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Congressional Justification 2011

DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine (NCCAM)

This document provides justification for the Fiscal Year 2011. It outlines our plans and priorities, provides details of our budget, and notes our legislative history.

On this page:

Organization Chart

This image is an organization chart that visually displays the organizational relationship and structure of the offices and divisions of the National Center for Complementary and Alternative Medicine. In the Office of the Director Josephine P. Briggs, M.D. is Director and Jack Killen, M.D. is Deputy Director. The Senior Advisor for Scientific Coordination and Outreach is Richard Nahin, Ph.D., M.P.H. ans is parallel to the Office of the director. The National Advisory Council for Complementary and Alternative Medicine is another group parallel to the Office of the director. In the Executive Office/Office of  Administrative Operations Camille Hoover is Executive Officer. In the Office of Communications and Public Liaison Chris Thomsen is Director. In the Office of Policy, Planning, and Evaluation Chris Thomsen is Acting Director. In the Division of Extramural Research Emmeline Edwards, Ph.D. is Director. In the Manual and Mind Body Medicine Branch, under the Division of Extramural Research, Richard Nahin, Ph.D., is Acting Chief. In the Natural Products Branch, under the Division of Extramural Research, Carol Pontzer, is Chief. In the Office of Clinical and Regulatory Affairs, under the Division of Extramural Research, Catherine Meyers, M.D., is Director. In the Division of Intramural Research, under the Division of Extramural Research, Robert B. Nussenblatt, M.D. is Acting Director. In the Endocrine Section, under the Division of Intramural Research, Robert B. Nussenblatt, M.D. is Acting Chief. In the Diabetes Unit, under the Division of Intramural Research, Michael Quon, M.D., Ph.D. is Chief. In the Division of Extramural Activities Martin Goldrosen, Ph.D. is Director. In the Office of Scientific Review, under the Division of Extramural Activities, Dale Birkle Dreer, Ph.D. is Chief. In the Office of Grants Management, under the Division of Extramural Activities, George Tucker, M.B.A. is Director.

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Appropriation Language

NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine

For carrying out section 301 and title IV of the Public Health Services Act with respect to complementary and alternative medicine [$128,844,000] $132,004,000
(Public Law 111–117, Consolidated Appropriations Act, 2010)

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Amounts Available for Obligation 1/
Source of Funding FY 2009 Actual FY 2010 Estimate FY 2011
PB
1/ Excludes the following amounts for reimbursable activities carried out by this account:
FY 2009 -$2,000
FY 2010 -$2,000
FY 2011 -$2,000

Excludes $0 in FY 2009; $0 in FY 2010 and $0 in FY 2011 for royalties.

Appropriation $125,471,000 $128,844,000 $132,004,000
Type 1 Diabetes 0 0 0
Rescission 0 0 0
Supplemental 0 0 0
Subtotal, adjusted appropriation 125,471,000 128,844,000 132,004,000
Real transfer under Director's one-percent transfer authority (GEI) -205,000 0 0
Real transfer to the Global Fund to fight HIV/AIDS, Malaria and Tuberculosis 0 0 0
Comparative transfer to/from (specify) -40,000 -53,000 0
Comparative transfer under Director's one-percent transfer authority (GEI) 205,000 0 0
Comparative transfer to the Global Fund to fight HIV/AIDS, Malaria and Tuberculosis 0 0 0
Comparative transfer from DHHS for Autism 0 0 0
Subtotal, adjusted budget authority 125,431,000 128,791,000 132,004,000
Unobligated balance, start of year 0 0 0
Unobligated balance, end of year 0 0 0
Subtotal, adjusted budget authority 125,431,000 128,791,000 132,004,000
Unobligated balance lapsing -1,000 0 0
Total obligations 125,430,000 128,791,000 132,004,000

