National Center for Complementary and Integrative Health

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National Center for Complementary and Integrative Health
AbbreviationNCCIH
Formation1991
Type Governmental organization
Headquarters Bethesda, Maryland
Location
  • United States
Official language
English
Director
Helene Langevin, MD
Parent organization
National Institutes of Health
Affiliations United States Public Health Service
Website nccih.nih.gov
Formerly called
National Center for Complementary and Alternative Medicine (NCCAM)
Office of Alternative Medicine (OAM)

The National Center for Complementary and Integrative Health (NCCIH) is a United States government agency which explores complementary and alternative medicine (CAM). It was initially created in 1991 as the Office of Alternative Medicine (OAM), and renamed the National Center for Complementary and Alternative Medicine (NCCAM) before receiving its current name in 2014. [1] NCCIH is one of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the United States Department of Health and Human Services.

Contents

NCCIH has been criticized for funding and marketing pseudoscientific medicine. [2] [3]

Organization and history

Overview

The Office of Alternative Medicine (OAM) was established in October 1991 by the United States Congress. The OAM was expanded from an office into a center and renamed the National Center for Complementary and Alternative Medicine (NCCAM) in October 1998. [4] [5] [6] It is one of several centers within the National Institutes of Health (NIH).

The founding director of the center was Stephen Straus. In 2008, Josephine Briggs became the second director of NCCAM. The NCCAM was renamed the National Center for Complementary and Integrative Health (NCCIH) in December 2014. [1] In August 2018, Helene Langevin was named director of the NCCIH.

The 2014 name change to NCCIH has been described by critics as an attempt by the center to mitigate criticism by avoiding the term "alternative" and distancing itself from having funded studies of questionable merit. [7] [8]

The 2001 mission statement of the NCCAM stated that it was "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." [9]

As NCCIH, the mission statement is "to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care". [10]

As the OAM (1991–1998)

Joseph J. Jacobs was appointed the first director of the OAM in 1992. Jacobs' support for rigorous scientific methodology caused friction with Democrat U.S. Senator Tom Harkin and other OAM patrons. Harkin believed his allergies had been cured by bee pollen pills and expressed frustration with the "unbendable rules" of randomized clinical trials, saying, "it is not necessary for the scientific community to understand the process before the American public can benefit from these therapies." [11] Harkin's office reportedly pressured the OAM to fund studies of favored theories, including the use of bee pollen and antineoplastons as treatments. OAM board member Barrie Cassileth publicly criticized the office as a purveyor of nonsense and described it as a "place where opinions are counted as equal to data". [11] After Harkin appeared on television in 1994 with cancer patients who blamed Jacobs for blocking their access to antineoplastons, Jacobs resigned from the OAM in frustration. [11] In an interview with Science, Jacobs criticized Harkin and other politicians for pressuring his office, promoting certain therapies, and, he says, attempting an end-run around objective science." [12]

Harkin drew support from Iowa Democrat Representative Berkley Bedell, who believed that cow colostrum had cured his Lyme disease. [5]

The OAM's budget grew in the 1990s. The office drew increasing criticism for its perceived lack of rigorous scientific study of alternative approaches favoring uncritical boosterism. Paul Berg, a Nobel laureate in chemistry, wrote to the Senate[ when? ] that "Quackery will always prey on the gullible and uninformed, but we should not provide it with cover from the NIH," and called the office "an embarrassment to serious scientists". [13] [14] :175 Allen Bromley, then-president of the American Physical Society, similarly wrote to Congress[ when? ] 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". [11] [13] [14] :175 Leon Jaroff, writing for The New York Times in 1997, described the OAM as "Tom Harkin's folly". [15]

In 1995, Wayne Jonas, a promoter of homeopathy and political ally of Harkin, became the director of the OAM, and continued in that role until 1999. [16] In 1997, the NCCAM budget was increased from $12 million to $20 million annually. [13] From 1990 to 1997, use of alternative medicine in the US increased by 25%, with a corresponding 50% increase in expenditures. [17] The OAM drew increasing criticism from eminent members of the scientific community with letters to the Senate Appropriations Committee when discussion of renewal of funding OAM came up. [14] :175 In 1998, the President of the North Carolina Medical Association publicly called for shutting down the OAM. [18]

In 1998, NIH director and Nobel laureate Harold Varmus came into conflict with Harkin by pushing to have more NIH control of alternative medicine research. [2] The NIH Director placed the OAM under stricter scientific NIH control. [13] [2] Harkin responded by elevating OAM into an independent NIH "center", just short of being its own "institute", and renamed it the National Center for Complementary and Alternative Medicine (NCCAM). NCCAM had a mandate to promote a more rigorous and scientific approach to the study of alternative medicine, research training and career development, outreach, and "integration".

