National Center for Complementary and Alternative Medicine (NCCAM)

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Fiscal Year 2014 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

May 2013

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) 2014 budget request for NCCAM. The FY 2014 budget includes $129,041,000, which is $1,221,000 more than the comparable FY 2012 appropriation of $127,820,000.

Complementary and integrative health practices, which often have origins outside of conventional medicine, are increasingly being incorporated into health care. While decisions about the use of these interventions are sometimes made with the guidance of a health care provider, often this is not the case. Both consumers and providers are often confronted with limited objective information about the safety and effectiveness of these approaches. NCCAM is committed to developing the evidence needed for consumers and providers to make informed decisions about complementary and integrative health practices.

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Use of Complementary and Integrative Health Care

Data from the 2007 National Health Interview Survey (NHIS) conducted by Centers of Disease Control and Prevention (CDC), shows that almost 40 percent of Americans use complementary and integrative health practices and spend close to $34 billion annually out-of-pocket on these practices. New data from the 2012 NHIS is expected later this year; it will include the first comprehensive picture of use these practices by children. We are also looking forward to results from the 2012 National Ambulatory Medical Care Survey (NAMCS), in which 30,000 physicians were interviewed and which will provide the first detailed look at integration of these complementary interventions into private medical practice. NCCAM works closely with the CDC to develop the questions used in these surveys to assure they capture the most comprehensive picture of the use of complementary and integrative health practices in the United States.

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Reducing Pain and Improving Symptom Management

A top priority for NCCAM is research related to chronic pain, an enormous public health problem that affects 100 million Americans and is a major reason people use complementary health practices. While drug-based treatment options offer benefit to some people, they are only partially effective in others and can have serious side effects or be addictive. To help address these important issues, NCCAM is investing in research on several promising non-pharmacological approaches for treating chronic pain, such as massage, spinal manipulation, yoga, meditation, and acupuncture. For example, a recent NCCAM-funded study, employing individual patient data meta-analyses, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain and offers important insight into its analgesic effects.

Chronic low back pain (cLBP) is a complicated and expensive public health problem. Unfortunately, progress in research on cLBP is handicapped because investigators often use inconsistent terminology, case definitions, baseline assessments, and outcome measures. To address this issue, NCCAM is providing leadership to a trans-NIH Task Force which will develop common data elements to be used in clinical research studies on cLBP. Better standards will facilitate the comparison of studies and improve our ability to replicate findings and pool data from multiple studies.

In addition, we are particularly interested in understanding how complementary health practices can produce beneficial effects through changes in the perception of pain by the brain. For example, we are focusing the research of our intramural research program on understanding of 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 approaches. This past year, NCCAM appointed Dr. Catherine Bushnell, an internationally recognized pain and neuroscience researcher, scientific director of NCCAM’s intramural program. She will direct research on the mechanisms by which emotion, attention, placebo effects, and other such processes modulate pain or pain processing. While leading the NCCAM effort, Dr. Bushnell is ensuring that it is highly collaborative within the larger NIH neuroscience enterprise.

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Advancing Research on Natural Products

Another important area of emphasis for NCCAM is continued exploration of the underlying biological effects and mechanisms of action of complementary therapies. Accordingly, NCCAM supports research on the molecular and cellular targets of natural products and the biological mechanisms of both beneficial and harmful effects.

We are especially concerned with the safety of natural products, given the widespread availability and use of these products by the public. Evidence continues to emerge of potentially important interactions between medications and the chemical constituents of various natural products - whether consumed as dietary supplements or foods. For example, taking St. John’s Wort can decrease the effects of certain medications while drinking grapefruit juice can increase them. This is important because many patients taking prescription medications are also using various natural products, including herbal medicines, probiotics and other dietary supplements. To investigate these issues, NCCAM is working with experts to identify optimal technologies for studying interactions and strategies for implementing a more systematic approach to evaluation of natural product-drug interactions.

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Developing Methods to Study Real World Practices

One of the greatest methodological challenges in clinical research is moving beyond traditional methods of randomized clinical trials to more broad-based, real-world settings. To meet this challenge, the NIH Common Fund supports the Health Care Systems Research Collaboratory to develop innovative methods for conducting clinical research in partnerships with health care delivery organizations. NCCAM provides leadership for this initiative, which will address questions of major public health importance by conducting large-scale and more cost-effective clinical research within the settings where patients receive their care. NCCAM is overseeing the activities of the Collaboratory’s Coordinating Center, which provides national leadership and technical expertise in all aspects of research with the Collaboratory’s healthcare system partners.

NCCAM is also interested in maximizing learning about the real world usefulness of complementary and integrative health practices that are being integrated into U.S. military and veterans’ health care systems. Toward this end, NCCAM is partnering with the Department of Veterans Affairs and the National Institute of Drug Abuse to encourage research on complementary approaches for the management of pain and associated problems (e.g., stress, brain injury, depression, anxiety, sleep difficulties, substance abuse) among military personnel, veterans, and their families.

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Providing Useful Information to the Public

To help the public make informed decisions about the use of complementary and integrative health and to enable health care providers to better manage patient care, NCCAM provides reliable, evidence-based information through multiple channels, including its web site, broadcast, print and social media. Last summer, NCCAM launched an online video, Scientific Results of Yoga for Health and Well-Being, which highlights NCCAM-funded research on yoga as a complementary health practice. For healthcare professionals, NCCAM’s Web site provides links to scientific literature; clinical practice guidelines; and online continuing education modules. In addition, NCCAM’s monthly e-newsletter, NCCAM Clinical Digest, summarizes the state of the science on complementary health practices for specific health topics.

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Conclusion

To build the scientific evidence needed by consumers and healthcare professionals regarding the safety and usefulness of complementary practices, NCCAM funds research, provides leadership, and leverages partnerships within NIH, with other federal agencies and private sector healthcare delivery systems.

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.

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