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
(Dollars in Thousands)
Budget Mechanism—Total
MECHANISM FY 2009 Actual FY 2009 Recovery Act Actual FY 2010 Recovery Act Estimate FY 2010 Estimate FY 2011 PB Change
Number Amount Number Amount Number Amount Number Amount Number Amount Number Amount
Includes FTEs which are reimbursed from the NIH Roadmap for Medical Research
Research Grants:                        
Research Projects:                        
Noncompeting 120 $46,082   $0 27 $12,153 138 $52,923 140 $57,286 2 $4,363
Administrative supplements -16 4,986 -11 1,415 -2 551 -14 3,150 -11 1,650 -3 -1,500
Competing:                        
Renewal 0 200 1 1,200 0 0 0 0 0 0 0 0
New 74 22,496 18 9,734 1 399 66 20,642 60 19,164 -6 -1,478
Supplements 0 0 12 3,053 0 0 0 0 0 0 0 0
Subtotal, competing 74 22,696 31 13,987 1 399 66 20,642 60 19,164 -6 -1,478
Subtotal, RPGs 194 73,764 31 15,402 28 13,103 204 76,715 200 78,100 -4 1,385
SBIR/STTR 9 3,251 0 0 1 100 8 2,920 8 2,896 0 -24
Subtotal, RPGs 203 77,015 31 15,402 29 13,203 212 79,635 208 80,996 -4 1,361
Research Centers:                        
Specialized/comprehensive 6 2,401 2 1,224 2 1,234 6 2,460 6 2,500 0 40
Clinical research 0 0 0 0 0 0 0 0 0 0 0 0
Biotechnology 0 0 0 0 0 0 0 0 0 0 0 0
Comparative medicine 0 0 0 0 0 0 0 0 0 0 0 0
Research Centers in Minority Institutions 0 0 0 0 0 0 0 0 0 0 0 0
Subtotal, Centers 6 2,401 2 1,224 2 1,234 6 2,460 6 2,500 0 40
Other Research:                        
Research careers 55 6,650 1 54 1 54 56 6,748 58 6,950 2 202
Cancer education 0 0 0 0 0 0 0 0 0 0 0 0
Cooperative clinical research 0 0 0 0 0 0 0 0 0 0 0 0
Biomedical research support 0 0 0 0 0 0 0 0 0 0 0 0
Minority biomedical research support 0 0 0 0 0 0 0 0 0 0 0 0
Other 17 2,481 0 0 0 0 17 2,518 17 2,594 0 76
Subtotal, Other Research 72 9,131 1 54 1 54 73 9,266 75 9,544 2 278
Total Research Grants 281 88,547 34 16,680 32 14,491 291 91,361 289 93,040 -2 1,679
Research Training:                        
Individual awards 21 FTTPs 861 0 0 0 0 21 FTTPs 868 21 FTTPs 910 0 42
Institutional awards 56 FTTPs 3,055 0 0 0 0 56 FTTPs 3,080 56 FTTPs 3,228 0 148
Total, Training 77 FTTPs 3,916 0 0 0 0 77 FTTPs 3,948 77 FTTPs 4,138 0 190
Research & development contracts 0 FTTPs 9,792 0 0 0 0 0 FTTPs 9,934 0 FTTPs 10,240 0 306
(SBIR/STTR) 0 FTTPs 0 0 0 0 0 0 FTTPs 0 0 FTTPs 0 0 0
Intramural research 11 FTEs 8,043 0 FTEs 0 0 FTEs 159 11 FTEs 8,163 13 FTEs 8,426 2 FTEs 263
Research management and support 55 FTEs 15,133 0 FTEs 102 0 FTEs 296 54 FTEs 15,385 55 FTEs 16,160 1 FTEs 775
Construction 0 FTEs 0 0 FTEs 0 0 FTEs 0   0   0   0
Buildings and Facilities 0 FTEs 0 0 FTEs 0 0 FTEs 0   0   0   0
Total, NCCAM 66 125,431   16,782   14,946 65 128,791 68 132,004 3 3,213

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Budget Authority by Program
(Dollars in Thousands)
  FY 2007 Actual FY 2008 Actual FY 2009 Actual FY 2009 Comparable FY 2010 Estimate FY 2011 PB Change
FTEs Amount FTEs Amount FTEs Amount FTEs Amount FTEs Amount FTEs Amount FTEs Amount
Includes FTEs which are reimbursed from the NIH Roadmap for Medical Research
Extramural Research                            
Detail:                            
Clinical Research   $50,364   $49,071   $49,341   $49,341   $50,886   $51,930   1,044
Basic Research   36,955   39,927   42,129   42,129   43,235   44,088   853
Training   12,182   10,918   10,785   10,785   11,122   11,400   278
Subtotal, Extramural   99,501   99,916   102,255   102,255   105,243   107,418   2,175
Intramural research 13 7,443 12 7,452 11 8,043 11 8,043 11 8,163 13 8,426 2 263
Res. management & support 56 14,427 55 14,639 55 15,173 55 15,173 54 15,385 55 16,160 1 775
TOTAL 69 121,371 67 122,007 67 125,471 66 125,431 66 128,791 65 132,004 3 3,213

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Major Changes in the Fiscal Year 2011 Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanism and activity detail and these highlights will not sum to the total change for the FY 2011 budget request for the National Center for Complementary and Alternative Medicine which is $3.213 million more than the FY 2010 Estimate, for a total of $132.004 million.

Research Project Grants (+$1.361 million; total $80.996 million). NCCAM will support a total of 208 Research Project Grant (RPG) awards in FY 2011. Noncompeting RPG's will increase by 2 awards and increase $4.363 million of which $1.408 will be for conversion of Pathway to Independence awards from careers to noncompeting RPGs. Competing RPG's will decrease by 6 awards and decrease by $1.478 million. The NIH Budget policy for RPGs in FY 2011is to provide a 2% inflationary increase in noncompeting awards and a 2% increase in average cost for competing RPGs.

Research Careers (+$0.202 million; total $6.950 million). NCCAM will support the Pathway to Independence program, by funding 2 additional awards in FY 2011. Total support for the Pathway program in FY 2011 is 4 awards and $0.413 million.

