Statement to the House Subcommittee on Labor, DHHS, and Education Appropriations (March 6, 2007)
Ruth L. Kirschstein, M.D., Acting Director National Center for Complementary and Alternative Medicine
Mr. Chairman and Members of the Committee:
I am pleased to present the President's Fiscal Year (FY) 2008 budget request of $121,699,000 for the National Center for Complementary and Alternative Medicine (NCCAM).
In the 7 years since it was established, NCCAM has built a global enterprise of scientific excellence and leadership in research on complementary and alternative medicine (CAM). NCCAM-supported studies, carried out at more than 260 institutions, encompass the wide range of CAM practices and have resulted in more than 1,500 scientific papers published in peer-reviewed journals. This effort continues. In the past year, NCCAM has launched studies to:
- develop innovative tools and technology for studying biologically based and mind-body interventions;
- assess the potential of community-based primary care research networks to increase scientific knowledge about the safety, efficacy, and cost effectiveness of CAM; and
- increase scientific understanding of the mechanisms underlying manipulative and body-based practices.
The progress that has been made by the research community in understanding the scientific basis of CAM is, in large part, attributable to the leadership of Stephen E. Straus, M.D., NCCAM's director from 1999 to 2006. Dr. Straus championed research to establish the safety and efficacy of many CAM practices while maintaining the rigorous standards of science for which the National Institutes of Health is recognized. Under his leadership, CAM research has been established as a legitimate field of scientific inquiry which is laying the scientific foundation for the emerging discipline of integrative medicine.
NCCAM's Role and the Changing Nature of Medicine
Integrative medicine is a health care approach that makes use of all appropriate disciplines, therapies, and health care professionals to achieve optimal health and healing. This is a well-documented trend, both in American health care and globally. For example, the Consortium of Academic Health Centers for Integrative Medicine has grown from 9 institutions in 1999 to 36 North American research centers today. And the Association of American Medical Colleges reported that the proportion of medical schools offering CAM courses grew from 26 percent in 2001 to 78 percent in 2004. Patient demand and market forces are driving much of the integrative medicine movement. A recent American Hospital Association report states: “If we are genuinely interested in delivering person-centered care we must understand how to rationally integrate the use of complementary therapies in a safe, timely, effective, efficient, and equitable manner.” NCCAM's role is to support rigorous scientific research on CAM, disseminate authoritative, evidence-based information to both the public and health care professionals, and train the next generation of CAM researchers.
Building the Evidence Base of Integrative Medicine
Unlike most of modern medicine, which builds its evidence base from basic research findings to clinical trials, CAM research must pursue both basic and clinical tracks simultaneously, since CAM interventions are widely used by the public. Thus, NCCAM supports a diverse portfolio of basic, translational, and clinical studies.
The benefits of this strategy are well illustrated by the example of acupuncture. In the past several years, a number of clinical trials supported by NCCAM have documented the efficacy and safety of this widely used CAM practice in a number of conditions. More recently, basic and translational research employing state-of-the-art neuroimaging technology has led to new insights into the mechanisms of action by which acupuncture might work. Not only does this new information provide a scientific explanation for acupuncture's effect, but it also elucidates mechanisms of brain function that will have direct relevance to other approaches to pain relief.
Advances of similar importance are emerging in other areas of CAM research. As is the case with acupuncture, this clinical and preclinical information fills gaps in knowledge about a number of CAM practices and builds a fuller understanding of what CAM can offer. Whether a study's result is positive or negative, we expand our knowledge not only about the tested therapy, but also learn more about the condition it is supposed to treat. Several examples from the past year illustrate this point further:
Arthritis. As the U.S. population ages, the need for better, safer, and more effective treatments for arthritis increases. Through basic studies, NCCAM-supported investigators determined that extracts of the spice turmeric, an important component of Ayurvedic medicine that is used in the treatment of a number of inflammatory disorders, contains specific compounds with anti-arthritic activity, as well as others that can inhibit this activity. This research suggests the need for further investigation of the potential of turmeric, points toward ways in which its use might be optimized, and yields insight into the mechanisms of arthritic disease.
Neurodegenerative Diseases. Ginkgo biloba is a dietary supplement widely used for its purported beneficial effects on brain function. NCCAM-funded investigators studying it in an animal model of Alzheimer's disease found that it reduces both the formation of the specific brain abnormalities seen in humans, and the resulting paralysis seen in the animals. These experiments lend support to the hypothesis that Ginkgo biloba may be useful in slowing the progression of Alzheimer's disease. That hypothesis is being tested in a large clinical trial of Ginkgo biloba for the prevention of dementia, supported by NCCAM and several other NIH Institutes.
In another preliminary clinical investigation, a group of NCCAM investigators determined that the dietary supplement creatine was more effective than placebo in reducing an important marker of DNA damage associated with Huntington's disease. This work lays the foundation for a larger and more definitive clinical investigation, and provides information needed to design an optimal trial of creatine for this devastating neurodegenerative disorder.
Menopause and Black Cohosh. Given concerns about the use of hormone replacement therapy to treat symptoms of menopause, many women have turned to the dietary supplement black cohosh for relief, although evidence supporting this approach has been scant. In 2006, a clinical trial supported by the National Institute on Aging and NCCAM failed to show relief of menopause-associated hot flashes by black cohosh treatments. Two other large clinical trials of black cohosh continue.
Training the Next Generation of Cam Researchers
The rigorous basic, translational, and clinical research required to understand integrative medicine must be a collaboration between CAM practitioners and experienced scientists. This multidisciplinary approach is the fundamental tenet of NCCAM's strategy in support of research training and career development. Since its inception, the Center has increased the percentage of funds committed to research training and career development—from 1.3 percent in FY 1999 to 8.3 percent in FY 2006—to support research training, career development, and educational opportunities. Recipients of CAM doctoral degrees are now among those eligible for National Research Service Awards, as well as for the NIH-wide loan repayment program.
Delivering Authoritative Information
NCCAM is recognized as a source of authoritative, evidence-based information on CAM. Information on CAM treatments, herbs and dietary supplements, advice for consumers, research results, and clinical trials are available in English and Spanish in print and electronic form. In 2006, NCCAM's website, cited by Prevention magazine for “Best Alternative Medical Information,” had more than 2.6 million visitors. CAM on PubMed®, a database developed in partnership with the National Library of Medicine, now indexes more than 467,000 articles related to CAM. NCCAM's online continuing education program offers information on a variety of topics to the public and health professionals. A new patient/provider education initiative –“Time to Talk”– encourages informed and open communication between patients and physicians about CAM use, to ensure safe, integrated, and personalized care.
NCCAM will build on the foundation of scientific accomplishment and leadership that it has established during its first 7 years. Specific new activities planned for FY 2008 include the following.
- Working in partnership with the Centers for Disease Control and Prevention, NCCAM will support the first national, population-based survey assessing CAM use among the U.S. pediatric population. This study will fill an important information gap in knowledge of CAM use in children, and help NCCAM and the broader scientific community in establishing pediatric CAM research priorities.
- A new initiative will examine the potential influence of genetic variation on the likelihood of response to selected CAM interventions. This phenomenon, an important factor in the variation observed in responsiveness to conventional medicine, will be examined through linking new basic research to ongoing clinical trials, maximizing the value of the investment in both.
- A multidisciplinary workshop will bring together scientists from a broad range of the physical, social, and biological sciences to explore novel methodologies for clinical research of complex CAM approaches that make up whole medical systems.
Through these and other activities, NCCAM will continue to provide leadership in establishing the emerging discipline of integrative medicine. Thank you, Mr. Chairman. I would be pleased to answer any questions that the Committee may have.