<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article PUBLIC "-//NLM//DTD Journal Publishing DTD v2.0 20040830//EN" "journalpublishing.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="2.0" xml:lang="en" article-type="letter"><front><journal-meta><journal-id journal-id-type="nlm-ta">Interact J Med Res</journal-id><journal-id journal-id-type="publisher-id">i-jmr</journal-id><journal-id journal-id-type="index">3</journal-id><journal-title>Interactive Journal of Medical Research</journal-title><abbrev-journal-title>Interact J Med Res</abbrev-journal-title><issn pub-type="epub">1929-073X</issn><publisher><publisher-name>JMIR Publications</publisher-name><publisher-loc>Toronto, Canada</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">v15i1e86747</article-id><article-id pub-id-type="doi">10.2196/86747</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Letter</subject></subj-group></article-categories><title-group><article-title>The Shifting Landscape of Natural Health Product Licensing in Canada: The e-Commerce Case of Stem Cell Supplements</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name name-style="western"><surname>Marcon</surname><given-names>Alessandro R</given-names></name><degrees>MA</degrees><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name name-style="western"><surname>Jewer</surname><given-names>Michael</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name name-style="western"><surname>Caulfield</surname><given-names>Timothy</given-names></name><degrees>LLM</degrees><xref ref-type="aff" rid="aff1"/></contrib></contrib-group><aff id="aff1"><institution>Faculty of Law, Health Law Institute, University of Alberta</institution><addr-line>Office 470</addr-line><addr-line>Edmonton</addr-line><addr-line>AB</addr-line><country>Canada</country></aff><contrib-group><contrib contrib-type="editor"><name name-style="western"><surname>Balcarras</surname><given-names>Matthew</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="reviewer"><name name-style="western"><surname>Ikonomou</surname><given-names>Laertis</given-names></name></contrib><contrib contrib-type="reviewer"><name name-style="western"><surname>Chu</surname><given-names>Yuanchia</given-names></name></contrib></contrib-group><author-notes><corresp>Correspondence to Alessandro R Marcon, MA, Faculty of Law, Health Law Institute, University of Alberta, Office 470, Edmonton, AB, T6G 2H5, Canada, 1 780 248 1495; <email>marcon@ualberta.ca</email></corresp></author-notes><pub-date pub-type="collection"><year>2026</year></pub-date><pub-date pub-type="epub"><day>28</day><month>9</month><year>2026</year></pub-date><volume>15</volume><elocation-id>e86747</elocation-id><history><date date-type="received"><day>29</day><month>10</month><year>2025</year></date><date date-type="rev-recd"><day>16</day><month>08</month><year>2026</year></date><date date-type="accepted"><day>03</day><month>09</month><year>2026</year></date></history><copyright-statement>&#x00A9; Alessandro R Marcon, Michael Jewer, Timothy Caulfield. Originally published in the Interactive Journal of Medical Research (<ext-link ext-link-type="uri" xlink:href="https://www.i-jmr.org/">https://www.i-jmr.org/</ext-link>), 28.9.2026. </copyright-statement><copyright-year>2026</copyright-year><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete bibliographic information, a link to the original publication on <ext-link ext-link-type="uri" xlink:href="https://www.i-jmr.org/">https://www.i-jmr.org/</ext-link>, as well as this copyright and license information must be included.</p></license><self-uri xlink:type="simple" xlink:href="https://www.i-jmr.org/2026/1/e86747"/><abstract><p>Natural health product (NHP) regulations have shifted in Canada, with the aim of reducing &#x201C;red tape&#x201D; and enabling market entry. This study assessed how many &#x201C;stem cell&#x201D; supplements for sale on Amazon.ca had Health Canada&#x2013;required natural product number (NPN) licenses compared with vitamin D and &#x201C;longevity&#x201D; supplements. It also conducted a marketing overview analysis comparing the Amazon.ca discourse across the 3 product types. Findings show a gap in regulatory licensing compliance between &#x201C;stem cell&#x201D; supplements and vitamin D or &#x201C;longevity&#x201D; supplements. Marketing discourse also presented potential conflict with regulatory parameters. We discuss the impacts of loosening NHP regulations and the potential for products with weak evidentiary bases to enhance validation through NPN licensing.</p></abstract><kwd-group><kwd>stem cells</kwd><kwd>regenerative medicine</kwd><kwd>Amazon</kwd><kwd>e-commerce</kwd><kwd>supplements</kwd><kwd>natural health products</kwd><kwd>regulation</kwd></kwd-group></article-meta></front><body><sec id="s1" sec-type="intro"><title>Introduction</title><p>Scientifically unsupported commercial activity has long accompanied exciting regenerative medicine research [<xref ref-type="bibr" rid="ref1">1</xref>]. &#x201C;Stem cell&#x201D; supplements are now emerging in online marketplaces, including Amazon. In 2024, our research team assessed &#x201C;stem cell&#x201D; supplement marketing on Amazon.com, finding inconsistent adherence to Canadian and American regulations [<xref ref-type="bibr" rid="ref2">2</xref>]. In Canada, supplements that are natural health products (NHPs) require a licensed good manufacturing practices site and product license (natural product number [NPN]) from Health Canada for marketplace entry [<xref ref-type="bibr" rid="ref3">3</xref>]. Internal analysis on our 2024 study data found that many &#x201C;stem cell&#x201D; supplements lacked traceable NPNs in Health Canada&#x2019;s NHP database. In 2025, Health Canada implemented NHP regulatory changes to reduce regulatory &#x201C;red tape&#x201D; and facilitate market access [<xref ref-type="bibr" rid="ref4">4</xref>]. This project&#x2019;s goal was to reassess whether, in July 2026, stem cell supplements on Amazon.ca aligned with NPN license&#x2014;and broader NHP&#x2014;regulations.