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Summary of Changes
FY 2009 estimate $128,791,000
FY 2010 estimated budget authority 132,004,000
Net change 3,213,000
NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Summary of Changes
CHANGES 2010 Current Estimate Base Change from Base
FTEs Budget Authority FTEs Budget Authority
A. Built-in:        
1. Intramural research:        
a. Annualization of January 2010 pay increase   $1,646,000   $10,000
b. January FY 2011 pay increase   1,646,000   17,000
c. Zero less days of pay (n/a for 2011)   1,646,000   0
d. Payment for centrally furnished services   2,064,000   36,000
e. Increased cost of laboratory supplies, materials, and other expenses   4,734,000   76,000
Subtotal       139,000
2. Research management and support:        
a. Annualization of January 2010 pay increase   $7,882,000   $48,000
b. January FY 2011 pay increase   7,882,000   83,000
c. Zero less days of pay (n/a for 2011)   7,882,000   0
d. Payment for centrally furnished services   1,234,000   25,000
e. Increased cost of laboratory supplies, materials, and other expenses   6,260,000   100,000
Subtotal       256,000
Subtotal, Built-in       395,000
NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Summary of Changes (continued)
CHANGES 2010 Current Estimate Base Change from Base
Number Amount Number Amount
B. Program:        
1. Research project grants:        
a. Noncompeting 138 $56,073,000 2 $2,863,000
b. Competing 66 20,642,000 (2) (1,067,000)
c. SBIR/STTR 8 2,920,000 0 (24,000
Total 212 79,635,000 (4) 1,361,000
2. Research centers 6 2,460,000 0 40,000
3. Other research 73 9,266,000 2 278,000
4. Research training 77 3,948,000 0 190,000
5. Research and development contracts 0 9,934,000 0 306,000
Subtotal, extramural       2,175,000
  FTEs   FTEs  
6. Intramural research 11 8,163,000 2 124,000
7. Research management and support 54 15,385,000 1 519,000
8. Construction   0   0
9. Buildings and Facilities   0   0
Subtotal, program   128,791,000   2,818,000
Total changes 65   3 3,213,000

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Fiscal Year 2011 Budget Graphs

Funding Levels by Fiscal Year

A bar graph reflecting a 5 year history of the Center's funding levels in millions of dollars for fiscal years 2007 through 2011. 2007 an actual of $121M, 2008 an actual of $122M, 2009 an actual of $125M, 2010 an estimate $128M, and 2011 an estimate of $132M.

Full-Time Employees by Fiscal Year

A bar graph reflecting a 5 year employment history (fiscal years 2007 through 2011) indicated by the Center's number of full time equivalents (FTEs). 2007 an actual of 69, 2008 an actual of 69, 2009 an actual of 66, 2010 an estimate 65, and 2011 an estimate of 68.

FY 2011 Budget Mechanism

A pie chart reflecting a distribution of funds by mechanism as a percent of the total appropriation for fiscal year 2011. RPG's 61%, Centers 2%, Other Research 8%, Research Training 3%, R&D Contracts 8%, Intramural Research 6%, Research, Management and Support 12%.

FY 2011 Estimate
Percent Change from FY 2010 Mechanism

A bar graph reflecting the change in mechanism as a percent between fiscal years 2010 and 2011. RPG's 1.7%, Centers 1.6%, Other Research 3.0%, Research Training 4.8%, R&D Contracts 3.1%, Intramural Research 3.2%, Research, Management and Support 5%.

Justification of Budget Request
National Center for Complementary and Alternative Medicine
March 13, 2009

Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.

  FY 2009 Appropriation FY 2010 Appropriation FY 2011 President's Budget FY 2011 +/- 2010 Appropriation
BA $125,431,000 $128,791,000 $132,004,000 +$3,213,000
FTE 66 65 68 +3

This document provides justification for the Fiscal Year (FY) 2011 activities of the National Center for Complementary and Alternative (NCCAM), including HIV/ AIDS activities. Details of the FY 2011 HIV/AIDS activities are in the "Office of AIDS Research (OAR)" Section of the Overview. Details on the Common Fund are located in the Overview, Volume One. Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.

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Director's Overview

The National Center for Complementary and Alternative Medicine (NCCAM) is entering its second decade as the Federal Government's lead agency for research on complementary and alternative medicine (CAM). Building on 10 years of scientific progress, a robust research enterprise, and strong collaborations across the National Institutes of Health, NCCAM is now shaping its future through a comprehensive strategic planning process that involves its diverse stakeholder community. The Center's third strategic plan will ensure that NCCAM not only continues to support the best and most promising CAM research but also provides evidence-based information on CAM therapies used by millions of Americans. The strategic plan will focus on establishing research priorities that reflect emerging evidence on which therapies are most promising, as well as how Americans are using complementary health practices.

By both criteria—use and scientific promise—research on CAM for chronic pain is a top priority. Millions of Americans suffer from chronic pain. Its annual economic cost, including health care expenses, lost income, and lost productivity, is estimated to be $100 billion. In addition, the 2007 National Health Interview Survey (NHIS) found that chronic pain is by far the most common reason Americans use CAM. Increasing evidence from rigorous scientific studies indicates that certain CAM therapies (e.g., relaxation techniques, acupuncture, chiropractic manipulation, and massage) may be useful in managing chronic pain.

