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National Center for Complementary and Integrative Health

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National Center for Complementary and Integrative Health
AbbreviationNCCIH (formerly NCCAM)
Formation1991 (as Office of Alternative Medicine)
1998 (as NCCAM)
TypeU.S. government agency
HeadquartersBethesda, Maryland
Official language
English
Director
Josephine P. Briggs, MD
Parent organization
National Institutes of Health
AffiliationsUnited States Public Health Service
Websitenccih.nih.gov

The National Center for Complementary and Integrative Health (NCCIH)[1] — formerly the National Center for Complementary and Alternative Medicine (NCCAM), and before that the Office of Alternative Medicine (OAM) — is a United States government agency with the goals of investigating complementary and alternative medicine (CAM) using rigorous scientific methodology, training complementary and alternative medicine researchers, and disseminating authoritative information to the public and professionals.

NCCIH is one of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the Department of Health and Human Services of the federal government of the United States. The NIH is one of eight agencies under the Public Health Service (PHS) in the Department of Health and Human Services (DHHS).

Organization and history

NCCIH was established in October 1991, as the Office of Alternative Medicine (OAM), which was re-established as NCCAM in October 1998.[2] Its mission statement declares that it is "dedicated to exploring complementary and alternative healing practices in the context of rigorous science; training complementary and alternative medicine researchers; and disseminating authoritative information to the public and professionals."

Joseph M. Jacobs was appointed the first director of the OAM in 1992. Initially, Jacobs' insistence on rigorous scientific methodology caused friction with the office's patrons, such as U.S. Senator Tom Harkin. Harkin criticized the "unbendable rules of randomized clinical trials" and, citing his use of bee pollen to treat his allergies, stated: "It is not necessary for the scientific community to understand the process before the American public can benefit from these therapies."[3] Harkin's office reportedly pressured the OAM to fund studies of specific "pet theories," including bee pollen and antineoplastons. In the face of increasing resistance to the use of scientific methodology in the study of alternative medicine, one of the OAM board members, Barrie Cassileth, publicly criticized the office, saying: "The degree to which nonsense has trickled down to every aspect of this office is astonishing ... It's the only place where opinions are counted as equal to data."[3] Finally, in 1994, Harkin appeared on television with cancer patients who blamed Jacobs for blocking their access to antineoplastons, leading Jacobs to resign from the OAM in frustration with the political climate.[3] In an interview with Science, Jacobs "blasted politicians - especially Senator Tom Harkin... for pressuring his office, promoting certain therapies, and, he says, attempting an end run around objective science."[4]

With the OAM's increasing budget in the 1990s, the office drew increasing criticism for its perceived lack of rigorous scientific study of alternative approaches in favor of uncritical boosterism. Paul Berg, a Nobel laureate in chemistry, wrote to the Senate that "Quackery will always prey on the gullible and uninformed, but we should not provide it with cover from the NIH." Allen Bromley, then-president of the American Physical Society, similarly wrote to Congress that the OAM had "emerged as an undiscriminating advocate of unconventional medicine. It has bestowed the considerable prestige of the NIH on a variety of highly dubious practices, some of which clearly violate basic laws of physics and more clearly resemble witchcraft."[3] One opinion writer in the New York Times described the OAM as "Tom Harkin's folly".[5]

Ultimately, in 1998, the Office of Alternative Medicine was elevated to the status of an NIH Center and renamed the National Center for Complementary and Alternative Medicine (NCCAM). With the increasing profile and budget of the Center, Stephen Straus, a former laboratory chief at the National Institute of Allergy and Infectious Disease, was brought in to head NCCAM with a mandate to promote a more rigorous and scientific approach to the study of alternative medicine.[3] On January 24, 2008, Josephine P. Briggs, MD, was named director of NCCAM.

NCCIH funds research into complementary and alternative medicine, including support for clinical trials of CAM techniques.