</p></sec><sec id="s2" sec-type="methods"><title>Methods</title><sec id="s2-1"><title>Overview</title><p>In July 2026, we deployed the Apify Amazon Scraper (Apify), a data scraper, to build a dataset of &#x201C;stem cell supplement&#x201D; advertisement data for 100 relevant products on Amazon.ca. We also downloaded advertising data from 100 vitamin D and 100 longevity supplements (search: &#x201C;vitamin D supplement&#x201D; and &#x201C;longevity supplement&#x201D;) to act as control and comparison product types. Vitamin D is popular and typically unrelated to stem cells/regenerative medicine, whereas &#x201C;longevity&#x201D; supplements may be associated with aging-related health claims similar to stem cell supplement marketing [<xref ref-type="bibr" rid="ref2">2</xref>]. Downloaded data, held and analyzed on Google Sheets, included over 400 data columns for each product (including labels, product and use descriptions, and details).</p><p>Analysis consisted of describing the central advertising themes across the 3 product types (vitamin D, longevity, and stem cell supplements) and determining whether each product had a legitimate NPN (traceable and active) on Health Canada&#x2019;s NHP database [<xref ref-type="bibr" rid="ref5">5</xref>]. To discern central themes, we deployed a straightforward keyword analysis, modeled on our previous research [<xref ref-type="bibr" rid="ref2">2</xref>], establishing 6 overarching categories: cell activity, health topic, serious health topic, general effect, general qualifier, and science (<xref ref-type="table" rid="table1">Table 1</xref>). This analysis provided a general marketing overview and potential distinctions between the 3 product types. To identify NPNs, we searched product advertising data, including images (eg, product labels), and, if found, verified NPN legitimacy. If no product NPN was found in the advertisement data, we searched the NHP database for product or brand name(s). Products marketed for animals or exclusively for skin care were excluded, as were duplicates. The data from products with broken Amazon URLs or products listed as &#x201C;not currently available&#x201D; were analyzed but excluded from the results.</p><table-wrap id="t1" position="float"><label>Table 1.</label><caption><p>Health Canada natural product number (NPN) verification and marketing keywords for 3 supplement types on Amazon.ca.</p></caption><table id="table1" frame="hsides" rules="groups"><thead><tr><td align="left" valign="bottom"/><td align="left" valign="bottom">Vitamin D (N=78)</td><td align="left" valign="bottom">Longevity supplements (N=90)</td><td align="left" valign="bottom">Stem cell supplements (N=80)</td></tr></thead><tbody><tr><td align="left" valign="top">Product characteristics</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>NPNs found, n (%)</td><td align="char" char="." valign="top">78 (100)</td><td align="char" char="." valign="top">90 (100)</td><td align="char" char="." valign="top">73 (91.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Unique NPNs, n (%)</td><td align="char" char="." valign="top">78 (100)</td><td align="char" char="." valign="top">86 (95.6)</td><td align="char" char="." valign="top">70 (87.5)</td></tr><tr><td align="left" valign="top">Unique brands, n</td><td align="char" char="." valign="top">47</td><td align="char" char="." valign="top">44</td><td align="char" char="." valign="top">56</td></tr><tr><td align="left" valign="top">Marketing keywords by category, n (%)</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cell activity</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Stem cell</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">2 (2.2)</td><td align="char" char="." valign="top">7 (8.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Rejuv_</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">4 (4.4)</td><td align="char" char="." valign="top">9 (11.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Regen_</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">3 (3.3)</td><td align="char" char="." valign="top">6 (7.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Nicotinamide<sup><xref ref-type="table-fn" rid="table1fn1">a</xref></sup></td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">27 (30)</td><td align="char" char="." valign="top">27 (33.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>DNA</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">8 (8.9)</td><td align="char" char="." valign="top">7 (8.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>DNA repair</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">6 (6.7)</td><td align="char" char="." valign="top">5 (6.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cell</td><td align="char" char="." valign="top">10 (12.8)</td><td align="char" char="." valign="top">49 (54.4)</td><td align="char" char="." valign="top">58 (72.