Given these facts, NCCAM is strengthening its portfolio of research on non-pharmacological pain management. For example, NCCAM has recently refined its signature research program, Centers of Excellence for Research on CAM (CERC), to focus on studying CAM therapies for pain management. Through the CERC initiative, researchers at leading research institutions will bring a multidisciplinary, synergistic approach to the study of CAM for its potential for addressing this important public health problem.

Other new NHIS data show that Americans are spending approximately $34 billion out-of-pocket on CAM products and services—with nearly two-thirds being spent on "self-care" items, forms of CAM that individuals use on their own without seeing a health care provider. Of this, approximately $14.8 billion is spent on nonvitamin, nonmineral, natural products (such as botanicals and other dietary supplements). These findings reinforce the importance of NCCAM's continued commitment to building a base of rigorous, objective, scientific evidence on the safety and efficacy of natural products. NCCAM-funded botanical researchers are taking advantage of the unprecedented scientific opportunities now available to understand the mechanisms by which natural products could change disease processes through the application of state-of-the-art technologies, such as high throughput screening methods, studies of epigenomics, and studies of the microbiome. These techniques are yielding promising leads for new therapies, as well as insights into the biological mechanisms of natural products. And in light of continuing reports highlighting safety concerns of natural products, the Center in close cooperation with regulatory agencies, will maintain its focus on helping to provide consumers, health care providers, and policymakers with reliable and objective data regarding the safety of natural products.

As in other areas of biomedical science, building an evidence base for CAM requires research that addresses a continuum of questions. Basic research asks how a therapy affects the body and bodily processes (such as how the chemicals in an herb reduce inflammation, or how the brain responds to acupuncture). Translational research, also known as "bench-to-bedside" research, determines whether we have the methods and tools needed to detect and measure a therapy's effect in people. Efficacy studies look for evidence of a therapy's safety and benefit in people under optimal research conditions, as in controlled clinical trials. Effectiveness research asks how well the therapy works in the real world and in comparison to other treatments. Ensuring an optimal balance among these wide-ranging questions for priority research areas is a third focus of NCCAM's strategic planning efforts.

Because many of the most promising CAM approaches are already in widespread use, comparative effectiveness research (CER) studies are of particular interest and importance in the field of CAM research. This kind of research looks at data from real-world settings to compare strengths and weaknesses of various medical interventions. Results can provide patients and health care providers with practical information for choosing interventions that are most effective and have the most value. It is interesting to note that at least 3 of the top 100 priorities for CER identified in a recent Institute of Medicine study involved CAM therapies (acupuncture, dietary supplements, and mindfulness approaches). Ongoing NCCAM studies are comparing the effectiveness of CAM and conventional approaches, as well as interventions that combine them in various ways. For example, one study is using existing data (including 5 years of insurance claims) to compare patients who see CAM providers to treat their back pain with those who do not. The study will evaluate back pain-related outcomes, quality of care, costs, and use of other services.

To conduct this research on CAM, we must have a strong research community, one that includes both conventional researchers and CAM practitioners skilled and knowledgeable in research methodology. NCCAM has partnered with the Bernard Osher Foundation to support research training for CAM practitioners. This effort is critical to the long-term investment in building and sustaining the biomedical research community.

NCCAM enters its second decade at a time of both extraordinary scientific opportunity and the special challenge of health care reform. In partnership with a vibrant research community, we must embrace this time of opportunity and challenge and continue to build an evidence base on the safety and potential value of CAM. Moreover, we need to share the results of our research with the public, health care professionals, and policymakers so that the best possible decisions can be made regarding CAM use and its integration with other forms of health care.

Overall Budget Policy:

Guided by its strategic plan, the advice of the National Advisory Council for Complementary and Alternative Medicine, and input from a diverse community of stakeholders, NCCAM builds the scientific evidence base for complementary and alternative medicine (CAM) by stimulating research and increasing research capacity. In FY 2011, NCCAM will continue to fund multidisciplinary investigator-initiated research, will support new investigators on R01 equivalent awards at success rates equivalent to those of established investigators submitting new R01 equivalent applications, and encourage capacity building across the field of CAM research. Areas of special emphasis include studies examining the effectiveness of CAM approaches to alleviate chronic pain and translational research to improve the quality, reproducibility, and comparability of clinical CAM research. The Division of Intramural Research and Research Management and Support will receive modest increases to maintain staffing levels and ensure responsible oversight of research activities.

Funds are included in R&D contracts to support several trans-NIH initiatives, such as the Therapies for Rare and Neglected Diseases program (TRND), the Basic Behavioral and Social Sciences Opportunity Network (OppNet), and support for a new synchrotron at the Brookhaven National Laboratory, as well as increased support for other HHS agencies through the program evaluation set-aside."

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FY 2011 Justification by Program

Program Descriptions and Accomplishments

Extramural Basic Research: Basic research clarifies fundamental biological effects that are central to the development of the evidence base in complementary and alternative medicine (CAM) and underpins the design of clinical research. NCCAM supports investigator-initiated basic research and will increase, through targeted initiatives, its support for translational research on CAM. NCCAM has basic research initiatives such as Mechanisms of Immune Modulation, which fund studies with the ability of various interventions to affect inflammatory processes that underlie many conditions for which Americans frequently use CAM, such as chronic pain and allergy.

