancreatic cancer. Registration: The protocol was registered on PROSPERO (registration number: CRD42022334025).

Low back pain patients' perceived effectiveness of utilizing complementary and alternative medicine: a systematic review of qualitative studies.

OBJECTIVES: The purpose of this systematic review of qualitative studies is to explore patients' perceived effectiveness of utilizing complementary and alternative medicine (CAM) for the treatment and/or management of low back pain (LBP). METHODS: MEDLINE, EMBASE, AMED, and CINAHL were systematically searched from database inception until May 2020. Eligible articles included qualitative data about LBP patients' perceptions of using CAM. RESULTS: Of 1,567 items, 1,542 items were excluded; the remaining 25 articles were included in this review. Three themes emerged as follows: physical benefits; mental health benefits; and negative or no perceived effectiveness of CAM on patients with LBP. CONCLUSIONS: This study explores perceptions of CAM effectiveness among patients with LBP. These findings provide valuable information to CAM and non-CAM practitioners regarding the importance of individualized patient care based on their preferences, values, needs, and perspectives. Further exploration could include practitioners' perceptions of CAM and their impact on the patient-practitioner relationship.

Trends in the St. John's wort (Hypericum perforatum) research literature: a bibliometric analysis.

OBJECTIVES: St. John's wort (Hypericum perforatum) has been used in traditional medicine for centuries for different conditions, including kidney and lung ailments, insomnia, depression, and to aid wound healing. The objective of the present bibliometric analysis is to capture the characteristics of research publications on the topic of St. John's wort. METHODS: Searches were run on April 09, 2021, and results were exported on the same day to prevent discrepancies between daily database updates. Trends associated with this subset of publications were identified and presented. Bibliometric networks were constructed and visualized using the software tool VOSviewer. RESULTS: A total of 1,970 publications were published by 5,849 authors across 961 journals from 1859 to 2021. Beginning in the late 1990s, a steep increase was found in the volume of publication on this topic. The journal that published the largest number of publications was Phytotherapy Research. The most productive countries included Germany and the United States. CONCLUSIONS: The present study provides the characteristics of the St. John's wort literature that allows understanding of the past, present, and future of research in this area. It is a useful evidence-based framework on which to base future research actions and academic directions.

Characteristics of bibliometric analyses of the complementary, alternative, and integrative medicine literature: A scoping review protocol.

Background: There is a growing body of literature on complementary, alternative, and integrative medicine (CAIM), which offers a holistic approach to health and the maintenance of social and cultural values. Bibliometric analyses are an increasingly commonly used method employing quantitative statistical techniques to understand trends in a particular scientific field. The objective of this scoping review is to investigate the quantity and characteristics of evidence in relation to bibliometric analyses of CAIM literature. Methods: The following bibliographic databases will be searched: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Scopus and Web of Science. Studies published in English, conducting any type of bibliometric analysis involving any CAIM therapies, as detailed by an operational definition of CAIM adopted by Cochrane Complementary Medicine, will be included. Conference abstracts and study protocols will be excluded. The following variables will be extracted from included studies: title, author, year, country, study objective, type of CAIM, health condition targeted, databases searched in the bibliometric analysis, the type of bibliometric variables assessed, how bibliometric information was reported, main findings, conclusions, and limitations. Findings will be summarized narratively, as well as in tabular and graphical format. Conclusions: To the best of our knowledge, this scoping review will be the first to investigate the characteristics of evidence in relation to bibliometric analyses on CAIM literature. The findings of this review may be useful to identify variations in the objectives, methods, and results of bibliometric analyses of CAIM research literature.

Surveying Canadian Pain Physicians' Attitudes and Beliefs Regarding Medical Cannabis for Chronic Noncancer Pain: A Qualitative Study.