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cellular</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">37 (41.1)</td><td align="char" char="." valign="top">38 (47.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Health topic</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Aging</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">32 (35.6)</td><td align="char" char="." valign="top">29 (36.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Anti-aging</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">14 (15.6)</td><td align="char" char="." valign="top">17 (21.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Immun_</td><td align="char" char="." valign="top">61 (78.2)</td><td align="char" char="." valign="top">30 (33.3)</td><td align="char" char="." valign="top">24 (30)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Inflamm_</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">9 (10)</td><td align="char" char="." valign="top">10 (12.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cardiov_</td><td align="char" char="." valign="top">11 (14.1)</td><td align="char" char="." valign="top">11 (12.2)</td><td align="char" char="." valign="top">10 (12.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Stress</td><td align="char" char="." valign="top">6 (7.7)</td><td align="char" char="." valign="top">24 (26.7)</td><td align="char" char="." valign="top">20 (25)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Oxidative</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">23 (25.6)</td><td align="char" char="." valign="top">23 (28.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Energy</td><td align="char" char="." valign="top">11 (14.1)</td><td align="char" char="." valign="top">49 (54.4)</td><td align="char" char="." valign="top">40 (50)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Brain related<sup><xref ref-type="table-fn" rid="table1fn2">b</xref></sup></td><td align="char" char="." valign="top">7 (9)</td><td align="char" char="." valign="top">29 (32.2)</td><td align="char" char="." valign="top">16 (20)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Mood</td><td align="char" char="." valign="top">6 (7.7)</td><td align="char" char="." valign="top">4 (4.4)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Bone</td><td align="char" char="." valign="top">76 (97.4)</td><td align="char" char="." valign="top">6 (6.7)</td><td align="char" char="." valign="top">6 (7.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Joint</td><td align="char" char="." valign="top">7 (9)</td><td align="char" char="." valign="top">8 (8.9)</td><td align="char" char="." valign="top">11 (13.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Heart</td><td align="char" char="." valign="top">15 (19.2)</td><td align="char" char="." valign="top">12 (13.3)</td><td align="char" char="." valign="top">8 (10)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Weight loss</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">1 (1.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Recover</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">5 (5.6)</td><td align="char" char="." valign="top">5 (6.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Longev_</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">37 (41.1)</td><td align="char" char="." valign="top">12 (15)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Sleep</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">5 (5.6)</td><td align="char" char="." valign="top">3 (3.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Gut</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">13 (14.4)</td><td align="char" char="." valign="top">5 (6.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Toxi_</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">5 (5.6)</td><td align="char" char="." valign="top">5 (6.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Serious health topic</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cancer</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">1 (1.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Asthma</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Depression</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Disease</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">2 (2.2)</td><td align="char" char="." valign="top">3 (3.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Alzh_</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Dementia</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>General effect</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Heal</td><td align="char" char="." valign="top">73 (93.6)</td><td align="char" char="." valign="top">83 (92.2)</td><td align="char" char="." valign="top">66 (82.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Repair</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">14 (15.6)</td><td align="char" char="." valign="top">18 (22.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cure</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">2 (2.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Treat</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">3 (3.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Prevent</td><td align="char" char="." valign="top">28 (35.9)</td><td align="char" char="." valign="top">3 (3.3)</td><td align="char" char="." valign="top">3 (3.