National Center for Complementary and Alternative Medicine (NCCAM)

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Fiscal Year 2015 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

April 2, 2014

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) 2015 budget request for NCCAM. The FY 2015 budget includes $124,509,000, which is $213,000 more than the comparable FY 2014 appropriation of $124,296,000.

The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government’s lead agency for supporting scientific research on complementary practices and integrative health interventions. NCCAM’s mission is to define, through rigorous scientific investigation, the usefulness and safety of such practices and their roles in improving health and health care.

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Complementary and Integrative Health Care

Complementary and integrative health practices are defined as having origins outside of mainstream conventional medicine and include both self-care practices like meditation, yoga, and dietary supplements, as well as health care provider administered care such as acupuncture, chiropractic, osteopathic and naturopathic medicine. As these modalities are increasingly integrated into mainstream health care, NCCAM is committed to developing the scientific evidence needed by the public, health care professionals and health policymakers to make informed decisions about the use and integration of these various practices.

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Use of Complementary and Integrative Health Care

For the past decade, some 30 to 40 percent of Americans have used complementary and integrative health practices, according to data from the National Health Interview Survey (NHIS) conducted by Centers of Disease Control and Prevention (CDC). The NHIS data shows that Americans are willing to pay for these services, spending some $34 billion in 2007, which represented 1.5 percent of total health expenditures and 11 percent of out-of-pocket costs. NCCAM has worked with the CDC since 2002, to develop the questions on complementary health care that are included in the NHIS every five years (2002, 2007, and 2012). Results from the latest survey are currently being analyzed for publication later this spring. Analysis will include, for the first time, a comparison of regional variations in use of complementary health practices by adults in the United States. We also look forward to the first detailed look at integration of complementary interventions into private medical practice when the results of the 2012 National Ambulatory Medical Care Survey, that involved interviews of 30,000 physicians, are analyzed. NCCAM worked closely with the CDC to develop the questions used in this survey, as well.

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Impact on Public Health

NCCAM’s approach to setting priorities and investment in research is guided by the need for rigorous evidence that ultimately may have a significant impact on public health. One example of this approach involves a major clinical trial supported jointly by NCCAM and the National Heart, Lung, and Blood Institute examining the efficacy of using EDTA-based chelation therapy to reduce cardiovascular disease and prevent heart attacks. The trial, which involved 1,700 patients, showed a modest reduction in cardiovascular events for adults aged 50 and older who had suffered a prior heart attack. However, the results from a secondary analysis of the trial data suggest that the chelation treatments produced a marked reduction in cardiovascular events and death in patients with diabetes, but not in those without diabetes. Addressing cardiovascular disease in diabetics is an important public health challenge, and better treatment options are required. As this study was not designed to discover how or why chelation might benefit patients with diabetes, further investigation is needed. Thus, NCCAM is exploring the possibility of a follow up study in collaboration with several other NIH Institutes.

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Reducing Pain and Improving Symptom Management

According to the Institute of Medicine, pain is a major public health problem affecting over 100 million Americans and costing the nation over $600 billion in medical costs and lost productivity. Pain is also the most common reason Americans turn to complementary and integrative health practices, as conventional medicine often provides incomplete relief. Therefore, pain research is a top priority for NCCAM. As such, we continue to invest in research on several promising approaches for treating pain, such as spinal manipulation, massage, yoga, meditation, and acupuncture. We are particularly interested in understanding how these interventions work, for what type of pain condition, and for determining the optimal method of practice and delivery. Toward this end, NCCAM partners with others in supporting research initiatives, participates in the NIH Pain Consortium, and leads an NIH Task Force to improve standards for research on chronic low back pain (cLBP). The cLBP Task Force has developed common standards, measures, and other tools for clinical research on cLBP, and a report is expected to be published in The Journal of Pain later this year.

Another important collaborative effort is our partnership with the National Institute on Drug Abuse and the Department of Veterans Affairs to foster research on complementary and integrative approaches to managing pain and other symptoms experienced by military personnel and veterans. A number of grant applications were submitted in response to our joint solicitation, and we anticipate funding multiple studies later this fall.

One area of particular interest is the means by which complementary health practices affect the perception of pain by the brain. Specifically, we seek to understand the mechanisms by which emotions, attention, and context modulate pain. Using neuroimaging and cutting edge technologies, our intramural research program (IRP) is exploring the central mechanisms of pain and its modulation, with the long term goal of improving clinical management of chronic pain through the integration of pharmacological and non-pharmacological complementary health approaches. NCCAM’s IRP engages and leverages the exceptional basic and clinical neuroscience efforts across NIH.

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Advancing Research on Natural Products

Another important area of emphasis for NCCAM is research on natural products. In addition to exploring the underlying biological effects and mechanisms of natural products such as dietary supplements, herbs, botanicals, and probiotics, we are concerned about their safety. While there is widespread use of these products by the public, there is limited scientific evidence about their effectiveness and safety. In addition to a gaining greater understanding of whether natural products are effective or safe when used alone, there is a need to study how they interact with prescription medications. This is very important because many patients taking prescription medications also use natural products, such as dietary supplements, herbs and probiotics. To investigate these issues, NCCAM will launch an initiative to develop rigorous methods to evaluate potential interactions between natural products and medications. The ultimate goal is to ensure that consumers, health care providers, and health policymakers are better informed of the potential risks and/or benefits associated with the use of natural products in combination with medications.

To propel needed innovations in technology and methodology for research on natural products, NCCAM and the NIH Office of Dietary Supplements are supporting the establishment of a Center for Advancing Natural Products Technology and Innovation. The Center is expected to better support the needs of the natural products community while reducing resource redundancies.

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Providing Useful Information to the Public

NCCAM provides objective, evidence-based information to scientists, health care providers, and the general public through a variety of approaches, including emerging technology and platforms (i.e., video, social media, and mobile applications) and an information-rich Web site (www.nccam.nih.gov). Through these approaches, science-based information on the safety and efficacy of complementary and integrative health practices – already in wide public use - is made available to a broad audience.

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Conclusion

NCCAM continues to support research, collaborate with others, and leverage partnerships to build the scientific evidence needed by consumers, healthcare professionals, and health policymakers regarding the safety and value 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. Dr. Briggs brings a focus on translational research to the study of complementary and integrative health practices to help build a fuller understanding of the usefulness and safety of these approaches.

In addition to her position at NCCAM, Dr. Briggs has served on several, key, trans-NIH committees, including the NIH Steering Committee; the Clinical Center Governing Board; the Advisory Board for Clinical Research; the Executive Committee of the NIH Pain Consortium; and as co-chair of the Executive Committee of the NIH Common Fund’s Health Care Systems Research Collaboratory.

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, CT. 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, MI, 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 Medical Institute. In 2008, she became NCCAM’s second director.

Dr. Briggs’ 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.