U.S. National Center for Complementary and Alternative Medicine
Encyclopedia
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
government agency dedicated to exploring complementary and alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
(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
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
(NIH) within the Department of Health and Human Services of the federal government of the United States
Federal government of the United States
The federal government of the United States is the national government of the constitutional republic of fifty states that is the United States of America. The federal government comprises three distinct branches of government: a legislative, an executive and a judiciary. These branches and...
. 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. 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
Tom Harkin
Thomas Richard "Tom" Harkin is the junior United States Senator from Iowa and a member of the Democratic Party. He previously served in the United States House of Representatives ....
. 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." Harkin's office reportedly pressured the OAM to fund studies of specific "pet theories", including bee pollen and antineoplaston
Antineoplaston
Antineoplaston , a word derived from neoplasm, is a name coined by Stanislaw Burzynski for a group of peptides, derivatives, and mixtures that he uses as an alternative cancer treatment...
s. 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." 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.
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
Paul Berg
Paul Berg is an American biochemist and professor emeritus at Stanford University. He was the recipient of the Nobel Prize in Chemistry in 1980, along with Walter Gilbert and Frederick Sanger. The award recognized their contributions to basic research involving nucleic acids...
, a Nobel laureate in chemistry
Nobel Prize in Chemistry
The Nobel Prize in Chemistry is awarded annually by the Royal Swedish Academy of Sciences to scientists in the various fields of chemistry. It is one of the five Nobel Prizes established by the will of Alfred Nobel in 1895, awarded for outstanding contributions in chemistry, physics, literature,...
, 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
American Physical Society
The American Physical Society is the world's second largest organization of physicists, behind the Deutsche Physikalische Gesellschaft. The Society publishes more than a dozen scientific journals, including the world renowned Physical Review and Physical Review Letters, and organizes more than 20...
, 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".
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. 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 trial
Clinical trial
Clinical trials are a set of procedures in medical research and drug development that are conducted to allow safety and efficacy data to be collected for health interventions...
s 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, MarylandBethesda, MarylandBethesda is a census designated place in southern Montgomery County, Maryland, United States, just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House , which in turn took its name from Jerusalem's Pool of Bethesda...
. - 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:
- Whole medical systems such as homeopathyHomeopathyHomeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
, naturopathy, traditional Chinese medicineTraditional Chinese medicineTraditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
, and ayurvedaAyurvedaAyurveda or ayurvedic medicine is a system of traditional medicine native to India and a form of alternative medicine. In Sanskrit, words , meaning "longevity", and , meaning "knowledge" or "science". The earliest literature on Indian medical practice appeared during the Vedic period in India,...
. - Mind-body medicine such as meditationMeditationMeditation is any form of a family of practices in which practitioners train their minds or self-induce a mode of consciousness to realize some benefit....
, prayerPrayerPrayer is a form of religious practice that seeks to activate a volitional rapport to a deity through deliberate practice. Prayer may be either individual or communal and take place in public or in private. It may involve the use of words or song. When language is used, prayer may take the form of...
, mental healing, art therapyArt therapyBecause of its dual origins in art and psychotherapy, art therapy definitions vary. They commonly either lean more toward the ART art-making process as therapeutic in and of itself, "art as therapy," or focus on the psychotherapeutic transference process between the therapist and the client who...
, music therapyMusic therapyMusic therapy is an allied health profession and one of the expressive therapies, consisting of an interpersonal process in which a trained music therapist uses music and all of its facets—physical, emotional, mental, social, aesthetic, and spiritual—to help clients to improve or maintain their...
, and dance therapyDance therapyDance therapy, or dance movement therapy is the psychotherapeutic use of movement and dance for emotional, cognitive, social, behavioral and physical conditions. As a form of expressive therapy, DMT is founded on the basis that movement and emotion are directly related...
. - Biologically based practices such as dietary supplements, herbal supplements, and other scientifically unproven therapies such as shark cartilageShark cartilageShark cartilage is a dietary supplement made from the dried and powdered cartilage of a shark; that is, from the tough material that composes a shark's skeleton. Shark cartilage is claimed to combat and/or prevent a variety of illnesses, most notably cancer. It is often marketed under the names...