Stephen Strauss was the director of NCCAM from 1999 to 2006. He tried to bring more scientific rigor to the organization. [19] In 1999 the NCCAM budget was increased from $20 million to $50 million. [18] [2] The United States Congress approved the appropriations without dissent. In 2000, the budget was increased to about $68 million, in 2001 to $90 million, in 2002 to $104 million, and in 2003, to $113 million. [18]

As NCCAM (1998–2014)

In 2008 Josephine Briggs was appointed as director of NCCAM. She was "a nephrologist with impeccable scientific credentials". The appointment was considered surprising since she did not have a complementary and alternative medicine background or integrative medicine background. Writing for Science-Based Medicine, David Gorski states Briggs was in an impossible position: "She was a real scientist trying to impose scientific rigor on an enterprise that was inherently resistant to such an imposition." She attempted to impose a more scientific approach with two long-term strategic plans. The plans used "one of the most harmful tactics of quacks to legitimize their quackery under the banner of 'integrative medicine,' the co-opting of the opioid crisis as an excuse to claim all nonpharmacological treatments for pain as being 'integrative.' The results are threatening great harm to chronic pain patients by misguided governments wanting to force them to undergo quack treatments like acupuncture as a means of getting them off opioids." However, she was able to eliminate studies on homeopathy and tried to counter anti-vaccine beliefs. Energy healing was "relegated to the fringes, if not eliminated". Most of the studies became centered around nutrition, exercise, pharmacognosy, "and other modalities within the realm of science-based medicine". [19]

In 2009, after 17 years of government testing for $2.5 billion, almost no clearly proven efficacy of alternative therapies had been found. [20] Senator Harkin complained, "One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. I think quite frankly that in this center and the office previously before it, most of its focus has been on disproving things rather than seeking out and approving." [2] [21] [22] Members of the scientific community criticized this comment as showing Harkin did not understand the basics of scientific inquiry, which tests hypotheses, but never intentionally attempts to "validate approaches". [2] In 2009, the NCCAM's yearly budget was increased to about $122 million. [2] Overall NIH funding for CAM research increased to $300 million by 2009. [2] By 2009, Americans were spending $34 billion annually on CAM. [23]

In 2012, the Journal of the American Medical Association (JAMA) published a criticism that NCCAM had funded study after study, but had "failed to prove that complementary or alternative therapies are anything more than placebos". [24] The JAMA criticism pointed to large wasting of research money on testing scientifically implausible treatments, citing "NCCAM officials spending $374,000 to find that inhaling lemon and lavender scents does not promote wound healing; $750,000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390,000 to find that ancient Indian remedies do not control type 2 diabetes; $700,000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406,000 to find that coffee enemas do not cure pancreatic cancer." [24] It was pointed out that the public generally ignored negative results from testing, that people continue to "believe what they want to believe, arguing that it does not matter what the data show: They know what works for them". [24] Continued increasing use of CAM products was also blamed on the lack of FDA ability to regulate alternative products, where negative studies do not result in FDA warnings or FDA-mandated changes on labeling, whereby few consumers are aware that many claims of many supplements were found not to be supported. [24]

As NCCIH (2014–present)

In 2014, while Josephine Briggs was the director, the NCCAM was renamed the National Center for Complementary and Integrative Health (NCCIH). Briggs retired in October 2017. [25]

On August 29, 2018, the NCCIH announced Helene Langevin as the new director. [26] She was previously the director of the Osher Center and professor-in-residence of medicine at Harvard Medical School. Her medical interests involve connective tissue. Langevin "believes that the stretching of connective tissue is how several CAM modalities 'work,' such as chiropractic, massage, and ... acupuncture". Langevin has been studying acupuncture since the 1990s. At the time of her appointment, Gorski expressed concern that the balance of power at NCCIH would "shift back towards pseudoscience" with a massive budget to fund the shift. [19]

Operations

The NCCIH operates under a charter set by the National Advisory Council for Complementary and Integrative Health (NACCIH). The charter states that: [27]

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 public policy, law, health policy, economics, and management. Three of the six shall represent the interests of individual consumers of complementary and alternative medicine.