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Diagnose</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">0 (0)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Antiox or anti-ox</td><td align="char" char="." valign="top">6 (7.7)</td><td align="char" char="." valign="top">45 (50)</td><td align="char" char="." valign="top">43 (53.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Detox</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">6 (6.7)</td><td align="char" char="." valign="top">6 (7.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Cleanse</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">3 (3.3)</td><td align="char" char="." valign="top">4 (5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Support</td><td align="char" char="." valign="top">72 (92.3)</td><td align="char" char="." valign="top">84 (93.3)</td><td align="char" char="." valign="top">71 (88.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Boost</td><td align="char" char="." valign="top">17 (21.8)</td><td align="char" char="." valign="top">34 (37.8)</td><td align="char" char="." valign="top">33 (41.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Strengthen</td><td align="char" char="." valign="top">8 (10.3)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">3 (3.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>General qualifier</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Trust</td><td align="char" char="." valign="top">15 (19.2)</td><td align="char" char="." valign="top">16 (17.8)</td><td align="char" char="." valign="top">15 (18.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Super</td><td align="char" char="." valign="top">7 (9)</td><td align="char" char="." valign="top">14 (15.6)</td><td align="char" char="." valign="top">13 (16.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Good</td><td align="char" char="." valign="top">18 (23.1)</td><td align="char" char="." valign="top">25 (27.8)</td><td align="char" char="." valign="top">14 (17.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Pure</td><td align="char" char="." valign="top">28 (35.9)</td><td align="char" char="." valign="top">44 (48.9)</td><td align="char" char="." valign="top">27 (33.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Wellness</td><td align="char" char="." valign="top">17 (21.8)</td><td align="char" char="." valign="top">49 (54.4)</td><td align="char" char="." valign="top">25 (31.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Natural</td><td align="char" char="." valign="top">45 (57.7)</td><td align="char" char="." valign="top">66 (73.3)</td><td align="char" char="." valign="top">51 (63.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Science related</td><td align="left" valign="top"/><td align="left" valign="top"/><td align="left" valign="top"/></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Science</td><td align="char" char="." valign="top">3 (3.8)</td><td align="char" char="." valign="top">2 (2.2)</td><td align="char" char="." valign="top">11 (13.8)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Scientific</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">5 (5.6)</td><td align="char" char="." valign="top">8 (10)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Scientist</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">0 (0)</td><td align="char" char="." valign="top">1 (1.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Research</td><td align="char" char="." valign="top">5 (6.4)</td><td align="char" char="." valign="top">15 (16.7)</td><td align="char" char="." valign="top">13 (16.3)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Proven</td><td align="char" char="." valign="top">1 (1.3)</td><td align="char" char="." valign="top">6 (6.7)</td><td align="char" char="." valign="top">6 (7.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Evidence</td><td align="char" char="." valign="top">2 (2.6)</td><td align="char" char="." valign="top">1 (1.1)</td><td align="char" char="." valign="top">2 (2.5)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Any science-related<sup><xref ref-type="table-fn" rid="table1fn3">c</xref></sup></td><td align="char" char="." valign="top">8 (10.3)</td><td align="char" char="." valign="top">20 (22.2)</td><td align="char" char="." valign="top">28 (35)</td></tr><tr><td align="left" valign="top"><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content><named-content content-type="indent">&#x00A0;&#x00A0;&#x00A0;&#x00A0;</named-content>Tested</td><td align="char" char="." valign="top">21 (26.9)</td><td align="char" char="." valign="top">38 (42.2)</td><td align="char" char="." valign="top">31 (38.8)</td></tr></tbody></table><table-wrap-foot><fn id="table1fn1"><p><sup>a</sup>Includes &#x201C;NAD+,&#x201D; &#x201C;NAD,&#x201D; &#x201C;NMN,&#x201D; and &#x201C;nicotinamide.&#x201D;</p></fn><fn id="table1fn2"><p><sup>b</sup>Includes &#x201C;brain,&#x201D; &#x201C;mental,&#x201D; &#x201C;cognit_,&#x201D; and &#x201C;memory.&#x201D;</p></fn><fn id="table1fn3"><p><sup>c</sup>Refers to all listed terms excluding &#x201C;tested.&#x201D;</p></fn></table-wrap-foot></table-wrap></sec><sec id="s2-2"><title>Ethical Considerations</title><p>Ethics approval and informed consent were not required as all Amazon ads are publicly visible. No product, brand, or company names appear in this manuscript.