National Center for Complementary and Alternative Medicine (NCCAM)

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Fiscal Year 2012 Budget Request

Witness appearing before the Senate Subcommittee on Labor-HHS-Education Appropriations

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

May 11, 2011

Mr. Chairman and Members of the Committee:

I am pleased to present the President's Fiscal Year (FY) 2012 budget request for the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health. The FY 2012 budget includes $131,002,000, which is $3,399,000 more than the comparable FY 2011 appropriation of $127,603,000.

The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government's lead agency for scientific research on complementary and alternative medicine (CAM). CAM includes a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine (sometimes called Western or allopathic medicine). The boundaries between CAM and conventional medicine are not absolute; instead, they are constantly evolving: interventions such as hospice care or relaxation and breathing techniques in childbirth that were once considered unconventional are now widely accepted. Furthermore, there is growing interest in more integrative approaches that use both CAM and conventional interventions. For example, both the Departments of Defense1 and Veterans Affairs are integrating select CAM modalities into treatments for pain, stress, and sleep disorders.

CAM is used by many in the United States, both in treating health problems and in promoting better health and well-being. Data from the 2007 National Health Interview Survey2 (NHIS), developed under NCCAM leadership in collaboration with the National Center for Health Statistics at the Centers for Disease Control and Prevention (CDC), show that nearly 40 percent of adult Americans and 12 percent of children are using some form of CAM. The data also show that in 2007 out-of-pocket expenditures for CAM totaled $33.9 billion. While this amount accounted for only 1.5 percent of total health care expenditures, it was more than 11 percent of out-of-pocket expenditures. Finally, NHIS data indicate that a large portion of CAM use is best described as "self-care" in that it occurs outside of the framework of a relationship with a health care professional. The scope, associated costs, and self-care nature of CAM use in the United States reinforce the need to develop reliable, objective scientific evidence concerning the usefulness and safety—or lack thereof—of CAM interventions, and to ensure the public has access to accurate and timely evidence-based information.

NCCAM is shaping its research directions through our third strategic plan, which was developed with considerable input from our diverse stakeholder community and released in February 2011. The strategic plan, Exploring the Science of Complementary and Alternative Medicine (available at nccam.nih.gov), was built around three long-range goals aimed at improving the state and use of scientific evidence regarding the two major reasons for use of CAM in the United States—treating health problems and supporting or promoting better health and well-being. The three goals are to 1) advance the science and practice of symptom management; 2) develop effective, practical, personalized strategies for promoting health and well-being; and 3) enable better evidence-based decision making regarding CAM use and its integration into health care and health promotion.

  1. Pain Management Task Force Final Report: Providing a Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors and Their Families, Office of the Army Surgeon General, Department of Defense, May 2010.
  2. Nahin RL, Barnes PM, Stussman BA, et al. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007 [362KB PDF*]. CDC National Health Statistics Report #18. 2009.

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Pain and Symptom Mangement

CAM approaches, as treatments for health problems, are used most often to manage symptoms such back or neck pain, arthritic or other musculoskeletal pain, headache, and insomnia. These are all difficult problems and there is broad agreement that existing options are less than fully satisfactory for many patients. For example, chronic back pain is, by far, the most frequent health problem for which Americans turn to CAM. They might try CAM approaches after exhausting other options such as opioids, injections, surgery, or physical therapy. More often, however, they pursue CAM treatment options, including spinal manipulation, yoga, acupuncture, and massage, in conjunction with conventional approaches. Individuals suffering from chronic pain conditions, their health care providers, and health policymakers all need better evidence regarding the value and safety of these complementary and integrative approaches in alleviating pain, and in improving quality of life.

To address this critical need, NCCAM is intensifying its focus on determining whether and how CAM interventions add value to existing approaches and on understanding their biological mechanisms. In order to advance the science and practice of symptom management, NCCAM plans to support Centers of Excellence for Research on CAM for Pain in FY 2011. NCCAM is also working with our colleagues at the Department of Defense to explore ways that CAM mind and body approaches can be used in integrative approaches to treat pain, stress disorders, and other symptoms. For example, we recently sponsored a joint workshop on acupuncture for the treatment of acute pain. We are also investigating potential collaborations with the Department of Veterans Affairs to advance CAM research and to maximize our investments in bringing relief to our wounded warriors.

