Congressional Justification FY 2017 | NCCIH

National Center for Complementary and Integrative Health

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, [$130,789,000]$126,673,000

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Amounts Available for Obligation¹

(Dollars in Thousands)

National Center for Complementary and Integrative Health

Budget Mechanism - Total¹

(Dollars in Thousands)

National Center for Complementary and Integrative Health

Summary of Changes¹

(Dollars in Thousands)

National Center for Complementary and Integrative Health

Summary of Changes¹ (continued)

(Dollars in Thousands)

History of Budget Authority and FTEs:

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Funding Levels by Fiscal Year

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Full-Time Employees by Fiscal Year

Distribution by Mechanism

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FY 2017 Budget Mechanism

¹ Includes mandatory financing.

Change by Selected Mechanism

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FY 2017 Estimated Percent Change from FY 2016 Mechanism

National Center for Complementary and Integrative Health

Budget Authority by Activity¹

(Dollars in Thousands)

National Center for Complementary and Integrative Health

Authorizing Legislation

PHS Act/Other Citation	U.S. Code Citation	2016 Amount Authorized		FY 2016 Enacted	2017 Amount Authorized		FY 2017 President’s Budget 1
Research and Investigation	Section 301	42§241	Indefinite	Image	Indefinite	Image
$129,941,000	$126,673,000
National Center for Complementary and Integrative Health	Section 401(a)	42§281	Indefinite		Indefinite
Total, Budget Authority	$129,941,000	$126,673,000

National Center for Complementary and Integrative Health

Appropriations History

National Center for Complementary and Integrative Health

Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.

Budget Authority (BA):

Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.

Director's Overview

The National Center for Complementary and Integrative Health (NCCIH) is the lead Federal agency for scientific research on the usefulness and safety of complementary and integrative health practices. Complementary and integrative health approaches include mind-body interventions, such as massage, acupuncture, yoga, and meditation, and natural products, such as dietary supplements and probiotics. To address the need for objective evidence as to the safety and efficacy of many of these approaches, NCCIH supports rigorous scientific investigation to better understand how these interventions work, for whom, and the optimal method of practice and delivery.

Results from the 2012 National Health Interview Survey (NHIS), conducted by the Centers for Disease Control and Prevention (CDC) with support from NCCIH, indicate that one-third of U.S. adults aged 18 and older use complementary and integrative health approaches. Many of these individuals seek complementary and integrative health approaches to improve their health and well-being or to manage symptoms of chronic diseases or the side effects of conventional medicine. Natural products (dietary supplements other than vitamins and minerals) are the most commonly used complementary health approach, followed by deep breathing exercises and yoga.

Reducing Pain and Improving Symptom Management

Pain is a major public health problem and is the most common reason Americans turn to complementary and integrative health practices. Data from the 2012 NHIS found that an estimated 25.3 million adults in the United States (11.2 percent) experience daily pain – pain every day for the three months prior to the survey. In addition, nearly 40 million adults (17.6 percent) experience severe levels of pain and are also likely to have worse health status than the general public.¹ The cost of complementary care for adults using complementary health approaches to treat or manage pain is estimated to be $14.9 billion in out-of-pocket expenses, according to the 2007 NHIS. This amount accounts for 20-25 percent of all out-of pocket spending to treat or manage pain, including complementary and conventional care.²

CDC has classified fatal overdoses involving opioid analgesics, medications used to treat pain, as an epidemic. NCCIH’s research investment in pain, particularly the non-pharmacologic management of pain, helps address the critical need for improved pain management strategies. NCCIH’s intramural research program is devoted to studying the role of the brain in perceiving, modifying, and managing pain. Specifically, scientists are investigating the role of the brain in pain processing and how factors such as emotion, environment, and genetics affect its perception. In addition, NCCIH is involved in ongoing collaborations across NIH, the Department of Veterans Affairs, and the Department of Defense to develop and test efficacious and effective non-pharmacological approaches to pain management and comorbidities (including opioid misuse, abuse, and disorder) in military personnel, veterans, and their families. NCCIH’s extramural research program supports investigators examining the safety and efficacy of complementary health approaches for pain management. Furthermore, NCCIH participates in the NIH BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative, which is accelerating the development and application of technologies to study the brain. Additionally, NCCIH is leveraging its resources through the NIH Common Fund’s Stimulating Peripheral Activity to Relieve Conditions (SPARC) program in order to better understand the mechanisms of action and the development of “electroceuticals” for therapies in which nerves are stimulated to control organ function.

