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
- Appropriation Language
- Amounts Available for Obligation
- Budget Mechanism—Total
- Budget Authority by Program
- Major Changes in the Fiscal Year 2011 Budget Request
- Summary of Changes
- Fiscal Year 2011 Budget Graphs
- Director's Overview
- Justification by Program
- Budget Authority by Object
- Salaries and Expenses
- Authorizing Legislation
- Appropriations History
- Details of Full-Time Equivalent Employment (FTEs)
- Details of Positions
- New Positions Requested for Fiscal Year 2011
Organization Chart
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)
| 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 |
| 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 | ||
| 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 |
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.
| FY 2009 estimate | $128,791,000 |
|---|---|
| FY 2010 estimated budget authority | 132,004,000 |
| Net change | 3,213,000 |
| 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 | |||
| 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 | |
Fiscal Year 2011 Budget Graphs
Funding Levels by Fiscal Year
Full-Time Employees by Fiscal Year
FY 2011 Budget Mechanism
FY 2011 Estimate
Percent Change from FY 2010 Mechanism
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.
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."
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
| 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 |
| 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 |
| 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 |
| 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 |  $128,791,000 |
Indefinite | $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 |
| 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 | |||
| 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) |
| FISCAL YEAR | Average GM/GS Grade |
|---|---|
| 2007 | 12.2 |
| 2008 | 12.2 |
| 2009 | 12.4 |
| 2010 | 12.4 |
| 2011 | 12.4 |
| 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 |
New Positions Requested
| 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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The NCCAM Clearinghouse provides information on NCCAM and complementary health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.
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