The mission of NCCIH is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care.
Scientific evidence informs decisionmaking by the public, by health care professionals, and by health policymakers regarding the use and integration of complementary and integrative health approaches.
The National Center for Complementary and Integrative Health (NCCIH) is the lead Federal agency for scientific research on the usefulness and safety of complementary and integrative health practices. To address the need for objective evidence as to the safety and efficacy of many of these approaches, NCCIH supports rigorous scientific investigation to better understand how these interventions work, for whom, and the optimal methods of practice and delivery.
NCCIH supports research on a broad range of practices, interventions, and natural products that have origins outside of conventional Western medicine. The research supported spans the continuum of basic, mechanistic, translational, efficacy, and effectiveness research. Continued emphasis on both basic research to understand biological effects and mechanisms of action and on efficacy studies to determine specific clinical effects of interventions is essential in developing the scientific evidence base. “Complementary” health approaches include mind and body interventions such as massage, acupuncture, yoga, and meditation, and natural products such as herbs, fish oil, melatonin, and probiotics. Many of these products and practices are in widespread use by the public, as shown by the 2012 National Health Interview Survey (NHIS), though most people who use complementary health approaches use them in conjunction with conventional health care.
NCCIH also supports research on integrative health approaches that bring conventional and complementary approaches together in a coordinated way. The use of integrative approaches to health and wellness has grown within care settings across the United States. The evidence base on integrative approaches, however, is limited, but growing. For example, researchers are currently exploring the potential benefits of integrative health in a variety of situations, including pain management for military personnel and Veterans, relief of symptoms in cancer patients and survivors, and programs to promote healthy behaviors.
To fulfill its mission and leverage its research investments, NCCIH collaborates with other National Institutes of Health (NIH) Institutes, Centers, and Offices; other Federal agencies; professional societies; patient advocacy groups; and organizations with an interest in improving health and well-being. Through these collaborations, NCCIH enhances its research portfolio, expands its multidisciplinary expertise, and incorporates a broader understanding of the health needs and perspectives of individuals using complementary health practices.
Use of Complementary and Integrative Approaches in the United States
The NHIS conducted by the Centers for Disease Control and Prevention (CDC), provides the most comprehensive data available on Americans’ health. In 2002, 2007, and 2012, the NHIS included a special section, developed jointly by the CDC National Center for Health Statistics and NCCIH and supported by NCCIH, on the use of complementary and integrative health approaches.
NHIS data show that about one in three U.S. adults (33.2 percent) used complementary health approaches in 2012, as did about one in nine children age 4 to 17 (11.6 percent). Natural products (dietary supplements other than vitamins and minerals) were used by 17.7 percent of adults and 4.9 percent of children. Fish oil, glucosamine and/or chondroitin, probiotics/prebiotics, and melatonin were among the most widely used natural products. Mind and body approaches in widespread use included yoga (used by 9.5 percent of adults and 3.1 percent of children), chiropractic or osteopathic manipulation (8.4 percent of adults; 3.3 percent of children), meditation (8.0 percent of adults; 1.6 percent of children), and massage therapy (6.9 percent of adults; 0.7 percent of children).
- Complementary Health Approaches
- A group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional or allopathic medicine. Most of these practices are used together with conventional therapies.
- Integrative Medicine
- The term usually used to refer to a style of practice that places strong emphasis on a holistic approach to patient care while focusing on reduced use of technology. Physicians advocating this approach generally include selected complementary health practices in the care they offer patients, and many have established practice settings that include complementary health practitioners.
- Natural Products
- A group of complementary health approaches that includes a variety of products such as herbs (also known as botanicals), vitamins and minerals, and probiotics. These products are widely marketed, readily available to consumers, and often sold as dietary supplements.
- Mind and Body Practices
- Complementary health approaches that include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher such as yoga, chiropractic and osteopathic manipulation, meditation, acupuncture, and massage therapy.
Examples of Complementary Health Approaches
- Herbs (also called botanicals
- Vitamins and minerals
Mind and Body Practices
- Art therapy
- Breathing practices
- Craniosacral therapy
- Guided imagery
- Healing touch
- Massage therapy
- Progressive relaxation
- Qi gong
- Spinal manipulation
- Tai chi
- Trager psychophysical integration
Foster Discovery and Innovation by Setting Priorities and Enhancing Stewardship
NCCIH strives to invest in research that will drive new discoveries that may lead to improved public health and health care. The Center’s research priorities reflect public health needs, scientific promise, amenability of topics to rigorous scientific inquiry, potential to impact health care practices, and relationship to use and practice.