In its cornerstone Centers of Excellence for Research on CAM (CERC), NCCAM researchers at the Massachusetts General Hospital are studying the neural basis for the effects of acupuncture through the use of functional magnetic resonance imaging. The Center is testing the hypothesis that acupuncture generates a widespread response in the brain, and that the brain's limbic system plays a central role in this response. The NCCAM CERC at Oregon State University is using cell culture studies and relevant animal models to determine the molecular and cellular mechanisms of action and in vivo safety and efficacy of selected antioxidant therapies in aging, amyotrophic lateral sclerosis (ALS, commonly known as Lou Gehrig's disease), and cardiovascular diseases.

Budget Policy: The FY 2011 NCCAM budget estimate for extramural basic research is $51.930 million, an increase of $1.044 million or 2.0 percent above the FY 2010 enacted level. The FY 2011 basic research plan supports an increase of the evidence base on the physiological mechanisms underlying CAM practices, as well as the development and validation of methods and approaches needed to ensure that clinical research has a solid foundation and facilitate the integration of proven CAM approaches into health care.

Extramural Clinical Research: The NCCAM extramural research program funds multidisciplinary clinical investigations at leading U.S. biomedical and CAM research institutions on various CAM modalities. Clinical CAM research ranges from small pilot studies to large-scale clinical trials and epidemiological studies supported through solicited research initiatives, collaboration between NIH Institutes and Centers, and investigator-initiated research.

There are numerous and important basic, translational, and clinical research questions to be addressed in pursuing the promising leads which have emerged in the past decade and building an evidence base regarding the safety and utility of CAM approaches in treating pain. NCCAM has identified use of CAM for alleviation of pain as the focus of the CERC program in FY 2011. Such research requires a multidisciplinary, multi-level, interactive CERC program.

Budget Policy: The FY 2011 NCCAM budget estimate for extramural clinical research is $44.088 million, an increase of $0.853 million or 2.0 percent above the FY 2010 enacted level. The NCCAM clinical research plan will target the strategic priorities of support for CAM efficacy and effectiveness research, with the ultimate goal to inform the scientific evidence base on CAM for specific indications.

Portrait of a Program—Effectiveness of Complementary and Alternative Health Practices

FY 2010 $2.255 million
FY 2011 $2.316 million
Change $0.061 million

Although existing studies have provided information on patterns of complementary and alternative medicine (CAM) use in the general population, little research has been conducted on the effectiveness of CAM modalities and integrated health models in primary care. To address this knowledge gap, NCCAM will support research to: 1) discover if certain well-characterized CAM modalities for which there is already evidence of efficacy add value to conventional treatment for back pain; and 2) measure the impact of integrative medicine delivery models on the promotion of healthy behaviors such as smoking cessation, physical activity, and healthy eating.

Research funded by this initiative will take advantage of new or existing practice-based research networks (PBRNs), which cover large patient populations in diverse medical settings and are likely to be representative of patients seeking primary care. The utilization of collaborative networks of office-based practices for the purpose of research is a promising approach to the study of CAM. CAM and integrative medicine providers tend to deal with the management of unselected patients, many of whom present with multiple problems or because they seek improved overall health. This initiative will assess whether data collected at PBRNs can be used to increase scientific knowledge about CAM through the application of health services research methodology.

This initiative will make an important contribution to comparative effectiveness research as it will study CAM as it is used in real-world settings. Since nearly 40 percent of American adults use CAM and spend nearly $34 billion out-of-pocket each year on CAM products and services, the impact on health policy is significant. That is why the PBRN network is a logical research setting. PBRNs—some of which have existed in the United States for more than 20 years—involve community-based clinicians and their staffs in activities designed to understand and improve primary care. PBRN efforts link relevant clinical questions with rigorous research methods in community settings to produce scientific information that is externally valid, and, in theory, assimilated more easily into everyday practice. Increasingly, PBRNs are recognizing their potential to expand their purpose, and are supporting quality improvement activities within primary care practices and the adoption of an evidence-based culture in primary care practice. This initiative will provide rigorous evaluation of the value of CAM approaches in real world primary care settings and will contribute to the NIH goal of putting science to work for the benefit of health reform.

Portrait of a Program—Complementary Health Practices for Pain Management

FY 2010 $14.917 million
FY 2011 $15.320 million
Change $0.403 million

Alleviation of pain is by far the most common health problem for which Americans turn to complementary and alternative medicine (CAM). According to data from the 2007 National Health Interview Survey, chronic pain (including back pain, headache, and arthritis pain) is the most common reason for the use of CAM, and patients with musculoskeletal problems make up the majority of visits to CAM providers. A growing body of research suggests that certain CAM health practices can complement the pharmacological management of pain and may at times yield better clinical outcomes than the use of drugs alone. The potential of this research to affect practice is supported by recent recommendations in guidelines of the American College of Physicians and the American Pain Society to consider massage, chiropractic, or acupuncture in back pain management.