</p></sec></sec><sec id="s3" sec-type="results"><title>Results</title><p>Nearly all supplements had legitimate NPNs. All 78 vitamin D products and all 90 longevity products had legitimate NPNs. Of the 80 stem cell supplements (56 unique brands), 73 (91%) had NPNs. The 7 (9%) products lacking NPNs came from 3 unique brands and explicitly mentioned &#x201C;stem cell&#x201D; in their Amazon.ca marketing. Of these 7 products, 2 were available for purchase but showed a discontinued NPN in Health Canada&#x2019;s database. An additional 2 stem cell products and 1 longevity product did not produce a legitimate NPN but were excluded for having broken URLs or being unavailable for purchase.</p><p>NHP companies selling vitamin D, longevity, and stem cell supplements presented different themes in the advertising discourse (<xref ref-type="table" rid="table1">Table 1</xref>). Compared to vitamin D products, stem cell and longevity supplements presented greater focus on cell activity and covered a much greater range of health topics (eg, energy, aging, immunity, stress, oxidative, and brain related). Vitamin D products focused almost exclusively on immunity and bone health. Stem cell products presented cell activity with greater frequency than longevity supplements. None of the product types mentioned serious health topics with frequency. The effect descriptors &#x201C;heal,&#x201D; &#x201C;support,&#x201D; and &#x201C;boost&#x201D; were common across all product types, but &#x201C;cure&#x201D; and &#x201C;treat&#x201D; were scant. The general qualifiers &#x201C;pure,&#x201D; &#x201C;wellness,&#x201D; and &#x201C;natural&#x201D; had a similarly prominent presence across the 3 product types. Stem cell products had the highest presence of science-related discourse (n=28, 35%) compared to longevity (n=20, 22%) and vitamin D (n=8, 10%) (Table 1).</p></sec><sec id="s4" sec-type="discussion"><title>Discussion</title><p>The overwhelming majority of vitamin D, longevity, and stem cell supplements on Amazon.ca in this cross-sectional sample analysis had traceable NPNs in Health Canada&#x2019;s NHP database. Only stem cell products presented cases of regulatory NPN noncompliance (7/80, 9%). Demonstrating overall regulatory compliance, the marketing for these products scarcely mentioned serious health topics (eg, cancer, dementia) and causal modes of action (eg, cure, treat), which could constitute NHP regulatory breaches [<xref ref-type="bibr" rid="ref6">6</xref>]. Issues persist, however, about the validation of questionable NHPs by Health Canada&#x2019;s current regulations and whether obtaining a Health Canada&#x2013;certified NPN may bolster product credibility.</p><p>NHPs certified by Health Canada should not have free rein for deceptive marketing. Both the stem cell and longevity supplements&#x2019; marketing in this study frequently mentioned cell activity and a range of health topics. For example, nicotinamide, which is mentioned in approximately 30% of stem cell supplement marketing and 30% of longevity supplement marketing, remains therapeutically speculative despite preclinical development [<xref ref-type="bibr" rid="ref7">7</xref>]. Vitamin D supplementation also has inconclusive health benefits for nondeficient patients [<xref ref-type="bibr" rid="ref8">8</xref>]. Canadian NHP regulations restrict marketing that distorts the evidentiary base related to health claims [<xref ref-type="bibr" rid="ref2">2</xref>]. This project&#x2019;s broad marketing analysis found science-related discourse in 35% of the stem cell supplement ads and 22% of the longevity supplement ads. Scientific discourse typically works toward promoting evidence around product reliability or efficacy [<xref ref-type="bibr" rid="ref2">2</xref>]. Notably, stem cell and longevity supplements have a more speculative evidentiary base but more frequently presented appeals to science.</p><p>Health Canada&#x2019;s recent loosening of NHP regulations may be increasing the e-commerce market availability of NHPs, including on Amazon.ca. Correspondingly, the nature of effective surveillance (eg, automated, licensing, risk-based targeting) and enforcement may be fluctuating significantly. The relatively high levels of regulatory compliance shown in this research suggest an opportunity for increasing regulatory pressure around deceptive or overexaggerated product promotion, especially given recent industry-favorable measures to facilitate market access. Ongoing and diligent NHP marketplace surveillance is needed to track the emergence of new products (where compliance may be low) and the corresponding marketing used to promote products with limited, circumstantial, or nonexistent health value for Canadian consumers.</p></sec></body><back><ack><p>The authors thank Tuvini de Silva for her coding contributions and Robyn Hyde-Law for project management and administrative assistance.</p></ack><notes><sec><title>Funding</title><p>This research was funded by the Stem Cell Network under the projects Law, Public Policy and Social License for Next-Generation Regenerative Medicine (grant number 917390), and Regenerative Medicine, Wellness Influencers, and Scienceploitation (grant number IE-C5R1-1). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.</p></sec><sec><title>Data Availability</title><p>Data have been uploaded to a publicly accessible OSF repository [<xref ref-type="bibr" rid="ref9">9</xref>].</p></sec></notes><fn-group><fn fn-type="con"><p>ARM and TC conceived the study. MJ collected the data. ARM and MJ performed the analysis. ARM and MJ wrote the manuscript. 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