Meta-Research in Traditional,Complementary,and Integrative Medicine: The Value of Standing on the Outside Looking in

The field of traditional, complementary, and integrative medicine (TCIM) has gained significant attention for its holistic approach to health and diverse therapeutic modalities. This multifaceted field encompasses not only the physical aspects of healing but also the spiritual and cultural dimensions of wellness, reflecting a holistic approach to health. TCIM reflects a diverse array of practices and therapies, including herbal medicine, acupuncture, mind-body interventions, many of which are rooted in rich cultural traditions, the evidence-base for which are evolving through modern scientific inquiry. ¹

Despite its potential, the reliability and credibility of TCIM research findings have often been questioned due to the diverse nature of therapeutic modalities and the varying methodologies used across studies, complicating the process of establishing a robust evidence-base. This is where we argue that meta-research, or the study of research practices themselves, becomes critically important. Meta-research can be defined as “the study of research itself: its methods, reporting, reproducibility, evaluation, and incentives.” ² Meta-research scrutinizes the methodologies, designs, and reporting standards of individual studies, providing a comprehensive mechanism to evaluate and improve the quality of TCIM research. ³

As TCIM researchers, if we want to generate trustworthy evidence, the pursuit of methodological rigour must stand as a cornerstone of quality when conducting our studies. Meta-research emerges as an indispensable tool in this pursuit, playing a key role in evaluating and enhancing the methodological robustness of TCIM studies. Yet, this requires us to metaphorically stand outside the field of TCIM and take a careful look in at what is going on across our community of researchers. Meta-research can explore the complexities of study designs, carefully identifying both their strengths and weaknesses. This assessment not only helps identify potential biases but also can lead to the development of strategic recommendations to enhance the overall quality of research in TCIM. ⁴

In addition to methodological rigour, transparency, and integrity are paramount to the credibility of research findings. Meta-research can serve to both safeguard against and detect issues in research ethics, integrity, and misconduct within the field of TCIM. The adoption of support for meta-research within the TCIM researcher community means advocating for evaluating or improving processes such as informed consent procedures, data management, disclosure of conflicts of interest, and the combating of data fabrication and falsification. As such, meta-research cultivates a culture of transparency, ensuring that the findings derived from TCIM studies are rooted in ethical conduct and transparent practices, which in turn, we hope, will reinforce trust among biomedical researchers and the public in the integrity of TCIM research endeavours.

Furthermore, a core component of meta-research includes the conduct of reproducibility and replicability studies, which serve to confirm the validity of research findings in TCIM. These terms both refer to the consistency of study findings when replicated by other researchers with the same or new data. Meta-research in this area evaluates the extent to which findings can be replicated or reproduced across different settings or by independent researchers. Key considerations include the transparency of study methods, availability of raw data, and consistency of results across studies. ⁵ Meta-research can also identify factors influencing replicability and reproducibility in TCIM research, such as methodological variations, publication biases, and selective reporting of outcomes.

Meta-research extends beyond the evaluation and improvement of individual studies. Peer review and journal editorial practices are vital for maintaining the quality and integrity of research publications. Meta-research in this area may seek to evaluate the quality of peer review and editorial practices taking place within TCIM journals. Key considerations include the transparency of peer review procedures, the content and methodological expertise of reviewers, and the consistency of editorial decision-making. Here, meta-research may identify potential biases, conflicts of interest, and inefficiencies. Concerns about misconduct in peer review or editorial practices, which can lead to article retractions, also highlight the importance of meta-research in the context of scholarly journals. ^6,7

Lastly, meta-research can play a role in improving the processes of advancement and sustainability of research. Research funding, including grants and awards, is essential for supporting and advancing research endeavors. Meta-research can evaluate the distribution, impact, and outcomes of research funding in TCIM, exploring potential biases and disparities in allocation. Key considerations include the transparency and fairness of funding processes, alignment of funding priorities with research needs, and the influence of funding sources on research outcomes. By assessing the effectiveness and impact of research funding, meta-research helps optimize resource allocation, foster collaboration, and advance evidence-based practice in TCIM. ^8,9 Hiring, promotion, and tenure processes are crucial for academic advancement and career development, with TCIM researchers facing unique, field-specific challenges. Meta-research in this context can evaluate the criteria, practices, and outcomes of these academic decisions. Key considerations include the transparency and fairness of evaluation criteria, the recognition of research contributions, and the alignment of institutional practices with evolving research priorities. Work in this area can identify potential biases, disparities, and barriers in these processes. ^10,11 By improving the processes of advancement and sustainability of research, meta-research can ultimately optimize career advancement pathways, and enhance the quality and impact of TCIM research.

In conclusion, meta-research emerges as an item of value in evaluating and improving the quality of TCIM research. Educating TCIM researchers about how to conduct meta-research will equip them with essential tools and insights to both advocate for and conduct research of high quality. The converse is also true, whereby knowledge of meta-research also enables TCIM researchers to prevent the proliferation of biased or otherwise poor-quality research and also combat misconduct. Further to this, we argue that there is great value in establishing a global movement encouraging TCIM researchers to conduct meta-research of their own. Research initiatives in meta-research for TCIM offers valuable opportunities to advance evidence-based practice, foster global collaboration, and address diverse health challenges. Additionally, this work could serve to better inform policy and practice, promote cultural understanding, and respect by acknowledging diverse health care traditions and beliefs. Thus, we envision that the long-term effects of evaluating and improving TCIM research will ultimately contribute to improving health care outcomes worldwide.