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 30, 2015
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s fiscal year (FY) 2016 budget request for the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH). The FY 2016 budget request for NCCIH is $127,521,000, which is $3,459,000 more than the FY 2015 level.
NCCIH is the Federal Government’s lead agency for supporting research on complementary and integrative health practices. NCCIH’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. Complementary and integrative health approaches include: mind-body interventions, such as massage, acupuncture, yoga, meditation; and use of natural products, such as dietary supplements and probiotics.
Results from the 2012 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention with support from NCCIH, indicate that one-third of U.S. adults aged 18 and older use complementary and integrative health approaches. Many of these individuals seek complementary and integrative health approaches to improve their health and well-being or to manage symptoms of chronic diseases or the side effects of conventional medicine. Natural products (dietary supplements other than vitamins and minerals) are the most commonly used complementary health approach, followed by deep breathing exercises and yoga.
Reducing Pain and Improving Symptom Management
Pain is the most common reason Americans turn to complementary and integrative health practices. Chronic pain affects approximately 100 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. According to the Institute of Medicine, the expenses of treatment and lost productivity due to pain cost the Nation more than $600 billion annually. For people living with pain, many conventional treatments provide inadequate relief and often have unacceptable side effects. To address this public health need, NCCIH invests in research on pain and the non-pharmacologic management of pain. NCCIH’s intramural research program is devoted to studying the role of the brain in perceiving, modifying, and managing pain. Scientists are investigating the role of the brain in pain processing and how factors such as emotion, environment, and genetics affect its perception. NCCIH’s extramural research program supports investigators examining the safety and efficacy of complementary health approaches for pain. Recently, several NCCIH-funded studies of spinal manipulation yielded interesting results. One study found that manual thrust manipulation provided greater short-term reductions in disability and pain for people with acute or sub-acute low-back pain than mechanical-assisted manipulation or usual medical care. Another study found that chiropractic spinal manipulation did not increase the risk of stroke in older people with neck pain.
NCCIH is collaborating with the National Institute on Drug Abuse (NIDA) and the Department of Veterans Affairs (VA) on a clinical research program to address the critical need for non-drug options to treat and manage chronic pain in military and veteran populations. These populations are disproportionately affected by pain and prescription drug abuse. This program is funding 13 research projects that explore non-drug approaches to manage pain and related health conditions, such as post-traumatic stress disorder, drug abuse, and sleep disorders. In addition, a working group of NCCIH’s Advisory Council, along with VA and Department of Defense (DOD) stakeholders, developed recommendations for future collaborations among NCCIH, VA, and DOD. Its recommendations included: assessing the feasibility of conducting large-scale research studies on non-drug approaches for pain management in cooperation with DOD and VA; and evaluating the impact of a multi-component, patient-centered integrative approach to pain, with function and quality of life as primary outcome measures.
Advancing Research on Natural Products
Natural products or probiotics, whether consumed as components of the diet or as dietary supplements, have a major impact on health. NCCIH supports research on the biological mechanisms of the benefits and potential harmful effects of natural products, including their interaction with medications. In FY 2015, NCCIH plans to establish a Center of Excellence for Natural Product-Drug Interaction Research to systematically examine methods for studying natural product-drug interactions; to develop standards to clarify which interactions have clinical impact; and to disseminate the standards broadly. To propel needed innovations in technology and methodology in the field of natural products research, NCCIH, in partnership with the NIH Office of Dietary Supplements, plans to support a Center for Advancing Natural Products Technology and Innovation in FY 2015.
The 2012 NHIS found that Americans’ consumption of probiotics has increased four-fold since 2007. Probiotics are live microorganisms (in most cases, bacteria) that may be helpful for diarrhea and possibly other conditions. They are available as dietary supplements and are contained in some dairy foods, such as yogurt. Evidence is emerging about the importance of bacteria in the intestinal tract (gut microbiota) in weight management, inflammation, and other conditions. The potential role of probiotics in maintaining or restoring gut microbiota is an area of active investigation. NCCIH aligns its probiotics research with the trans-NIH Human Microbiome Project and works closely with other NIH Institutes and Centers, the Food and Drug Administration, and the Department of Agriculture.
Strengthening The Research Workforce
NCCIH supports a variety of training and career development programs. For example, NCCIH’s Interdisciplinary Complementary and Integrative Health Clinical Training Award funds partnerships between research-intensive institutions and those focused on clinical training in complementary approaches.
NCCIH makes research findings available to the public by leveraging emerging technologies, including video and social media. The NCCIH website provides information for consumers and health care providers, and NCCIH engages the public directly through Twitter chats on a variety of health topics with leading experts.
NCCIH continues to support research and leverage its strategic partnerships to build the scientific evidence needed by consumers, health care providers, and policymakers regarding the safety and efficacy of complementary and integrative health practices. NCCIH’s support of rigorous research is helping to increase our understanding of how these interventions work and for whom, and the optimal method of practice and delivery.
Josephine P. Briggs, M.D. Director, National Center for Complementary and Integrative Health
Josephine P. Briggs, M.D., an accomplished researcher and physician, is Director of the National Center for Complementary and Integrative Health. 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 leadership of NCCIH, Dr. Briggs is co-leader of the NIH Common Fund Health Care Systems Research Collaboratory, a five-year effort to conduct pragmatic clinical trials in partnership with clinical investigators and health care systems in the United States. Dr. Briggs is also a member of the NIH Steering Committee, the most senior governing board at NIH, and serves as a member of the NIH Scientific Management Review Board. She also is on the Executive Committee of the NIH Pain Consortium. In the past, she served as Acting Director of the Division of Clinical Innovation at the newly established National Center for Advancing Translational Sciences.
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.
In 1985, Dr. Briggs moved to the University of Michigan, Ann Arbor, Michigan, 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. In 2006, she accepted a position as senior scientific officer at the Howard Hughes Medical Institute. In 2008, she became NCCIH’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 and was deputy editor for the Journal of Clinical Investigation. She is an elected member of the Association of American 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, several NIH Director’s Awards, and the American Society of Nephrology John P. Peters Award in recognition for her wide-ranging contributions to improving the lives of patients and to furthering the understanding of kidney in health and diseases.