On December 17, 2014, the agency announced a name change to "National Center for Complementary and Integrative Health" (NCCIH).[1]

Focus

The four primary areas of focus are research, research training and career development, outreach, and integration.[6] NCCIH divides complementary and integrative medicine into five forms:[7]

Operations

The NCCIH charter states that "Of the 18 appointed members (of the council) 12 shall be selected from among the leading representatives of the health and scientific disciplines (including not less than 2 individuals who are leaders in the fields of public health and the behavioral or social sciences) relevant to the activities of NCCIH, particularly representatives of the health and scientific disciplines in the area of complementary and alternative medicine. Nine of the members shall be practitioners licensed in one or more of the major systems with which the Center is involved. Six of the members shall be appointed by the Secretary from the general public and shall include leaders in the fields of public policy, law, health policy, economics, and management. Three of the six shall represent the interests of individual consumers of complementary and alternative medicine."[9]

The NCCIH budget for 2005 was $123 million. For fiscal year 2009 (ending September 30, 2009), it was $122 million.[10]

Research in alternative medicine is done elsewhere at NIH, notably in the National Cancer Institute. The NIH's Office of Cancer Complementary and Alternative Medicine had the same budget as NCCIH, $122 million, for fiscal year 2009. Other parts of NIH had an additional $50 million for FY 2009; NIH's total budget was about $29 billion.[10]

The NCCIH budget for 2011 was $127.7 million.[11] They requested a $3,399,000 funding increase for their 2012 budget.[12]

Criticism

NCCIH has been criticized by Steven E. Nissen, Stephen Barrett, and Kimball Atwood among others, for funding, along with the National Heart, Lung, and Blood Institute[13] a study of EDTA chelation therapy for coronary artery disease, which lasted about 10 years and cost about $31 million, even though smaller, controlled trials found chelation ineffective.[14][15][16] Other NCCIH-funded studies have included the benefits of distant prayer for AIDS, the effects of lemon and lavender essential oils on wound healing,[17][18] "energy chelation", and "rats stressed out by white noise".[19]

In 2006, Donald Marcus and Arthur Grollman, fellows at the Institute for Science in Medicine, a scientific skepticism group,[20] criticized NCCIH in Science for funding a trial of gemcitabine with the Gonzalez regimen for stage II to IV pancreatic cancer, in the belief that cancer is caused by a deficiency of pancreatic proteolytic enzymes. Severe adverse effects were associated with the Gonzalez regimen, and no evidence in peer-reviewed journals supported the plausibility or efficacy of the regimen or chelation therapy.[21] The authors further commented, "We believe that NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science; and it is structured by its charter in a manner that precludes an independent review of its performance." They suggested that, while it was appropriate to study alternative therapies, the quality of its research was lower than other NIH institutes, and that these studies could be performed under the auspices of other institutes within the NIH.[21]

A 2012 study published in the Skeptical Inquirer examined the grants and awards funded by NCCIH from 2000 to 2011, which totaled $1.3 billion. The study found no discoveries in complementary and alternative medicine that would justify the existence of this center. The authors argued that, after 20 years and an expenditure of $2 billion, the failure of NCCIH was evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed medical journals. They recommended that NCCIH be defunded or abolished, and the concept of funding alternative medicine be discontinued.[22]

In his 2013 book Do You Believe in Magic?, Paul A. Offit — Professor of Vaccinology and Pediatrics at the University of Pennsylvania — took NCCIH to task for constituting a waste of public funds.