Directors

Past directors 1999 - present [28]

PortraitDirectorTook officeLeft office
Noimage.svg William R. Harlan (acting)January 1999October 1999
Stephen E. Straus (NCCIH).jpg Stephen Straus October 1999November 2006
Ruth Kirschstein 1926-2009 (33345823081).jpg Ruth L. Kirschstein (acting)November 2006January 2008
Josephine-P-Briggs.jpg Josephine Briggs January 2008October 2017
Acting NCCIH Director David Shurtleff.jpg David Shurtleff (acting)October 2017November 2018
Helene Langevin, M.D., Director, National Center for Complementary and Integrative Health (NCCIH), NIH.jpg Helene Langevin November 26, 2018Present

Research areas and funding

Research focus

NCCIH funds research into complementary and alternative medicine, including support for clinical trials of CAM techniques. The four primary areas of focus are research, research training and career development, outreach, and integration. [29] NCCIH divides complementary and alternative medicine into natural products, including dietary supplements and herbal supplements; mind and body practices, including meditation, yoga, qigong, acupuncture and spinal manipulation (both chiropractic and osteopathic); and other approaches, such as homeopathy, naturopathy, Traditional Chinese Medicine (TCM), and ayurveda. [30]

Funding trajectory

Since 1999, the division's funding increased more than six-fold. [6] By 2012, OAM and NCCAM spent $1.6 billion in grant funding. [5] Between 1999 and 2009, NCCAM supported approximately 50% of the National Cancer Institute spending on CAM, with the total amount spent on CAM during that time frame $2.856 billion. [6]

The NCCIH budget for 2005 was $123 million. For fiscal year 2009 (ending September 30, 2009), it was $122 million. [31]

The NIH has also conducted research in alternative medicine at the National Cancer Institute by the Office of Cancer Complementary and Alternative Medicine which, in 2009, had the same, $122  million budget as NCCIH. For FY 2009; NIH's total budget was about $29 billion. [31]

The NCCIH budget for 2015 was $124.1 million. [32] They requested a $3,459,000 funding increase for their 2016 budget. [33]

Examples of NCCAM research projects funded prior to 2012

Grant (USD)PurposeResult
$110,000,000 [6] 362 projects for diabetes (e.g. whether expressive writing[ clarification needed ] reduces symptoms)No results reported.
$374 000 [5] Does inhaling lemon, and lavender scents promote wound healing?No evidence for such.
$22,000,000 [6] Does prayer treat diseases?No results reported.
$417,000 [6] Does distance healing improve outcome of HIV patients?"Distant healing or prayer from a distance does not appear to improve selected clinical outcomes in HIV patients who are on a combination antiretroviral therapy.”
$823,000 [6] To study effect of prayer on glioblastoma No results reported.
$390 000 [5] Can ancient Indian remedies control type 2 diabetes?No evidence for such
$2,000,000 [6] Can magnets cure arthritis, carpal tunnel syndrome, or migraine headaches?"[I]mprovements (in pain intensity) did not differ significantly from changes in the Sham group or the Usual Care group."
$406,000 [5] Use of coffee enemas to cure pancreatic cancerNo evidence for curative effects
$250,000 in 2012 [6] Effects of Energy Healers on cholesterol-fed rabbitsNo results reported.