Background: Medical cannabis is commonly and increasingly used by Canadians to manage chronic pain. As of March 2021, Health Canada reported that approximately 300,000 Canadians who were authorized to access medical cannabis, which is more than a 1000% increase from the 24,000 registered in 2015. Physicians, however, receive limited information on therapeutic cannabis during their training, and their perceptions regarding this therapeutic option are uncertain. This study focused on exploring attitudes and beliefs of pain physicians regarding medical cannabis for the management of chronic noncancer pain. Methods: This study utilized a focused ethnography approach. Pain management clinicians within the Greater Toronto and Hamilton Area were recruited through snowball sampling methods, and individually interviewed. We applied thematic analysis to interview transcripts and identified representative quotes. The Hamilton Integrated Research Ethics Board reviewed and approved this project. Results: Thirteen physicians who focused their clinical practice on pain management agreed to be interviewed, and three themes regarding medical cannabis emerged: 1) evidence regarding medical cannabis, 2) medical cannabis as first-line therapy for chronic pain, and 3) barriers to accessing medical cannabis. Subthemes of the last theme included out-of-pocket costs, stigma by society and healthcare providers, and lack of knowledge among physicians. Conclusion: Despite increasing use of medical cannabis for chronic pain among Canadians, pain physicians in our study expressed concerns regarding the evidence to support this therapy and acknowledged important barriers to access.

The quality of health information provided on web sites selling cannabis to consumers in Canada is poor.

BACKGROUND: Cannabis is used by millions of people for both medical and recreational purposes, and this use is even greater in jurisdictions where it is legalized, such as Canada. Online cannabis vendors have gained popularity for purchasing cannabis due to easy access and convenience to consumers. The objective of this study was to evaluate the quality of health information provided by web sites of cannabis vendors selling products to Canadian consumers and to further identify trends in the information provided. METHODS: Six different searches were conducted on Google.ca, and the first 40 webpages of each search were screened for eligibility. A total of 33 unique web sites of cannabis vendors selling products to Canadian consumers were identified and included. The DISCERN instrument, which consists of 16 questions divided into three sections, was used to evaluate the quality of cannabis-related health information on these web sites. RESULTS: Across the 33 web sites, the average of the summed DISCERN scores was 36.83 (SD = 9.73) out of 75, and the mean score for the overall quality of the publication (DISCERN question 16) was 2.41 (SD = 0.71) out of 5. Many of these web sites failed to discuss uncertainties in research evidence on cannabis, the impact of cannabis use on quality of life, alternatives to cannabis use, risks associated with cannabis use, and lacked references to support claims on effects and benefits of use. CONCLUSION: Our findings indicate that the quality of cannabis-related health information provided by online vendors is poor. Healthcare providers should be aware that patients may use these web sites as primary sources of information and appropriately caution patients while directing them to high-quality sources. Future research should serve to replicate this study in other jurisdictions and assess the accuracy of information provided by online cannabis vendors, as this was outside the scope of the DISCERN instrument.

Exploration of facilitators and barriers to the regulatory frameworks of dietary and herbal supplements: a scoping review.

BACKGROUND: Over the last decade, the use of dietary and herbal supplements (DHSs) has expanded greatly across national healthcare settings for the prevention, management and/or treatment of a variety of health issues. Although regulatory policies for DHSs across different countries have been aimed towards evaluating safety and efficacy, performing quality controls, monitoring the manufacturing practices, and encouraging further research, significant safety issues have emerged from inappropriate regulatory classification, lack of suitable quality controls, and inadequate testing and labeling of these products. Therefore, the purpose of this scoping review was to identify facilitators and barriers to DHS regulation across different countries. METHODS: A scoping review was conducted and informed by the five-stage methodological framework proposed by Arksey and O'Malley and further enhanced by Levac et al. MEDLINE, EMBASE, AMED, and PsycINFO databases were systematically searched for eligible articles from database inception to September 29, 2020. Studies analyzing DHS regulatory frameworks were eligible for review. Relevant data from eligible articles were extracted and categorized into themes to provide a descriptive overview of the literature. RESULTS: Searches generated 4314 results, 1800 of which were duplicates, followed by 2472 that were excluded after screening the titles and abstracts of these articles. Of the remaining 42 full-texts, 15 eligible articles were included in this review. Themes identified include: (1) increased financial and human resources encouraging knowledge expansion as a facilitator to DHS regulation; (2) variances in DHS classification and regulatory requirements across countries as a barrier to DHS regulation, and (3) collaboration between various stakeholders (experts, policymakers, representatives of regulatory bodies, product companies and research institutions) facilitating DHS regulation. CONCLUSION: The present scoping review identified facilitators and barriers to DHS regulation across different countries. We highlight that safety assessments of DHSs continue to be inadequate, and emerging technologies could potentially play a significant role in establishing common reference standards of herbal materials and products between regulatory agencies. Regulatory harmonization, increased scientific research, and collaboration could improve regulations globally through appropriate categorization and safe application of DHSs.