National Center for Complementary and Alternative Medicine (NCCAM)

eJournal > National Center for Complementary and Alternative Medicine (NCCAM)

by Kenton H Johnson, Executive Director, CompWellness Network and the NCCAM

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The NCCAM is an outgrowth of the Office of Alternative Medicine, both in the US National Institutes of Health. It has grown from a $2M to a $69M budget, and is the US government agency spearheading the validation of Complementary Healthcare modalities and practices.

As one of the 25 institutes and centers in the National Institutes of Health (NIH), the NCCAM conducts and supports basic and applied research and training and disseminates information on complementary and alternative medicine to practitioners and the public. The NIH is one of eight health agencies of the U.S. Public Health Service and is part of the US Department of Health and Human Services (DHHS).

Although the NCCAM does not serve as a referral agency for various alternative medical treatments or individual practitioners, it is one of the world’s foremost biomedical research institutions, and the Federal focal point for biomedical research in the United States.

It was originally initiated by Congressional mandate in 1992 as the Office of Alternative Medicine. Then in 1998, it was established as the NCCAM.

The National Advisory Council for Complementary and Alternative Medicine (NACCAM) comprises scientists, practitioners, physicians and other interested parties from across the country, who provide advice and support to the Director of the NCCAM. Members of the NACCAM are:

  • Michael F Cantwell, MD, MPH — San Francisco CA
  • Mary K Chung, BS — San Francisco CA
  • Richard H Grimm, MD, PhD — Minneapolis MN
  • Susan Holloran, BS — Bluemont VA
  • Janet R Kahn, PhD, LMT — Silver Spring MD
  • Konrad Kail, ND — Phoenix AZ
  • Ted Kaptchuk, OMD, LAC — Boston MA
  • Dana J Lawrence, DC — Lombard IL
  • Diane C Manley, LMT — New Bern NC
  • William C Meeker, DC, MPH — Davenport IA
  • Karen N Olness, MD — Cleveland OH
  • Herbert Pardes, MD — New York NY
  • Gilbert Ramirez, DrPH — Fort Worth TX
  • Everett R Rhoades, MD — Oklahoma City OK
  • Marilyn J Schlitz, PhD — Sausalito CA
  • Leanna Standish, ND, PhD, LAC — Kenmore WA
  • James E Williams, Jr, MS — Camp Hill PA

Director’s Message Optimistic

Stephen E Straus, MD – Courtesy of NCCAM – CLICK TO EMAIL

Newly appointed Director, Stephen E Straus, MD:

“The Federal Government created the National Center for Complementary and Alternative Medicine (NCCAM) as a response to the accelerating interest by the American people in the healing possibilities of CAM. NCCAM’s mission, in its simplest terms, is to assure our citizens, through the use of excellent science, that CAM procedures and products do what they purport to do. It is a mission I totally support and will do my very best to carry out.

“I believe well-designed and well-executed clinical research must be the essential factor in NCCAM’s search for scientific truth.

See the Director’s full statement by clicking on this section’s title.

“The big challenge for the NCCAM is moving from a limited body of knowledge to a scientifically valid one,” said Dr Straus. He announced a new extramural Frontier Medicine Research Program defined as those CAM practices for which there is no plausible biomedical explanation. Examples would include such interventions as magnet therapy, energy healing, and homeopathy. Despite the fact that these therapies are extensively used by the U.S. public, little high-quality research has investigated their efficacy and safety.

“NCCAM’s next generation of clinical trials will involve the study of milk thistle in treating liver disease and injury, melatonin and valerian for easing insomnia, feverfew for treatment of migraine headaches, and echinacea for use against respiratory tract infections and otitis media. Similarly, the NCCAM funded the national CAM research centers and botanical centers to seek advances in areas high on the public’s list of priorities, such as depression, dementia, osteoarthritis, and lung cancer.

Statistics

The Fall 1998 NCCAM Newsletter reported that a 1998 Stanford University survey found that 69 percent of Americans used some form of CAM in the past year. Researchers randomly surveyed 1,000 Americans about their use of 19 treatments and therapies ranging from Acupuncture to Yoga. They found that of those surveyed, 73 percent of men and 87 percent of women reported they have a conventional medical doctor they use for routine care. Of the respondents who used alternative medicine, 55 percent said they had reduced their use of conventional medical services. More than half of the respondents said their health insurance companies should cover alternative therapies and were willing to spend an average of more than $15 a month for those services.

Assistance for Practitioner Studies

In last year’s inaugural meeting of the NCCAM, the Acting Director, Dr William Harlan, noted that much of the information used as an evidence base for CAM is from case studies by CAM practitioners, ranging from manual manipulation to spirituality to use of herbs. The Cancer Advisory Panel For Complementary and Alternative Medicine (CAPCAM) looks at experiences that practitioners have had, organizes that set of experiences, reviews information, and decides what direction should be taken next. It does not make grants or fund project, but instead provides technical assistance and advice.