Strategies for Promoting Health and Well-Being

It is generally accepted and well established that sustaining healthy behaviors (e.g., good eating habits and regular physical exercise) and modifying unhealthy behaviors (e.g., smoking) reduce risks of major chronic diseases. Many CAM and integrative medicine practitioners and disciplines employ various interventions (e.g., meditation or yoga) to help motivate people to adopt and sustain health-seeking behaviors, or to encourage dietary practices (sometimes grounded in traditional medical systems) that incorporate a healthy food philosophy. Newly emerging evidence suggests that CAM use may be associated with greater degrees of health-seeking behavior. While causal relationships between CAM use and healthy behavior have not been established, the claims and preliminary data deserve investigation given the formidable public health challenges in motivating behavior change. Research is needed to explore, clarify, and examine the hypothesis that certain CAM approaches or practices can, in fact, be useful in encouraging better self-care, an improved personal sense of well-being, and a greater commitment to a healthy lifestyle.

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CAM Research Challenges

Given the scope and self-care nature of CAM use by Americans, NCCAM remains committed to supporting rigorous research that will address the need for scientific evidence to help the public and their health care providers make better-informed decisions about CAM use. For example, herbal medicines, dietary supplements, and other CAM natural products are readily available to and purchased by consumers, but evidence regarding usefulness of many does not exist. In addition, some people believe that herbal medicines, dietary supplements, and other CAM natural products are inherently healthier or safer than drugs. In fact, there are ongoing concerns about safety, including the presence of contaminants or adulterants (e.g., conventional drugs) in some CAM natural products, and the potential of toxic interactions with drugs or other natural products.

Clinical research to address these needs will remain a cornerstone of the CAM research enterprise, but these studies are complex, expensive, and time-consuming. NCCAM's strategic approach is to ensure that clinical trials of CAM natural products are based on a scientifically sound hypotheses and methods that are grounded in basic mechanistic and translational research. This foundation facilitates design of maximally informative clinical trials that include measures of biological effect relevant to the hypothesis (e.g., biomarkers or surrogate markers), as well as measures of clinical outcomes.

Investigators studying mind and body interventions face other scientific challenges in designing rigorous research that will address the questions of greatest importance to consumers, providers, and health care policymakers. These include identifying relevant study endpoints and defining appropriate experimental designs to test interventions. To address such challenges, NCCAM recently collaborated with several NIH ICs to sponsor a workshop on control and comparison groups for studies of non-pharmacological interventions.3

3. NCCAM Workshop on Control/Comparison Groups for Trials of Non-Pharmacologic Interventions, April 26, 2010.

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Conclusion

As established in its third strategic plan, NCCAM is focusing the Center's efforts and resources on two compelling areas of public health need: better strategies for managing symptoms such as chronic pain, and better strategies for promoting health and well-being. In both areas there exist promising scientific opportunities for research on CAM interventions to contribute to real and meaningful progress in addressing common and vexing individual and social problems, and in developing more integrative approaches to health care and the support of healthy behaviors and lifestyles.

Finally, NCCAM's plan looks to a vision in which scientific evidence informs decisionmaking by the public, by health care professionals, and by health policymakers regarding CAM use. NCCAM will continue its multi-pronged efforts to provide world-class information about the safety and usefulness of CAM interventions to consumers, and to foster dialogue about CAM use between patients and their health care providers. In addition, a new online resource, tailored to the needs of health care professionals, is being launched on the NCCAM website. It includes information on the safety and efficacy of a range of CAM practices, and was developed in response to providers' needs for an evidence-based, one-stop resource to help answer their patients' questions on CAM.

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 alternative medicine to help build a fuller understanding of the usefulness and safety of CAM practices.

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, NY, 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, 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 the National Institutes of Health 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. Dr. Briggs is also a member of the NIH Steering Committee, the senior most governing board at the NIH.

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