Research

As an academic healthcare researcher, Jeremy Y. Ng, MSc, PhD has collaborated with investigators in both Canada and internationally, and leads a research program involving his primary research interests including: complementary, alternative and integrative medicine (CAIM) and natural health products (NHPs). Jeremy’s methodological expertise includes the following: systematic, scoping and narrative reviews; clinical practice guideline assessment; consumer health information quality assessment; qualitative interviews and synthesis; health policy analysis; cross-sectional surveying; and bibliometric analysis. To date, he has conducted studies that have specifically investigated: 1) the quantity and quality of CAIM/DHSs recommendations across clinical practice guidelines for a wide range of diseases/conditions, 2) the quality of CAIM/DHSs consumer health information across web-resources for a wide range of diseases/conditions, 3) patient/provider attitudes towards various CAIM/DHSs therapies, 4) the regulation of CAIM products/providers and DHSs, and 5) the quantity and quality of global output of CAIM/DHSs research. More recently, he has also become interested in, and initiated research, in the field of publication science and journalology, with the goal of developing reporting guidelines that better improve the reporting, dissemination, and publication of CAIM/DHS research, in addition to healthcare research in general. To learn more about Jeremy’s contributions to these bodies of research, please see his publications and presentations.

Natural Health Products
According to Health Canada, a federal department of the government of Canada responsible for national public health, “natural health products (NHPs)” are defined as “naturally occurring substances that are used to restore or maintain good health. They are often made from plants, but can also be made from animals, microorganisms and marine sources. They come in a wide variety of forms like tablets, capsules, tinctures, solutions, creams, ointments and drops” [1].

Health Canada categorizes NHPs into six categories including the following [1]:
1. vitamins and minerals
2. herbal remedies
3. homeopathic medicines
4. traditional medicines like traditional Chinese and Ayurvedic (East Indian) medicines
5. probiotics
6. other products like amino acids and essential fatty acids

It should be noted that “natural health product” is largely a Canadian term, and may be referred to as dietary and/or herbal supplements in other countries around the world.

Why is the study of natural health products important?
NHPs are a billion-dollar industry for Canadians; 71% have used NHPs before, and 12% of them report to have experienced unwanted side effects [1]; in developing countries, up to 95% of the population are known to use NHPs [2]. Unlike pharmaceutical medications, the standards associated with NHP manufacturing, packaging, labelling, and regulation are all of poorer quality in Canada [3], and undoubtedly in other countries as well. One major contributor to this includes the fact that a lack of research exists in this area [4].

Complementary, Alternative, and Integrative Medicine
Complementary, alternative and integrative medicine (CAIM) has a wide variety of definitions, however, according to the National Center for Complementary and Integrative Health (NCCIH), a centre of the National Institutes of Health of the United States Federal Government [5]:

• “If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.””
• “If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.””
• “Integrative health care often brings conventional and complementary approaches together in a coordinated way.”

It should be noted that CAIM is an umbrella term used to describe a number of different therapies that originate from different parts of the world. Generally, they can be categorized into the following five categories [6]:
1. Biologically Based Therapies (i.e. diet, natural health products)
2. Energy Therapies (i.e. acupuncture, reiki)
3. Manipulative and Body-Based Practices (i.e. chiropractic, osteopathic, cupping, moxibustion)
4. Mind-Body Medicine (i.e. guided imagery, mindfulness and meditation)
5. Whole Medical Systems (i.e. traditional medicine, naturopathy, homeopathy)

Why is the study of complementary, alternative, and integrative medicine important?
There is probably no field of research/medicine more controversial than that of complementary, alternative, and integrative medicine, with there being no shortage of critics. Despite this, the greatest justification for research in this area is the fact that large proportions of patients across virtually all countries, demographics, and disease categories use CAIM [7]. In Canada, approximately 80% of the population has used CAIM before [8], and internationally 88% of World Health Organization member states have acknowledged their use of CAIM (including traditional medicine) [7]. Furthermore, patients often fail to disclose CAIM use to their primary healthcare providers [9], the latter of whom are generally poorly trained to advise on these therapies [10].

Publication Science/Journalology
Publication science (or journalology) is the scholarly study of all aspects of the academic publishing process, or in other words, the process in which researchers share their discoveries with the world [11]. While the earliest scientific publications have existed as early as the seventeenth century [12], the academic publishing landscape has changed drastically as a result of the dot-com era and the internet [13].

Academic publishing models are fall into two main categories (or a hybrid model of both) [13]:
1. Subscription-based: A subscription-based model allows researchers to publish their research findings in a scholarly journal for free, however, published content is paywalled and readers (both individuals and institutions) pay a subscription fee to access it.
2. Open Access: An open access model allows anyone with an internet connection to read published content for free, however, researchers (or their institutions) are charged an article processing fee to publish their research in a scholarly journal.