Of 52 CAM clinical trial studies on HIV and Cancer, only 8 reported results. [6]

Education

NCCAM also funds education and outreach programs. Despite the negative findings on the effectiveness of distance healing, NCCAM awarded $180,000 to a consultant to develop an Internet-based wellness program on the healing by Qigong. [6]

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 [34] 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. [35] [36] [37] Other NCCIH-funded studies have included the benefits of distant prayer for AIDS, the effects of lemon and lavender essential oils on wound healing, [5] [38] "energy chelation", and "rats stressed out by white noise". [39]

In 2006, NCCIH was criticized in Science with the comment "NCCAM funds proposals of dubious merit; its research agenda is shaped more by politics than by science, and its charter structures it in a manner that precludes an independent review of its performance." [40] The authors 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. As an example, the authors described a trial of gemcitabine with the Gonzalez regimen for stage II to IV pancreatic cancer, in the belief that a deficiency of pancreatic proteolytic enzymes causes cancer. 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. [40]

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. [6]

In 2019, an analysis by the Center for Inquiry found that NCCIH was continuing to fund questionable science and that "there is little hope of reforming the NCCIH as it is currently incorporated". It concluded that "There is no legitimate function that the NCCIH can serve that could not be better carried out by other existing organizations within the NIH umbrella." [41]

Writing for Quackwatch in 2023, William London criticized the NCCIH and its article "6 Things To Know When Selecting a Complementary Health Practitioner" for "misleading consumers" and promoting—rather than warning against—complementary health, which "is often a euphemism for quackery." [3] [42]

Related Research Articles

Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability or evidence of effectiveness. Unlike modern medicine, which employs the scientific method to test plausible therapies by way of responsible and ethical clinical trials, producing repeatable evidence of either effect or of no effect, alternative therapies reside outside of medical science and do not originate from using the scientific method, but instead rely on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural "energies", pseudoscience, errors in reasoning, propaganda, fraud, or other unscientific sources. Frequently used terms for relevant practices are New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, and unconventional medicine, with little distinction from quackery.

<span class="mw-page-title-main">Bastyr University</span> Alternative medicine university

Bastyr University is a private alternative medicine university with campuses in Kenmore, Washington, and San Diego, California. Programs include naturopathy, acupuncture, Traditional Asian medicine, nutrition, herbal medicine, ayurvedic medicine, psychology, and midwifery.

<span class="mw-page-title-main">History of alternative medicine</span>

The history of alternative medicine refers to the history of a group of diverse medical practices that were collectively promoted as "alternative medicine" beginning in the 1970s, to the collection of individual histories of members of that group, or to the history of western medical practices that were labeled "irregular practices" by the western medical establishment. It includes the histories of complementary medicine and of integrative medicine. "Alternative medicine" is a loosely defined and very diverse set of products, practices, and theories that are perceived by its users to have the healing effects of medicine, but do not originate from evidence gathered using the scientific method, are not part of biomedicine, or are contradicted by scientific evidence or established science. "Biomedicine" is that part of medical science that applies principles of anatomy, physics, chemistry, biology, physiology, and other natural sciences to clinical practice, using scientific methods to establish the effectiveness of that practice.

<span class="mw-page-title-main">Chelation therapy</span> Medical procedure to remove heavy metals from the body

Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body. Chelation therapy has a long history of use in clinical toxicology and remains in use for some very specific medical treatments, although it is administered under very careful medical supervision due to various inherent risks, including the mobilization of mercury and other metals through the brain and other parts of the body by the use of weak chelating agents that unbind with metals before elimination, exacerbating existing damage. To avoid mobilization, some practitioners of chelation use strong chelators, such as selenium, taken at low doses over a long period of time.

Mind–body interventions (MBI) or mind-body training (MBT) are health and fitness interventions that are intended to work on a physical and mental level such as yoga, tai chi, and Pilates.

<span class="mw-page-title-main">National University of Natural Medicine</span> Private school n Portland, Oregon

The National University of Natural Medicine (NUNM) is a private university of naturopathic medicine and Classical Chinese medicine located in Portland, Oregon. The school has approximately 553 students.

<span class="mw-page-title-main">Alternative cancer treatments</span> Alternative or complementary treatments for cancer that have not demonstrated efficacy

Alternative cancer treatment describes any cancer treatment or practice that is not part of the conventional standard of cancer care. These include special diets and exercises, chemicals, herbs, devices, and manual procedures. Most alternative cancer treatments do not have high-quality evidence supporting their use and many have been described as fundamentally pseudoscientific. Concerns have been raised about the safety of some purported treatments and some have been found unsafe in clinical trials. Despite this, many untested and disproven treatments are used around the world.

