Mr. Chairman and Members of the Committee:
I am pleased to present the President's Fiscal Year (FY) 2007 budget request for the National Center for Complementary and Alternative Medicine (NCCAM). The FY 2007 budget includes $120,554,000, a decrease of $911,000 over the comparable FY 2006 appropriation of $121,465,000.
NCCAM has made significant progress in discovering the potential of complementary and alternative medicine (CAM) to prevent and treat disease. During NCCAM's first 7 years, the Center has formed a research enterprise that addresses the challenges of conducting CAM research as well as training investigators, conducting outreach, and facilitating the integration of proven CAM therapies into the health care that Americans receive.
Setting the Course
Through national surveys, we know that two-thirds of Americans are using some form of CAM each year. We are gaining understanding of which Americans use the various CAM modalities and for which health purposes. These patterns of CAM use will inform NCCAM's research priority setting in FY 2007, along with guidance from two key documents:
- The NCCAM Strategic Plan for 2005–2009 [10MB PDF] (developed with input from the public and scientific and medical communities nationwide); and
- The Institute of Medicine's 2005 report, “Complementary and Alternative Medicine in the United States.”
In FY 2007, NCCAM will again collaborate with the Centers for Disease Control and Prevention to support the National Health Interview Survey to capture changes in trends of the American public's use of CAM.
Furthering the Research Mission
Seven years of NCCAM investments in CAM research translate to the support of more than 1,200 projects (in research, training, and career development) at over 260 U.S. institutions. There has been a 20-fold increase in the number of CAM papers published in leading scientific journals by NCCAM grantees. In FY 2007, building upon this strong foundation, NCCAM plans to further enhance CAM research in the following areas:
A Flourishing Centers Program
NCCAM has expanded and refined its approach to research centers. As a result, the Center now has a diverse cadre of multidisciplinary research centers at conventional and CAM institutions nationwide.
- Centers of Excellence for Research on CAM. Six centers with outstanding research records direct teams of CAM and conventional investigators to explore, using cutting-edge technologies, how CAM therapies may work.
- Developmental Centers for Research on CAM. Scientists and practitioners at 18 CAM and conventional institutions have forged research partnerships. In FY 2007 there will be new Phase I developmental centers for CAM institutions just launching programs of research, and Phase II developmental centers for CAM institutions prepared to undertake more sophisticated research studies.
- International Centers for Research on CAM. Two centers support U.S. investigators who collaborate with experts in the traditional medical systems of their own countries, building research expertise and capacity abroad and providing foreign researchers with valuable experience in navigating the NIH grants system.
- Botanical Research Centers. Seven dietary supplement research centers focusing on studies of botanical products are funded by NCCAM and the NIH Office of Dietary Supplements. Research conducted by these centers will advance the scientific base of knowledge about the safety, effectiveness, and mechanisms of action of botanicals.
Studies of Herbals and Other Dietary Supplements
Herbals and other dietary supplements are widely used by the American public and they are a research priority for NCCAM. Studying botanicals, however, has presented special research challenges related to product characterization, standardization, and dosage. With the advice of experts in herbal medicine and leaders of the dietary supplement industry, NCCAM is improving product consistency for research studies and thus increasing the probability that the studies NCCAM funds will yield accurate findings.
In this regard, the Center has developed research-quality cranberry products to use in studies of urinary tract infections and standardized an extract of milk thistle (silymarin), for study in patients with chronic viral hepatitis and non-alcohol-related steatohepatitis, a collaborative project with the National Institute of Diabetes and Digestive and Kidney Diseases.
NCCAM has worked with several NIH partners to design, conduct, and fund large clinical trials of dietary supplements. The largest of these was reported in February 2006 in the New England Journal of Medicine: a 4-year study (co-funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases) of glucosamine and chondroitin sulfate, two dietary supplements widely used by people with knee osteoarthritis. In this study, the two supplements combined did not provide statistically significant pain relief for all the participants, compared to placebo. However, a small subset of participants with moderate-to-severe pain had significant pain relief. An ancillary study is continuing to determine whether the combination of these supplements can prevent or delay further joint deterioration, a common long-term outcome for people with osteoarthritis.
