National Center for Complementary and Alternative Medicine

The National Center for Complementary and Alternative Medicine (NCCAM), formerly the Office of Alternative Medicine (OAM), is a United States government agency dedicated to exploring complementary and alternative medicine (CAM) healing practices in the context of rigorous science, in training complementary and alternative medicine researchers, and in disseminating authoritative information to the public and professionals.

The NCCAM 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

NCCAM was established in October 1991, as the "Office of Alternative Medicine" (OAM), which was re-established as NCCAM in October 1998. ^[1] 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 Office of Alternative Medicine (OAM) in 1992. Initially, Jacobs' insistence on rigorous scientific methdology caused friction with the Office's patrons, such as 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."^[2] 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."^[2] Finally, in 1994, Harkin appeared on television with cancer patients who blamed Jacobs of blocking their access to antineoplastons, leading Jacobs to resign from the OAM in frustration with the political climate.^[2]

With the OAM's increasing budget in the 1990s, the Office drew increasing criticism for disdaining the 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 N.I.H." Allen Bromley, then president of the American Physical Society, similarly wrote to Congress that the OAM had "emerged as an undiscriminate 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." A New York Times editorial described the OAM as "Tom Harkin's folly".^[3]

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.^[2] On January 24, 2008, Josephine P. Briggs, M.D., was named Director of NCCAM.

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

Focus

The four primary areas of focus are:

• Research - support clinical and basic science research projects in CAM by awarding grants across the country and around the world; we also design, study, and analyze clinical and laboratory-based studies on the NIH campus in Bethesda, Maryland.
• Research training and career development - award grants that provide training and career development opportunities for predoctoral, postdoctoral, and career researchers.
• Outreach - sponsor conferences, educational programs, and exhibits; operate an information clearinghouse to answer inquiries and requests for information; provide a Web site and printed publications; and hold town meetings at selected locations in the United States.
• Integration - integrate scientifically proven CAM practices into conventional medicine by announcing published research results; studying ways to integrate evidence-based CAM practices into conventional medical practice; and supporting programs to develop models for incorporating CAM into the curriculum of medical, dental, and nursing schools.

The forms of medical systems covered include:^[4]

• Whole medical systems such as homeopathy, naturopathy, traditional Chinese medicine, and ayurveda.
• Mind-body medicine such as meditation, prayer, mental healing, art therapy, music therapy, and dance therapy.
• Biologically based practices such as dietary supplements, herbal supplements, and other scientifically unproven therapies such as shark cartilage.^[5]
• Manipulative and Body-Based Practices such as spinal manipulation (both chiropractic and osteopathic) and massage.
• Energy therapies such as qigong, reiki, therapeutic touch, and electromagnetic therapy.

Operations

The NCCAM 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 the NCCAM, 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.".

The NCCAM budget for 2005 was $123 million. For fiscal year 2009 (ending September 30, 2009), it was $122 million.^[6]

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 NCCAM, $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.^[6]

The NCCAM budget for 2011 was $127.7 million.^[7] They have requested a $3,399,000 funding increase for their 2012 budget.^[8]

Criticism

Critics allege that despite the publicized intentions at its founding, NCCAM and its predecessor, the Office of Alternative Medicine, have spent more than $800 million on such research since 1991 but have neither succeeded in demonstrating the efficacy of a single alternative method nor declared any alternative medicine treatment ineffective. "The NCCAM continues to fund and promote pseudoscience. Political pressures and the Center's charter would seem to make this inevitable," said Kimball C. Atwood IV, M.D.^[9]

A policy forum in Science stated,

We believe that NCCAM [National Center for Complementary and Alternative Medicine] 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...In view of the popularity of alternative therapies, it is appropriate to evaluate the efficacy and safety of selected treatments.

but research falls below the standards of other NIH institutes. NCCAM budget for 2005 was $123.1 million. The charter said that 12 of the 18 members of the NCCAM Advisory Council "shall be selected from among the leading 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". Clinical trials of St. John's wort, echinacea, and saw palmetto have been published; none was more effective than placebo, but manufacturers said the studies were flawed, and these studies are unlikely to change practices. 70% said they would continue using a supplement that a government agency said was ineffective. NCCAM is funding a study of EDTA chelation therapy for coronary artery disease with 2,300 patients, even though smaller controlled trials have found chelation ineffective. NCCAM is also 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 that would normally eliminate toxins; severe adverse effects are associated with the Gonzalez regimen. No evidence in peer-reviewed journals supports the plausibility or efficacy of chelation therapy or the Gonzalez protocol^[10] and a test of the protocol reported in 2009 found patients receiving the treatment had worse quality of life and died faster than conventionally treated counterparts.^[11]

References

1. ^ Important Events in NCCAM History
2. ^ ^{a b c d} Hurley, Dan (2006). Natural Causes. New York: Broadway Books. ISBN 978-0-7679-2042-1. 
3. ^ Jaroff, Leon (October 6, 1997). "Bee Pollen Bureaucracy". New York Times. http://www.nytimes.com/1997/10/06/opinion/bee-pollen-bureaucracy.html. Retrieved April 13, 2009. 
4. ^ "What is CAM?". NCCAM. February 2007. http://nccam.nih.gov/health/whatiscam/overview.htm. Retrieved 2009-04-18. 
5. ^ "Study Finds Shark Cartilage Extract Does Not Improve Lung Cancer Survival". NCCAM. February 2007. http://nccam.nih.gov/research/results/spotlight/061710.htm. Retrieved 2009-04-18.  A joint study funded by the NCCAM and the NCI (National Cancer Institute) found shark cartilage to be an ineffective treatment for cancer and do not endorse its use.
6. ^ ^{a b} By David Brown (March 17, 2009). "Critics Object to 'Pseudoscience' Center". Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602139.html. 
7. ^ "NCCAM Funding: Appropriations History". NIH. 12 September 2011. http://nccam.nih.gov/about/budget/appropriations.htm. Retrieved 2011-09-24. 
8. ^ "Fiscal Year 2012 Budget Request". NIH. 12 September 2011. http://nccam.nih.gov/about/offices/od/directortestimony/0511.htm. Retrieved 2011-09-24. 
9. ^ http://www.csicop.org/si/show/ongoing_problem_with_the_national_center
10. ^ 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. 
11. ^ Chabot, J. A.; Tsai, W. Y.; Fine, R. L.; Chen, C.; Kumah, C. K.; Antman, K. A.; Grann, V. R. (2009). "Pancreatic Proteolytic Enzyme Therapy Compared with Gemcitabine-Based Chemotherapy for the Treatment of Pancreatic Cancer". Journal of Clinical Oncology 28 (12): 2058–63. doi:10.1200/JCO.2009.22.8429. PMC 2860407. PMID 19687327. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2860407. 

External links

• NCCAM home page
• NCCAM research results
• NCCAM Clearinghouse, the public point of contact for scientifically based information on CAM and for information about NCCAM
• NCCAM Congressional appropriations
• Why the National Center for Complementary and Alternative Medicine (NCCAM) Should Be Defunded Essay by Wallace I. Sampson, M.D.