Advancing Research on Natural Products

Nearly one in five U.S. adults use botanical supplements and other non-vitamin, non-mineral dietary supplements, such as fish oil/omega-3 fatty acids and probiotics, according to the 2012 NHIS. The use of dietary supplements at times poses risks. For example, adverse events related to dietary supplements are estimated to contribute to 23,000 emergency department visits in the United States each year.³ To better inform consumers and their health care providers, NCCIH supports research on the biological mechanisms of the benefits and potential harmful effects of natural products, such as their interaction with medications and liver toxicity. To accelerate research on this important public health problem, NCCIH established a Center of Excellence for Natural Product-Drug Interaction Research in FY 2015. The new Center is systematically examining methods for studying natural product-drug interactions; developing standardized protocols to clarify which interactions have clinical impact; and disseminating the study findings and resources broadly. In essence, the new Center is developing a roadmap for the study of natural product-drug interactions with the ultimate goal of improving the body of knowledge available to health care providers, patients, and researchers.

To further enhance NCCIH’s natural products portfolio, NCCIH partnered with the NIH’s Office of Dietary Supplements (ODS) to fund five research centers in FY 2015. These centers focus on the safety of natural products, how they work within the body, and the development of cutting-edge research technologies. Specifically, the three Botanical Dietary Supplements Research Centers will advance the understanding of the mechanisms through which complex botanical dietary supplements may affect human health and resilience. The two Centers for Advancing Natural Products Innovation and Technology will propel chemical and biological investigation of natural products. They also will disseminate innovative methodology and good research practices. (For more details on this basic research effort, see the Program Portrait .)

Inspiring Public Trust through Stewardship

NCCIH works diligently to be an efficient steward of the resources provided by Americans. Currently, NCCIH is undertaking strategic planning activities focused on future research investments in complementary and integrative health and ensuring that research workforce needs are met. NCCIH continues to support research and leverage its strategic partnerships to build the scientific evidence needed by consumers, health care providers, and policymakers regarding the safety and efficacy of complementary and integrative health practices. NCCIH makes research findings available to the public through multiple platforms, including video, social media, and mobile applications. In addition, NCCIH engages the public directly through X chats with leading health experts.

¹ Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. Journal of Pain. 2015;16(8):769–780.

² Nahin RL, Stussman BJ, Herman PM. Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample. Journal of Pain. August 27, 2015. Epub ahead of print.

³ Geller, AI, et al. Emergency department visits for adverse events related to dietary supplements. N Engl J Med, 2015;373:1131–40.

Program Descriptions and Accomplishments

Extramural Clinical Research: The NCCIH extramural research program funds clinical investigations on complementary and integrative health practices and interventions. Projects range from small pilot studies to large-scale clinical trials and epidemiological studies, including several collaborations between NIH ICs and other Federal agencies. For instance, NCCIH and NHLBI are co-funding a replication trial to determine the potential cardiovascular benefits of chelation therapy for older patients with diabetes. Chelation is a chemical process in which a substance is delivered intravenously (through the veins) to bind atoms of metals or minerals and hold them tightly so that they can be removed from the body. While chelation is used as a treatment for heavy metal (for example, lead) poisoning, its use for treating heart disease is unproven.

Budget Policy:
The FY 2017 President’s Budget estimate for extramural clinical research is $53.860 million, which is an increase of $0.291 million or 0.5 percent compared to the FY 2016 Enacted level.

Extramural Basic Research: Basic research on fundamental biological effects and active components of interventions is central to the development of the evidence base on complementary and integrative health approaches, and underpins the design of clinical research. NCCIH supports investigator-initiated basic research and will continue, through targeted initiatives, its support for basic and translational research on promising complementary interventions. For example, NCCIH and ODS jointly funded three Botanical Dietary Supplements Research Centers. The three interdisciplinary and collaborative centers will advance understanding of the mechanisms through which complex botanical dietary supplements may affect human health and resilience. In addition, NCCIH and ODS funded two Centers for Advancing Natural Products Innovation and Technology, which are featured in the Program Portrait on the next page.

