National Center for Complementary and Alternative Medicine (NCCAM)

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Fiscal Year 2013 Budget Request

Statement for the Record
House Subcommittee on Labor-HHS-Education Appropriations

Josephine P. Briggs, M.D.
Director, National Center for Complementary and Alternative Medicine

March 2012

Mr. Chairman and Members of the Committee:

As the Director of the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH), I am pleased to present the President’s Fiscal Year (FY) 2013 budget request for NCCAM. The FY 2013 budget includes $127,930,000, which is $26,000 more than the comparable FY 2012 appropriation of $127,904,000.

The landscape of our health care system is changing in many important ways. Among them is a clear trend toward incorporation of complementary health practices, which often have origins outside of conventional medicine, into integrative approaches to care. There are a number of factors—including consumer demand and emerging scientific evidence—driving these changes. Nonetheless, there are compelling needs of the public, health care providers, and policymakers for good scientific evidence on the safety and potential benefit of these complementary and integrative approaches. Using the highest standards of scientific rigor, NCCAM is committed to developing evidence about practices that are being integrated into health care. We are particularly interested in those cases where there is scientific opportunity and/or important public health need.

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Trends in Complementary and Integrative Health Care

National surveys conducted by the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention show that nearly 40 percent of Americans report using one or more practices such as acupuncture, massage, yoga, meditation, spinal manipulation, dietary supplements or herbal medicines to help manage their health and wellness. Similarly, data show that health care systems and providers are incorporating such interventions. For example, an American Hospital Association survey conducted in 2007 showed that 37 percent of hospitals offered complementary modalities; and a national study reported last year by the NCHS reported widespread availability of complementary approaches in hospice settings. Other data from the Departments of Defense (DOD) and Veterans Affairs (VA) show increasing use of complementary modalities in their populations. According to the VA, 89 percent of their facilities offered complementary therapies in 2011. Both the DOD and VA have integrated complementary modalities into the care of patients with posttraumatic stress and sleep disorders, and to improve treatment of pain.

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Reducing Pain and Improving Symptom Management

One area of urgent public health need is better strategies for managing chronic pain. According to the Institute of Medicine, chronic pain affects an estimated 116 million Americans, and costs the Nation approximately $635 billion each year. Chronic pain is the most frequently cited reason for which Americans use complementary health practices. For many individuals suffering from chronic pain, conventional approaches provide incomplete relief. Furthermore, pharmacological treatment with opioids or anti-inflammatory drugs can have significant adverse effects. There is now emerging evidence, much of it from NCCAM-supported studies, that some nonpharmacological interventions, such as massage, spinal manipulation, yoga, meditation, and acupuncture, may be helpful in treating chronic pain. Additional scientific evidence is needed to better understand these findings, and the optimal use and safety of these integrative approaches.

To this end, NCCAM is supporting a growing portfolio of studies on the use of nonpharmacological interventions for the management of chronic pain, including back and neck pain and pain associated with osteoarthritis, fibromyalgia, and headaches. In addition, we are supporting research to better understand the biological mechanisms by which complementary modalities may contribute to management of pain and other symptoms. For example, we recently funded Centers of Excellence for Research on Complementary and Alternative Medicine that use advanced functional and structural neuroimaging technologies to study pain. NCCAM is also providing leadership to a working group within the trans-NIH Pain Consortium to develop standards for research on chronic low back pain. Finally, in the next year, NCCAM plans to focus its intramural research program on understanding the role of the brain in chronic pain syndromes. The program will be highly collaborative with other intramural neuroscience programs on the NIH campus.

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Advancing Research on Natural Products

NCCAM remains strongly committed to developing better evidence and information resources on the safety and efficacy of commonly used natural products. The Center is targeting investment in research in this arena on understanding the biological mechanisms of these products, thus creating the translational foundation for subsequent human studies.

In addition, research examining issues of safety is of great public health importance, given the widespread availability and use of these products by the public. In this regard, one area of specific need is rigorous scientific information about interactions of these products with drugs or with other natural products. This spring, NCCAM will lead a workshop, cosponsored by the NIH Office of Dietary Supplements and the National Cancer Institute, with researchers from a variety of fields to discuss ways to improve the methodologies needed to study herb-drug interactions. Workshop recommendations will help guide NCCAM’s research agenda.