NCCAM-funded basic and clinical research in pain management has demonstrated promising results in a number of areas. Basic research has provided evidence of significant effect of mind-body practices on the underlying biological mechanisms of pain perception and control. For example, brain imaging studies have yielded insights into the central mechanisms activated by placebo analgesia and acupuncture. Clinical studies have shown that patients with chronic low-back pain who received acupuncture or simulated acupuncture treatments benefited more than patients receiving only conventional care. Ongoing research is comparing the cost and utilization of conventional medical services for the treatments of musculoskeletal pain conditions by patients who use CAM providers with those who do not.

While NCCAM-supported research is producing promising results, much research remains to be done to pursue these promising leads and to build an evidence base on the safety and utility of CAM approaches to treating pain. To address this research need, NCCAM has identified the study of CAM practices for alleviation of pain as a high priority for future research. As part of this research priority, in 2008, NCCAM launched the Effectiveness Research—CAM Interventions and Chronic Back Pain initiative to strengthen the evidence for promising CAM interventions for pain management as used in "real world" health care settings. And, in 2009, NCCAM hosted the NIH Workshop on Nonpharmacologic Management of Back Pain to identify clinical research questions related to the treatment of back pain. Finally, the Center has identified pain management as the initial focus for the renewal of the Centers of Excellence for Research on CAM (CERC) program in 2009. The mission of the CERC program is to support and enhance research in NCCAM's targeted high-priority research areas, with a particular focus on research areas where multidisciplinary scientific teams are critical for progress.

Extramural Research Training and Capacity Building.

The basic, translational, and clinical research required to develop the evidence base for CAM cannot be developed without the expertise of CAM practitioners working in partnership with conventional researchers. To increase the number, quality, and diversity of investigators who conduct research on CAM, NCCAM supports a variety of training and career development activities for pre-doctoral and post-doctoral students, CAM practitioners, and conventional medical researchers and practitioners.

NCCAM continues to partner with The Bernard Osher Foundation on new training and career development awards to support research career development for CAM health professionals. The program's eligibility has been expanded to include individuals from a broader range of professional backgrounds.

Budget Policy: The NCCAM FY 2010 budget proposal for extramural research training and capacity building is $11.400 million, an increase of $0.278 million or 2.0 percent above the FY 2009 enacted level. To address the ongoing need to build and sustain CAM research capacity, NCCAM will make awards under its ongoing training initiatives that target CAM and conventional investigators at various stages of their careers, including the Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellowship Training in Complementary and Alternative Medicine (F31), Mentored Patient-Oriented Research Career Development Award (K23), Midcareer Investigator Award in Patient-Oriented Research (K24), and the Bernard Osher Foundation/NCCAM CAM Practitioner Research Career Development Award (K01).

Intramural Research. NCCAM's Division of Intramural Research (DIR) conducts basic, translational, and clinical research on a range of CAM modalities, including dietary supplements and acupuncture, and provides a Complementary and Integrative Medicine Consult Service to provide advice on the appropriate role of CAM interventions for patients who are participating in NIH Clinical Center research protocols (nccam.nih.gov/research/consultservice).

In FY 2009 NCCAM carried out a comprehensive assessment by an independent expert (Blue Ribbon) panel of the scientific contributions and future directions for the DIR as part of its third strategic plan development process. The panel recommended an interdisciplinary research program that should be built around the unifying theme of mind-body medicine. A search for a DIR director with neuroscience expertise is under way.

Research Management and Support (RMS). Through its RMS activities, NCCAM continued to fund meritorious basic, clinical, and translational research and research training efforts, and the Center has also continued its health information dissemination and education/outreach activities, such as the Time To Talk outreach initiative nccam.nih.gov/timetotalk and an online continuing education program for physicians and nurses.

In FY 2009, NCCAM celebrated its 10th anniversary as an NIH Center with a number of special outreach activities: The inaugural Stephen E. Straus Distinguished Lecture, a scientific symposium "Exploring the Science of CAM," and the launch of a new section of its website specifically for health care providers.

Recovery Act Implementation

Recovery Act Funding: $31.728 million

In FY 2009, the National Center for Complementary and Alternative Medicine (NCCAM) received $31.7 million under the American Recovery and Reinvestment Act. Of this amount, $16.8 million was obligated in FY 2009 and $14.9 million will be obligated in FY 2010. These funds will support scientific research on complementary and alternative medicine (CAM) for a number of significant health problems for which CAM shows promise of public health benefit.

With the 2007 National Health Interview Survey revealing that the most common reason Americans use CAM is for treatment of pain, studies on chronic pain are a vital component of NCCAM's research portfolio. Recovery Act-funded research on chronic pain examines the value of acupuncture for carpal tunnel syndrome, natural products and massage for osteoarthritis of the knee, and spinal manipulation for low back pain. Research on CAM approaches for diseases related to aging include studies on antioxidants for Parkinson's disease and omega-3 fatty acids (found in foods such as fatty fish and vegetable oil) for stroke. New projects related to digestive health research include herbal supplements for food allergies, probiotics - live microorganisms (in most cases, bacteria) that are similar to normal microorganisms found in the human gut - for newborn digestive health, and amino acids for inflammatory bowel disease.