Dr Harlan said that systematic reviews accomplish several things: they allow researchers to structure all information from various sources, as well as different outcomes, and give researchers the opportunity to make the best assessment based on that information. Over 90 percent of trials in the United Kingdom are preceded by systematic review. The trials must be large enough to determine what the reasonable effect would be in most people.

Dr Harlan outlined program mechanisms for building an evidence base in CAM. They include:

  • Large, often multisite, randomized controlled trials (RCTs) solicited through NCCAM initiatives
  • Pilot studies, funded by investigator-initiated applications
  • Centers or program projects
  • Large observational studies, most efficiently done using established cohorts and surveys
  • Small controlled trials (centers, R-01, private sector)
  • Characterization of products and approaches by P-50 botanical centers, CAM centers, and the private sector
  • Individual observations.

Clinical trials now underway include investigation of St John’s Wort for depression, acupuncture for osteoarthritis, glucosamine and/or chondroitin sulfate for osteoarthritis, ginkgo biloba to prevent cognitive decline, shark cartilage for solid tumors, and the Gonzales Regimen for pancreatic cancer.

In discussions, Dr Harlan noted that it is clear that people want more information on alternative therapies, and they want to see these therapies subjected to trials that are as rigorous as possible. Dr Harlan did note that CAPCAM built a bridge between traditional and CAM medicine, but that the trust level in the cancer community was higher than in other areas of medicine.

Dr Harlan added that over time he has seen a change of attitude in the scientific community, and that CAM investigators are now being sought.

Dr Harlan’s complete statement on the subject.

Classification of CAM Practices

One of the more interesting developments is a categorization scheme initially developed by an ad hoc advisory panel to the NCCAM, then further refined. Its purpose is to assist in prioritizing applications for research grants in CAM. It is divided into seven major categories and includes examples of practices or preparations in each category.

  • Mind-Body Medicine — such as Yoga, T’ai Chi, Psychotherapy and Art Therapy
  • Alternative Medical Systems — Oriental Medicine, Indigenous Systems, Non-Conventional Western Systems (e.g., Homeopathy) and Naturopathy
  • Lifestyle and Disease Prevention — Clinical Preventative Systems (e.g., Panchakarma), Lifestyle Therapies, and Health Promotion (mostly research)
  • Biologically-Based Therapies — Herbology, Special Diets, nutritional/food supplements, and other procedures/products
  • Manipulative and Body-Based Systems — Chiropractic, Bodywork (e.g., Massage Therapies), Non-Conventional Therapies (e.g., Colonics)
  • Biofield — Energy Therapies (e.g., Healing Touch and Reiki)
  • Bioelectromagnetics — medical electromagnetics

Click heading for the full listings under each category.

Trials and Projects

The new director of the NCCAM’s Division of Extramural Research, Training, and Review , Richard L Nahin, PhD, MPH, states, “…the large trials [studies] will be coming to an end and their results will be published.

  • Hypericum [St. John's wort]
  • Acupuncture
  • Shark cartilage
  • Glucosamine
  • Pain studies

… will generate a great deal of information about what works and what doesn’t–and why.”

Other well-supported and continuing studies, as reported to Congress in March when asking for a $71M budget for next year — see Current Research Studies. These included:

  • Ginkgo biloba
  • Chiropractic medicine
  • Botanicals
  • Palmetto extract

It was also reported that future studies and programs will include:

  • Study milk thistle extract for treating Hepatitis C and other hepatic diseases
  • Facilitate the integration of validated CAM therapies into conventional medical practice
  • Make awards to foster incorporation of CAM information into the curricula of medical and allied health schools and continuing medical education programs
  • Educate eager medical students about CAM so that they may knowledgeably guide an avid patient base toward safe and effective CAM applications.
  • Work to overcome the reluctance of conventional physicians to consider validated CAM therapies and to assimilate proven ones into their practice.

Opportunities

The grants and clinical trial opportunities are attainable and real.

Check at the NIH Grants site and the National SBIR Conference Center Web Site for complete information, as well as order PHS 2000-2 Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Grant Applications from the NCCAM Clearing House. The next conference is May 5-7 in Washington DC, and the next due date is August 1st.

The U.S. National Institutes of Health, through its National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members and members of the public current information about clinical research studies. Clinical trials are research studies in which new treatments — drugs, diagnostics procedures, vaccines, and other therapies — are tested in people to see if they are safe and effective

The Warren Grant Magnuson Clinical Center (NIH) Clinical Studies Database contains extensive clinical studies information.

Contact

Direct all requests for information and questions regarding the NCCAM to: NCCAM Clearinghouse, PO Box 8218, Silver Spring, MD 20907-8218, Email: nccam-info@nccam.nih.gov, Phone: 1-888-644-6226, TTY/TDY: 1-888-644-6226, Fax: 301-495-4957