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Building and Disseminating Rigorous Evidence

Researchers studying the effectiveness and safety of health care approaches already in widespread use face methodological challenges, challenges that are not unique to NCCAM’s mission. To develop better methods of studying health outcomes in real-world settings, NCCAM is leading an NIH Common Fund initiative, the Health Care Systems Research Collaboratory. The Collaboratory will develop innovative research partnerships with health care delivery organizations to maximize the potential use of electronic health information. NCCAM is also exploring possible collaborations with the DOD and the VA, aiming to leverage the data being gathered on the use of complementary and integrative practices in their health care systems. Additionally, NCCAM is providing leadership and support to the trans-NIH Patient-Reported Outcomes Measurement Information System (PROMIS), which will provide clinicians and researchers with more efficient and reliable means for gathering data on a variety of patient-reported measures of health and well-being.

NCCAM continues to provide reliable, objective, and evidence-based information on the usefulness and safety of complementary health practices to the public and health care providers. For example, NCCAM publishes the Clinical Digest (nccam.nih.gov/health/providers/digest), a monthly e-newsletter that summarizes the state of the science on complementary health practices and clinical guidelines. Additionally, NCCAM provides an online resource (nccam.nih.gov/health/providers) that enables health care providers to make informed recommendations.

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Conclusion

Strong consumer use of complementary health practices, and growing integration of these practices into a variety of conventional health care settings are important trends in U.S. health care. While there is emerging evidence of promise for some, there are many important unanswered questions about effectiveness and safety. NCCAM remains committed to building the scientific evidence needed by consumers, providers, and health policy makers to make informed decisions about the use of complementary and integrative health practices.

Josephine P. Briggs, M.D.
Director, National Center for Complementary and Alternative Medicine

Josephine P. Briggs, M.D., an accomplished researcher and physician, is Director of the National Center for Complementary and Alternative Medicine, and Acting Director of the Division of Clinical Innovation at the National Center for Advancing Translational Sciences. Dr. Briggs brings a focus on translational research to the study of complementary health practices to help build a fuller understanding of the usefulness and safety of complementary healthpractices.

Dr. Briggs received her A.B. cum laude in biology from Harvard-Radcliffe College and her M.D. from Harvard Medical School. She completed her residency training in internal medicine and nephrology at the Mount Sinai School of Medicine, New York, where she was also chief resident in the Department of Internal Medicine and a fellow in clinical nephrology. She then held a research fellowship in physiology at Yale School of Medicine, New Haven. Dr. Briggs was a research scientist for 7 years at the Physiology Institute at the University of Munich,Germany.

In 1985, Dr. Briggs moved to the University of Michigan, Ann Arbor, where she held several academic positions, including associate chair for research in the Department of Internal Medicine and professorships in the Division of Nephrology, Department of Internal Medicine and the Department of Physiology. Dr. Briggs joined NIH in 1997 as director of the Division of Kidney, Urologic, and Hematologic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) where she oversaw extramural research activities. While at NIDDK, she co-chaired an NIH Roadmap Committee on Translational Core Resources. In 2006, she accepted a position as senior scientific officer at the Howard Hughes MedicalInstitute. In 2008, she became NCCAM’s second director.

Dr. Briggs’s research interests include the renin-angiotensin system, diabetic nephropathy, circadian regulation of blood pressure, and the effect of antioxidants in kidney disease. She has published more than 175 research articles, book chapters, and scholarly publications. Dr. Briggs also has served on the editorial boards of several journals (including the Journal of Laboratory and Clinical Medicine, Seminars in Nephrology, and Hypertension) and was deputy editor for the Journal of Clinical Investigation. She is an elected member of the American Association of Physicians and the American Society of Clinical Investigation and a fellow of the American Association for the Advancement of Science. She is a recipient of many awards and prizes, including the Volhard Prize of the German Nephrological Society, the Alexander von Humboldt Scientific Exchange Award, and NIH Director’s Awards for her role in the development of the Trans-NIH Type I Diabetes Strategic Plan and her leadership of the Trans-NIH Zebrafish committee. Dr. Briggs is also a member of the NIH Steering Committee, the senior most governing board at NIH.