The relative burden of a disease or condition on human health and well-being is an important consideration in priority setting. According to the Institute for Health Metrics and Evaluation, the top five leading causes of years lived in less than ideal health (YLDs) include low-back and neck pain, other musculoskeletal disorders, depressive disorders, and anxiety disorders. Complementary and integrative health interventions have shown promise in treating and managing these conditions, but additional research is needed to identify and optimize beneficial interventions.
Consistent with this principle, NCCIH has made pain management a major emphasis in its research efforts. Pain is a major public health problem and is the most common reason why Americans use complementary and integrative health practices. Data from the 2012 NHIS estimated that 126.1 million adults reported some pain in the previous 3 months, with 25.3 million adults (11.2 percent) suffering from daily (chronic) pain and 23.4 million (10.3 percent) reporting a lot of pain. Conventional care often fails to manage chronic pain effectively, and other approaches to relieve or reduce pain and increase functional ability are needed. Research studies have shown that some complementary health modalities may reduce pain associated with some conditions; examples include massage, spinal manipulation, and yoga for chronic back pain and tai chi for fibromyalgia pain.
NCCIH also seeks to identify strategies for promoting health and preventing disease. Behavioral risk factors, including an unhealthy diet, being overweight or obese, living a sedentary life, smoking or using tobacco products, and the excessive consumption of alcohol, are linked to increased rates of cardiovascular disease, cancer, and diabetes. Preliminary evidence indicates that some complementary health approaches may be useful in encouraging improved self-care, an improved personal sense of well-being, and a greater commitment to a healthy lifestyle. For example, analysis of the 2012 NHIS data indicates that many people who practiced yoga reported that it motivated them to practice healthier behaviors, including eating better and exercising more regularly. While causal relationships between the practice of complementary approaches and healthy behaviors have not been established, further research is needed to explore, clarify, and examine their relationship.
Scientific Plausibility and Rigor
NCCIH focuses on areas that will have the greatest impact by prioritizing research topics that show scientific opportunity and promise and are amenable to rigorous scientific inquiry. No matter how interesting an approach may be, if the evidence favoring it is too limited to support the scope and direction of a proposed study, or if reliable, rigorous methods of measurement do not exist, that topic is not suitable for full-scale investigation.
As a responsible steward of its publicly provided resources, NCCIH is highly selective in the choice of topics for major clinical trials. Decisions about which large-scale trials to support must be based on the strength, reliability, and reproducibility of signals from clinical experience and preliminary, smaller pilot studies, as well as on evidence of scientific plausibility obtained from mechanistic studies. Adequate methods and tools to accurately and effectively measure clinical outcomes are equally important to sound research design. Objective, validated measurement tools are essential, and so are processes and procedures to ensure quality control, whether the intervention is mind and body–based or a natural product. For example, NCCIH has a strict natural product integrity policy to ensure that all natural products used in research supported by the Center are fully identified, characterized, and standardized.
Priority Setting Framework
NCCIH is committed to funding research in areas that will have an impact on health and health care. When considering funding a potential research project, the Center assesses whether it is reasonably likely that the results of the research could lead to changes in the health practices of American consumers or health care providers or in the decisions of health policymakers. The Center also considers whether the research addresses an important public health concern or need for scientific information regarding the safety, efficacy, or effectiveness of complementary and integrative health approaches.
- Scientific Promise
- Does a reasonable body of evidence support the potential of the proposed research to lead to improved (1) options or strategies to treat troubling or prevalent health conditions or symptoms or (2) approaches to promote better health and well-being?
- Is evidence sufficient to support the scope and directions of the proposed research? If not, what research is needed to establish such evidence?
- Amenability to Rigorous Scientific Inquiry
- Are the key research goals achievable, and are the key research questions amenable to rigorous scientific investigation, given needed and available methods for measurement, translational tools, and technologies?
- Are potential approaches feasible and scientifically plausible? Do they lend themselves to rigorous quality control? If not, does the proposed research focus appropriately on developing needed methods, tools, and technologies?
- Potential to Change Health Practices
- Is it reasonably likely that the results of the research or program could lead to changes in the health practices of consumers or health care providers or in the decisions of health policymakers?
- Relationship to Use and Practice
- Does the proposed project address an important public health concern or scientific information need regarding efficacy, safety, or public use of complementary health approaches?