Program Portrait: Advancing Natural Products Innovation and Technology

FY 2016 Level: $1.0 million

FY 2017 Level: $1.0 million

Change: $0.0 million

To propel research innovation, NCCIH and ODS jointly funded two new Centers for Advancing Natural Products Innovation and Technology. The Centers will develop pioneering methods and techniques to catalyze new research approaches and technologies that will have significant impact on the chemical and biological investigation of natural products. Once developed, the Centers will disseminate those resources to the larger natural products research community.

Each of the new Centers will tackle unique research challenges, and ultimately their resources will help advance NCCIH’s natural products portfolio as a whole. Specifically, the Center for High-throughput Functional Annotation of Natural Products at the University of Texas Southwestern Medical Center will improve the speed, breadth, and precision of the chemical and biological characterization of natural products. Its team will develop innovative cell-based screening approaches to uncover bioactive molecules of interest and their corresponding molecular targets. The team at the University of Illinois at Chicago Natural Products Technology Center will coordinate and disseminate state-of the art research technologies aimed at mining bioanalytical knowledge of natural products. This center will also develop and share cutting-edge bioanalytical methodologies that address important biomedical questions and advance a more holistic research approach regarding natural products and their metabolomic complexity.

Through its investment in these two Centers, NCCIH is energizing the research community to overcome the methodologic and technologic obstacles hindering natural products research.

Budget Policy:
The FY 2017 President’s Budget estimate for extramural basic research is $46.039 million, which is a decrease of $1.129 million or 2.4 percent compared to the FY 2016 Enacted level.

Extramural Research Training and Capacity Building: Improving the capacity of the field to carry out rigorous research of complementary health interventions is a high priority for NCCIH. To increase the number, quality, and diversity of investigators who conduct research on complementary health approaches, NCCIH supports a variety of training and career development activities for pre- and post-doctoral students, researchers, and clinicians. As part of its strategic planning effort, NCCIH established a working group of its Advisory Council to identify workforce needs for clinician-scientists and potential roles for NCCIH in developing a research workforce that can conduct rigorous studies of complementary health approaches. Its recommendations will help shape NCCIH’s future training and career development programs.

Budget Policy:
The FY 2017 President’s Budget estimate for extramural research training and capacity building is $3.974 million, which is an increase of $0.078 million or 2.0 percent compared to the FY 2016 Enacted level.

Intramural Research: NCCIH’s intramural research program is focused on understanding the central mechanisms of pain and its modulation, with the long-term goal of improving clinical management of chronic pain through the integration of pharmacologic and non-pharmacologic approaches. Among topics of particular interest are the pathways and mechanisms by which emotion, attention, placebo effects, and other such processes modulate pain or pain processing. The program both engages and leverages the exceptional basic and clinical research talent and resources of other neuroscience and neuroimaging efforts within the NIH intramural community.

Budget Policy:
The FY 2017 President’s Budget estimate for intramural research is $8.970 million, which is an increase of $261 thousand or three percent compared to the FY 2016 Enacted level.

Research Management and Support (RMS): Through its RMS activities, NCCIH provides administrative, budgetary, logistical, and scientific support in the review, award, monitoring, and management of research grants, training awards, and contracts. In addition, NCCIH provides reliable, objective, and science- and evidence-based information to the public, scientists, and healthcare providers so that they may make informed decisions about the use of complementary and integrative health therapies.

Budget Policy:
The FY 2017 President’s Budget estimate for research management and support is $17.099 million, which is an increase of $498 thousand or 3.0 percent compared to the FY 2016 Enacted level.

National Center for Complementary and Integrative Health

Budget Authority by Object Class¹

(Dollars in Thousands)

National Center for Complementary and Integrative Health

Salaries and Expenses

(Dollars in Thousands)

"NATIONAL INSTITUTES OF HEALTH National Center for Complementary and Integrative Health Detail of Full-Time Equivalent Employment (FTE) " OFFICE/DIVISION FY 2014 Actual FY 2015 Est. FY 2016 Est. Civilian Military Total Civilian Military Total Civilian Military Total

National Center for Complementary and Integrative Health

Detail of Full-Time Equivalent Employment (FTE)

National Center for Complementary and Integrative Health

Detail of Full-Time Equivalent Employment (FTE) (continued)

National Center for Complementary and Integrative Health

Detail of Positions¹