<span class="mw-page-title-main">Energy medicine</span> Pseudo-scientific alternative medicine

Energy medicine is a branch of alternative medicine based on a pseudo-scientific belief that healers can channel "healing energy" into a patient and effect positive results. The field is defined by shared beliefs and practices relating to mysticism and esotericism in the wider alternative medicine sphere rather than any sort of unified terminology, leading to terms such as energy healing or vibrational medicine being used as synonymous or alternative names. In most cases there is no empirically measurable energy involved: the term refers instead to so-called subtle energy. Practitioners may classify the practice as hands-on, hands-off, and distant where the patient and healer are in different locations. Many schools of energy healing exist using many names: for example, biofield energy healing, spiritual healing, contact healing, distant healing, therapeutic touch, Reiki or Qigong.


The Research Council for Complementary Medicine (RCCM) is a charitable organisation (UK Registered Charity Number 1146724) founded in 1983 to develop and promote good quality research into alternative and complementary medicine (CAM) and enhance evidence-based medicine in this area.

The Office of Cancer Complementary and Alternative Medicine (OCCAM) is an office of the National Cancer Institute (NCI) in the Division of Cancer Treatment and Diagnosis. OCCAM was founded in 1998 and is responsible for NCI's research agenda in pseudoscientific complementary and alternative medicine (CAM), as it relates to cancer prevention, diagnosis, treatment, and symptom management. The OCCAM differs from the National Center for Complementary and Integrative Health in that it is exclusively focused on cancer, while the NCCIH funds a much broader program of NIH research into CAM for all diseases and disorders. It last produced an annual report in 2011 and spent $105 million on CAM research in 2011.

The Complementary and Alternative Medicine Program was created in 2003 by Georgetown University Medical Center in response to a nationwide NIH-funded educational initiative to incorporate CAM into medical and graduate school curricula. This program is focused on training students to objectively assess the safety and efficacy of various CAM modalities such as acupuncture, massage, herbs and supplements, and mind-body interactions and introducing scientific rigor to much needed research in this field.

<span class="mw-page-title-main">David Gorski</span> Science-based medicine advocate

David Henry Gorski is an American surgical oncologist and professor of surgery at Wayne State University School of Medicine. He specializes in breast cancer surgery at the Karmanos Cancer Institute. Gorski is an outspoken skeptic and critic of alternative medicine and the anti-vaccination movement. A prolific blogger, he writes as Orac at Respectful Insolence, and as himself at Science-Based Medicine where he is the managing editor.

<span class="mw-page-title-main">Helene Langevin</span>

Helene Langevin is Director of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH).

<span class="mw-page-title-main">Kimball Atwood</span> American medical doctor, researcher and alternative medicine critic

Kimball C. Atwood IV is an American medical doctor and researcher from Newton, Massachusetts. He is retired as an assistant clinical professor at Tufts University School of Medicine and anesthesiologist at Newton-Wellesley Hospital.

<i>Alternative Therapies in Health and Medicine</i> Academic journal

Alternative Therapies in Health and Medicine is a bimonthly peer-reviewed medical journal covering alternative medical treatments. It publishes case reports, original research papers, and systematic reviews. It was established in 1995 by founding editor Larry Dossey and is published bimonthly by InnoVision Health Media. The current editor-in-chief is Andrew W. Campbell.

<span class="mw-page-title-main">Josephine Briggs</span> American nephrologist

Josephine P. Briggs is an American nephrologist and director emeritus of the National Center for Complementary and Integrative Health, an agency of the National Institutes of Health. She is currently the editor-in-chief of the Journal of the American Society of Nephrology.

<span class="mw-page-title-main">Stephen Straus</span> American virologist and science administrator

Stephen E. Straus was an American physician, immunologist, virologist and science administrator. He is particularly known for his research into human herpesviruses and chronic fatigue syndrome, and for his discovery of the autoimmune lymphoproliferative syndrome genetic disorder. He headed the Laboratory of Clinical Investigation of the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), and served as the founding director of the NIH's National Center for Complementary and Alternative Medicine.

Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon.

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