In addition, Recovery Act funding is supporting research on the effects of meditation on immune and psychosocial function, yoga for smoking cessation, and acupuncture for chronic insomnia.
NCCAM's Recovery Act funds are being invested in promising areas of research that will advance the field of CAM research, improve the health of the Nation, and create new jobs

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Budget Authority by Object
Total compensable workyears FY 2010 Estimate FY 2011 PB Increase or Decrease Percent Change
Includes FTEs which are reimbursed from the NIH Roadmap for Medical Research
Full-time employment 65 68 3 4.6
Full-time equivalent of overtime and holiday hours 0 0 0 0.0
Average ES salary $0 $0 $0 0.0
Average GM/GS grade 12.4 12.4 0.0 0.0
Average GM/GS salary $99,799 $101,795 $1,996 2.0
Average salary, grade established by act of July 1, 1944 (42 U.S.C. 207) $88,046 $89,807 $1,761 2.0
Average salary of ungraded positions 164,139 167,422 3,283 2.0
Budget Authority by Object
(continued)
OBJECT CLASSES FY 2010 Estimate FY 2011 PB Increase or Decrease Percent Change
Includes FTEs which are reimbursed from the NIH Roadmap for Medical Research
Personnel Compensation:        
11.1 Full-time permanent $5,199,000 $5,460,000 $261,000 5.0
11.3 Other than full-time permanent 1,627,000 1,759,000 132,000 8.1
11.5 Other personnel compensation 179,000 188,000 9,000 5.0
11.7 Military personnel 177,000 215,000 38,000 21.5
11.8 Special personnel services payments 269,000 314,000 45,000 16.7
Total, Personnel Compensation 7,451,000 7,936,000 485,000 6.5
12.0 Personnel benefits 1,876,000 1,986,000 110,000 5.9
12.2 Military personnel benefits 201,000 236,000 35,000 17.4
13.0 Benefits for former personnel 0 0 0 0.0
Subtotal, Pay Costs 9,528,000 10,158,000 630,000 6.6
21.0 Travel and transportation of persons 128,000 134,000 6,000 4.7
22.0 Transportation of things 75,000 81,000 6,000 8.0
23.1 Rental payments to GSA 0 0 0 0.0
23.2 Rental payments to others 12,000 12,000 0 0.0
23.3 Communications, utilities and miscellaneous charges 166,000 175,000 9,000 5.4
24.0 Printing and reproduction 105,000 113,000 9,000 7.6
25.1 Consulting services 1.008,000 1,072,000 64,000 6.3
25.2 Other services 4,023,000 4,166,000 143,000 1.0
25.3 Purchase of goods and services from government accounts 13,088,000 13,485,000 397,000 3.0
25.4 Operation and maintenance of facilities 69,000 74,000 5,000 7.2
25.5 Research and development contracts 4,374,000 4,447,000 73,000 1.7
25.6 Medical care 0 0 0 0.0
25.7 Operation and maintenance of equipment 125,000 129,000 4,000 3.2
25.8 Subsistence and support of persons 0 0 0 0.0
25.0 Subtotal, Other Contractual Services 22,687,000 23,373,000 686,000 3.0
26.0 Supplies and materials 585,000 576,000 (9,000) -1.5
31.0 Equipment 196,000 204,000 8,000 4.1
32.0 Land and structures 0 0 0 0.0
33.0 Investments and loans 0 0 0 0.0
41.0 Grants, subsidies and contributions 95,309,000 97,178,000 1,869,000 2.0
42.0 Insurance claims and indemnities 0 0 0 0.0
43.0 Interest and dividends 0 0 0 0.0
44.0 Refunds 0 0 0 0.0
Subtotal, Non-Pay Costs 119,263,000 121,846,000 2,583,000 2.2
Total Budget Authority by Object 128,791,000 132,004,000 3,213,000 2.5

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Salaries and Expenses
OBJECT CLASSES FY 2010 Estimate FY 2011 PB Increase or Decrease Percent Change
Personnel Compensation:        
Full-time permanent (11.1) $5,199,000 $5,490,000 $261,000 5.0
Other than full-time permanent (11.3) 1,627,000 1,759,000 132,000 8.1
Other personnel compensation (11.5) 179,000 188,000 9,000 5.0
Military personnel (11.7) 142,000 146,000 4,000 21.5
Special personnel services payments (11.8) 269,000 314,000 45,000 16.7
Total Personnel Compensation (11.9) 7,451,000 7,936,000 485,000 6.5
Civilian personnel benefits (12.1) 1,876,000 1,986,000 110,000 5.9
Military personnel benefits (12.2) 148,000 154,000 6,000 4.1
Benefits to former personnel (13.0) 0 0 0 0.0
Subtotal, Pay Costs 9,528,000 10,158,000 630,000 6.6
Travel (21.0) 128,000 134,000 6,000 4.7
Transportation of things (22.0) 75,000 81,000 6,000 8.0
Rental payments to others (23.2) 12,000 12,000 0 0.0
Communications, utilities and miscellaneous charges (23.3) 166,000 175,000 9,000 5.4
Printing and reproduction (24.0) 105,000 113,000 8,000 7.6
Other Contractual Services:        
Advisory and assistance services (25.1) 1,008,000 1,072,000 64,000 6.3
Other services (25.2) 4,023,000 4,166,000 143,000 3.6
Purchases from government accounts (25.3) 7,822,000 8,006,000 184,000 2.4
Operation and maintenance of facilities (25.4) 69,000 74,000 5,000 7.2
Operation and maintenance of equipment (25.7 125,000 129,000 4,000 3.2
Subsistence and support of persons (25.8) 0 0 0 0.0
Subtotal Other Contractual Services 13,047,000 13,447,000 400,000 3.1
Supplies and materials (26.0) 585,000 576,000 (9,000) -1.5
Subtotal, Non-Pay Costs 14,118,000 14,538,000 420,000 3.0
Total, Administrative Costs 23,646,000 24,696,000 1,050,000 4.4