. - Manipulative and Body-Based Practices such as spinal manipulationSpinal manipulationSpinal manipulation is a therapeutic intervention performed on spinal articulations which are synovial joints . These articulations in the spine that are amenable to spinal manipulative therapy include the z-joints, the atlanto-occipital, atlanto-axial, lumbosacral, sacroiliac, costotransverse...
(both chiropracticChiropracticChiropractic is a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health. It is generally categorized as complementary and alternative medicine...
and osteopathic) and massageMassageMassage is the manipulation of superficial and deeper layers of muscle and connective tissue to enhance function, aid in the healing process, and promote relaxation and well-being. The word comes from the French massage "friction of kneading", or from Arabic massa meaning "to touch, feel or handle"...
. - Energy therapies such as qigongQigongQigong or chi kung is a practice of aligning breath, movement, and awareness for exercise, healing, and meditation...
, reikiReikiis a spiritual practice developed in 1922 by Japanese Buddhist Mikao Usui. The teaching was continued and adapted by various teachers. It uses a technique commonly called palm healing as a form of complementary and alternative medicine and is sometimes classified as oriental medicine by some...
, therapeutic touchTherapeutic touchTherapeutic touch , also known as Non-Contact Therapeutic Touch , is an energy therapy which practitioners claim promotes healing and reduces pain and anxiety. Practitioners of therapeutic touch state that by placing their hands on, or near, a patient, they are able to detect and manipulate the...
, and electromagnetic therapyElectromagnetic therapyElectromagnetic therapy, is a form of alternative medicine which claims to treat disease by applying electromagnetic radiation or pulsed electromagnetic fields to the body....
.
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.
Research in alternative medicine is done elsewhere at NIH, notably in the National Cancer Institute
National Cancer Institute
The National Cancer Institute is part of the National Institutes of Health , which is one of 11 agencies that are part of the U.S. Department of Health and Human Services. The NCI coordinates the U.S...
. 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.
The NCCAM budget for 2011 was $127.7 million. They have requested a $3,399,000 funding increase for their 2012 budget.
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.A policy forum in Science stated,
We believe that NCCAM [National Center for Complementary and Alternative Medicinebut 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, echinaceaAlternative medicineAlternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
] 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.
Echinacea
Echinacea is a genus of herbaceous flowering plants in the daisy family, Asteraceae. The nine species it contains are commonly called purple coneflowers. They are endemic to eastern and central North America, where they are found growing in moist to dry prairies and open wooded areas. They have...
, and saw palmetto
Saw Palmetto
Serenoa repens, commonly known as saw palmetto, is the sole species currently classified in the genus Serenoa. It has been known by a number of synonyms, including Sabal serrulatum, under which name it still often appears in alternative medicine. It is a small palm, normally reaching a height of...
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
EDTA
Ethylenediaminetetraacetic acid, widely abbreviated as EDTA , is a polyamino carboxylic acid and a colourless, water-soluble solid. Its conjugate base is named ethylenediaminetetraacetate. It is widely used to dissolve limescale. Its usefulness arises because of its role as a hexadentate ligand...
chelation therapy
Chelation therapy
Chelation therapy is the administration of chelating agents to remove heavy metals from the body. For the most common forms of heavy metal intoxication—those involving lead, arsenic or mercury—the standard of care in the United States dictates the use of dimercaptosuccinic acid...
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
Pancreatic cancer
Pancreatic cancer refers to a malignant neoplasm of the pancreas. The most common type of pancreatic cancer, accounting for 95% of these tumors is adenocarcinoma, which arises within the exocrine component of the pancreas. A minority arises from the islet cells and is classified as a...
, 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 and a test of the protocol reported in 2009 found patients receiving the treatment had worse quality of life
Quality of life
The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...
and died faster than conventionally treated counterparts.
Mielczarek and Engler examined the grants and awards funded by NCCAM from 2000 to 2011, which cost a total of $1.3 billion. Their study showed no discoveries in complementary and alternative medicine that would justify the existence of this center. They argued that, after 20 years and an expenditure of $20 billion, the failure of NCCAM is evidenced by the lack of publications and the failure to report clinical trials in peer-reviewed scientific medical journals. They recommended NCCAM be defunded or abolished, and the concepts of funding alternative medicine be discontinued.
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.
- Committee for Skeptical Inquiry