The open access publishing model was largely hailed as a solution to subscription-based publishers changing increasingly expensive rates to access their content, however, this solution created a new problem: predatory journals and publishers [14]. A consensus definition for the term “predatory journals and publishers” has been developed by leading scholars and publishers from ten countries as follows: “Entities that prioritize self-interest at the expense of scholarship and are characterized by false or misleading information, deviation from best editorial and publication practices, a lack of transparency, and/or the use of aggressive and indiscriminate solicitation practices” [15].

Why is the study of publication science/journalology important?
While the open access publishing model provided a solution to one problem, it undoubtedly created another which has yet to be solved. Though predatory publishers may not consider the impact of their unethical behaviour, the consequences are both frightening and great. Emerging research has already confirmed that articles published in predatory journals are cited in the legitimate scientific literature that are indexed in reputable academic databases such as PubMed [16, 17]. Clinicians and policy makers rely on the legitimacy and validity of published scientific research in order to make well-informed decisions that can have significant and life-changing impacts on research, professional practice, policy and society. The quality of these decisions can therefore be directly influenced by the quality of published research.

References
[1] Government of Canada [Internet]. About natural health products. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html
[2] Robinson MM, Zhang X. The world medicines situation 2011, traditional medicines: Global situation, issues and challenges. World Health Organization, Geneva. 2011:1-2. Available from: http://digicollection.org/hss/documents/s18063en/s18063en.pdf
[3] White J, Reid G. A suggestion for evolution of Canada’s health regulatory system. FACETS. 2018 Jan 25;3(1):45-60. https://doi.org/10.1139/facets-2017-0049
[4] Barry AR. Patients’ perceptions and use of natural health products. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada. 2018 Jul;151(4):254-62. https://doi.org/10.1177%2F1715163518779409
[5] National Center for Complementary and Integrative Health (NCCIH). Complementary, alternative, or integrative health: What’s in a name? Available from: https://nccih.nih.gov/health/integrative-health
[6] Merck Manual. Types of Complementary and Alternative Medicine. Available from: https://www.merckmanuals.com/en-ca/professional/special-subjects/integrative,-complementary,-and-alternative-medicine/types-of-complementary-and-alternative-medicine
[7] World Health Organization. WHO global report on traditional and complementary medicine 2019. 2019 May 16. Available from: https://www.who.int/traditional-complementary-integrative-medicine/WhoGlobalReportOnTraditionalAndComplementaryMedicine2019.pdf?ua=1
[8] Esmail N. Complementary and alternative medicine: Use and public attitudes 1997, 2006, and 2016. Vancouver: Fraser Institute, 2017. Available from: https://www.fraserinstitute.org/studies/complementary-and-alternative-medicine-use-and-public-attitudes-1997-2006-and-2016
[9] Foley H, Steel A, Cramer H, Wardle J, Adams J. Disclosure of complementary medicine use to medical providers: a systematic review and meta-analysis. Scientific reports. 2019 Feb 7;9(1):1573. https://www.nature.com/articles/s41598-018-38279-8
[10] Aveni E, Bauer B, Ramelet AS, Decosterd I, Ballabeni P, Bonvin E, Rodondi PY. Healthcare professionals’ sources of knowledge of complementary medicine in an academic center. PloS one. 2017 Sep 29;12(9):e0184979.
[11] Galipeau J, Moher D, Campbell C, Hendry P, Cameron DW, Palepu A, Hébert PC. A systematic review highlights a knowledge gap regarding the effectiveness of health-related training programs in journalology. Journal of Clinical Epidemiology. 2015 Mar 1;68(3):257-65. https://doi.org/10.1016/j.jclinepi.2014.09.024
[12] Andrade EN. The birth and early days of the Philosophical Transactions. Notes and Records of the Royal Society of London. 1965 Jun 30;20(1):9-27. https://doi.org/10.1098/rsnr.1965.0002
[13] Wilson M, Moher D. The changing landscape of journalology in medicine. Seminars in Nuclear Medicine 2019 Mar; 49(2):105-114. https://doi.org/10.1053/j.semnuclmed.2018.11.009
[14] Beall J. Predatory publishers are corrupting open access. Nature News. 2012 Sep 13;489(7415):179. https://doi.org/10.1038/489179a
[15] Grudniewicz A, Moher D, Cobey KD, Bryson GL, Cukier S, Allen K. et al. Predatory journals: No definition, no defence. Nature. 2019 Dec;576, 210-212. https://doi.org/10.1038/d41586-019-03759-y
[16] Severin A, Low N. Readers beware! Predatory journals are infiltrating citation databases. International Journal of Public Health. 2019; 64:1123-1124. https://doi.org/10.1007/s00038-019-01284-3
[17] Ross-White A, Godfrey CM, Sears KA, Wilson R. Predatory publications in evidence syntheses. Journal of the Medical Library Association: JMLA. 2019 Jan;107(1):57. https://doi.org/10.5195%2Fjmla.2019.491

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