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Authorizing Legislation
  PHS Act/Other Citation U.S. Code Citation 2010 Amount Authorized FY 2010 Estimate 2011 Amount Authorized FY 2011 PB
Research and Investigation Section 301 42§241 Indefinite Combined $128,791,000 Indefinite Combined $132,004,000
National Center for Complementary and Alternative Medicine Section 402(a) 42§281 Indefinite Indefinite
Total, Budget Authority       128,791,000   132,004,000

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Appropriations History
Fiscal Year Budget Estimate to Congress House Allowance Senate Allowance Appropriation 1/
1/ Reflects enacted supplementals, rescissions, and reappropriations.
2002 100,063,000 99,288,000 110,000,000 104,644,000
Rescission       (52,000)
2003 112,547,000 112,547,000 114,149,000 114,149,000
Rescission       (742,000)
2004 116,202,000 116,202,000 117,092,000 117,752,000
Rescission       (774,000)
2005 121,116,000 121,116,000 121,900,000 123,116,000
Rescission       (1,011,000)
2006 122,692,000 122,692,000 126,978,000 122,692,000
Rescission       (1,227,000)
2007 120,554,000 120,554,000 121,982,000 121,576,000
Rescission       0
2008 121,699,000 123,380,000 124,213,000 121,577,000
Rescission       (2,162,000)
Supplemental       647,000
2009 121,695,000 125,878,000 125,082,000 125,471,000
Rescission       0
2010 127,241,000 129,953,000 127,591,000 128,844,000
Rescission       0
2011 132,004,000      

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Details of Full-Time Equivalent Employment (FTEs)
OFFICE/DIVISION FY 2009 Actual FY 2010 Estimate FY 2011 PB
Office of the Director 4 4 43
Office of Administrative Operations 15 14 14
Office of Communication and Public Liaison 7 7 7
Office of Science Policy, Planning and Evaluation 4 4 4
Division of Extramural Research and Training 16 16 16
Office of Scientific Review 6 6 6
Office of International Health Research 1 1 1
Office of Clinical and Regulatory Affairs 2 2 2
Office of Intramural Research 11 11 13
Total 66 65 68
Includes FTEs that are reimbursed from the NIH Roadmap for Medical Research
FTEs supported by funds from Cooperative Research and Development Agreements (0) (0) (0)
Details of Full-Time Equivalent Employment (FTEs)
(continued)
FISCAL YEAR Average GM/GS Grade
2007 12.2
2008 12.2
2009 12.4
2010 12.4
2011 12.4

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NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
Details of Positions
GRADE FY 2009 Actual FY 2010 Estimate FY 2011 PB
Includes FTEs which are reimbursed from the NIH Roadmap for Medical Research.
Total, ES Positions 0 0 0
Total, ES Salary 0 0 0
GM/GS-15 8 8 8
GM/GS-14 14 14 14
GM/GS-13 19 19 20
GS-12 7 6 7
GS-11 3 3 4
GS-10 0 0 0
GS-9 4 4 4
GS-8 0 0 0
GS-7 1 1 1
GS-6 0 0 0
GS-5 0 0 0
GS-4 1 1 1
GS-3 0 0 0
GS-2 0 0 0
GS-1 0 0 0
Subtotal 60 59 62
Grades established by Act of July 1, 1944 (42 U.S.C. 207):
Assistant Surgeon General 0 0 0
Director Grade 1 1 1
Senior Grade 0 0 0
Full Grade 0 0 0
Senior Assistant Grade 1 1 1
Assistant Grade 0 0 0
Subtotal 2 2 2
Ungraded 21 21 21
Total permanent positions 59 59 59
Total positions, end of year 83 83 83
Total full-time equivalent (FTE) employment, end of year 66 65 68
Average ES salary 0 0 0
Average GM/GS grade 12.4 12.4 12.4
Average GM/GS salary 99,799 99,799 101,795

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New Positions Requested

NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Alternative Medicine
New Positions Requested for Fiscal Year 2011
Grade Number Annual Salary
Health Science Administrator 13 1 $89,033
Nurse 12 1 74,872
Lab Technician 11 1 $62,467
Total Requested   3 $226,372

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