A Broad Research Portfolio
There are hundreds of different practices, products, and approaches that comprise CAM. Thus, the research that NCCAM funds is wide-ranging. Areas that NCCAM will emphasize further in FY 2007 include:
- Manual therapies. The mechanisms of action underlying the effects of manipulative and body-based therapies such as chiropractic and massage are little understood. Therefore, NCCAM is launching an initiative in FY 2007 on the biology of manual therapies to better understand the effects of these techniques on the body.
- Mind-body medicine. One recent NCCAM-funded study found that tai chi combined with standard medical care benefits patients with chronic heart failure. Studies of meditation and mindfulness-based stress reduction in various health conditions are under way. NCCAM is also redirecting the focus of its intramural research program to emphasize studies of mind-body medicine.
- Echinacea. Research on echinacea is being done both because of the public health burden of the common cold and the public's widespread use of this natural product. A study of a single dosage of Echinacea purpurea to treat viral colds in healthy children was recently completed by an NCCAM grantee. A larger study is being undertaken in which a range of doses of this popular herb will be assessed for its ability to prevent colds in children.
- Immune responses. Many CAM interventions are believed to affect the immune system, either by enhancing its ability to thwart infection or by suppressing an overactive response, as occurs in autoimmune diseases. NCCAM is exploring the immune effects and basic mechanisms of action of various CAM modalities such as traditional Chinese herbal mixtures, ginseng, green tea, and Ginkgo biloba.
Expanding Training and Career Development
There can be no significant CAM research progress without a sufficient cadre of investigators who are both skilled in rigorous research and knowledgeable about CAM practices. NCCAM has increased the number, quality, and diversity of the CAM research community using a variety of approaches and grant mechanisms. In FY 2007, NCCAM will offer three new training opportunities: supplements to existing research grants, in order to attract more CAM practitioners into research endeavors; the CAM Practitioner Research Career Development Award, for CAM practitioners interested in research; and the NCCAM Career Transition Award, to help outstanding postdoctoral research fellows in their transition to an independent career in CAM research.
From the outset, NCCAM has made it a priority to help practitioners, patients, and the public make informed decisions about CAM. The Center conducts outreach to public and professional audiences through a variety of channels: information clearinghouse, website, quarterly newsletter, conferences, Distinguished Lecture Series, and online continuing education. With the National Library of Medicine, the Center publishes CAM on PubMed®, an online database of more than 400,000 research papers on CAM.
NCCAM is committed to facilitating the integration of safe and effective CAM therapies into conventional medicine. One example of this effort is within the NIH itself. The Center is establishing a new Integrative Medicine Consult Service at the NIH Clinical Center, to provide integrative medical consultations and enrich patient care. In addition, NCCAM continues to provide CAM curriculum development grants to conventional medical, dental, and nursing schools.
Collaborating Across NIH
NCCAM continues its collaborations with other NIH Institutes and Centers, as a contributing member of the biomedical research community. For example, NCCAM is a partner in several of the NIH Roadmap for Medical Research initiatives, including the Exploratory Centers for Interdisciplinary Research. Also, by participating in efforts like the NIH Neuroscience Blueprint, the NIH Pain Consortium, and the Trans-NIH Obesity Initiative, NCCAM can accelerate efforts to unlock the potential of CAM therapies through these multidisciplinary research initiatives.
Looking Toward the Future
Mindful of the lessons learned in our first 7 years as an NIH Center, and with growing understanding of the scientific opportunities and public health priorities to be addressed with CAM approaches, NCCAM will continue to explore options to sustain and improve the health and well-being of the American people.
Thank you, Mr. Chairman. I would be pleased to answer any questions that the Committee may have.