Since its birth, in 1999, NCCAM officials have spent about $1.6 billion studying alternative therapies. They've spent $374,000 of taxpayer money to find out that inhaling lemon and lavender scents doesn't promote wound healing; $390,000 to find out that ancient Indian remedies don't control Type 2 diabetes; $446,000 to find that magnetic mattresses don't treat arthritis; $283,000 to discover that magnets don't treat migraine headaches; $406,000 to determine that coffee enemas don't cure pancreatic cancer; and $1.8 million to find out that prayer doesn't cure AIDS or brain tumors or improve healing after breast reconstruction surgery. Fortunately, NCCAM has recently abandoned these kinds of studies, choosing instead to focus on studies of dietary supplements and pain relief.[23]

References

  1. ^ a b NIH complementary and integrative health agency gets new name, NIH, December 17, 2014
  2. ^ "National Center for Complementary and Integrative Health - Organization - The NIH Almanac - National Institutes of Health (NIH)". Retrieved July 1, 2015.
  3. ^ a b c d e Dan Hurley (2006). Natural causes: death, lies, and politics in America's vitamin and herbal supplement industry. New York: Broadway Books. ISBN 978-0-7679-2042-1.
  4. ^ Marshall, Eliot (1994). "The Politics of Alternative Medicine". Science. 265 (5181): 2000–2002. doi:10.1126/science.8091220. PMID 8091220.
  5. ^ Jaroff, Leon (October 6, 1997). "Bee Pollen Bureaucracy". New York Times. Retrieved April 13, 2009.
  6. ^ Sharon K. Zoumbaris (2012). Encyclopedia of Wellness: From Acai Berry to Yo-yo Dieting. ABC-CLIO. p. 591. ISBN 978-0-313-39333-4.
  7. ^ "What is CAM?". NCCIH. February 2007. Retrieved April 18, 2009.
  8. ^ "Study Finds Shark Cartilage Extract Does Not Improve Lung Cancer Survival". NCCIH. February 2007. Retrieved April 18, 2009. A joint study funded by NCCIH and the NCI (National Cancer Institute) found shark cartilage to be an ineffective treatment for cancer and do not endorse its use.
  9. ^ "NACCIH Charter". NCCIH. Retrieved July 1, 2015.
  10. ^ a b David Brown (March 17, 2009). "Critics Object to 'Pseudoscience' Center". Washington Post.
  11. ^ "NCCAM Funding: Appropriations History". NIH. September 12, 2011. Retrieved September 24, 2011.
  12. ^ "Fiscal Year 2012 Budget Request". NIH. September 12, 2011. Retrieved September 24, 2011.
  13. ^ NHLBI Questions and Answers: The NIH Trial of EDTA Chelation Therapy for Coronary Heart Disease Page accessed March 19, 2015
  14. ^ Roni Caryn Robin for the New York Times Wellness Blog. April 15, 2013 of Chelation Therapy Shows Benefits, but Doubts Persist
  15. ^ Stephen Barrett for Chelationwatch. November 16, 2012 Why the NIH Study of Chelation Therapy Should Have Been Stopped
  16. ^ Kimball C. Atwood, KC et al. Why the NIH Trial to Assess Chelation Therapy (TACT) Should Be Abandoned. Medscape J Med. 2008; 10(5): 115. PMID 18596934 PMC 2438277
  17. ^ Offit PA (May 2012). "Studying complementary and alternative therapies". JAMA. 307 (17): 1803–4. doi:10.1001/jama.2012.518. PMID 22550193.
  18. ^ Tsouderos, Trine (December 11, 2011). "Federal center pays good money for suspect medicine". Chicago Tribune. Retrieved February 6, 2012.
  19. ^ Tsouderos, Trine (December 11, 2011). "Energy healing sparks debate". The Chicago Tribune. Retrieved December 18, 2011.
  20. ^ "Our Fellows". Institute for Science in Medicine.
  21. ^ a b Marcus, D. M.; Grollman, AP (2006). "Science and Government: Enhanced: Review for NCCAM is Overdue". Science. 313 (5785): 301–2. doi:10.1126/science.1126978. PMID 16857923.
  22. ^ Mielczarek, E., Engler, B. 2012. Measuring Mythology: Startling Concepts in NCCAM Grants. Skeptical Inquirer 36(1)(January/February):35-43, 2012.
  23. ^ Offit, Paul A. (2013), Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine; New York: Harper Collins, pg 97.
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