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How NCCAM's "Real World" Congressional Mandate is Optimal for NCCAM's 2010-2015 Strategic Plan PDF Print E-mail
Written by John Weeks   
Friday, 06 November 2009

How NCCAM's "Real World" Congressional Mandate is Optimal for NCCAM's 2010-2015 Strategic Plan

SummaryThis article aims to help you respond, as a stakeholder, to the next NCCAM strategic plan. Responses are due November 30. I first analyze the 1998 Congressional mandate relative to this most important issue that will face the integrative practice community in the coming 5 years; namely, the prioritization of $600-million the NIH NCCAM will spend. The mandate will surprise you: prioritized were outcomes research, exploration of "prevention modalities, disciplines and systems" and evaluation of "integration ... into delivery systems" rather than the basic research and RCTs that dominated NCCAM under its first director. Now, as NCCAM seeks your input, even as it is being reasonably challenged for having created limited value to date, might NCCAM be served to embrace what Congress originally mandated? I offer 14 trends in the healthcare and policy worlds and inside the integrative healthcare community that make the direction Congress' mandated 11 years ago even more auspicious at this time. This article is background for submitting your own stakeholder inputs on the NCCAM strategic plan. Get your comments in by November 19!
Send your comments to
for inclusion in a future Integrator. More important,
send your stakeholder comments here to NCCAM
by November 30.

Note: NCCAM's mandate from Congress is analyzed below,
then, following some trend, information printed in full at the bottom.
It is also available as pages 388-390 of this 920 page Federal document.


Image
Congress mandates an exploration of real world outcomes, disciplines, systems and integration
The
1998 Congressional mandate which established the NIH National Center for Complementary and Alternative Medicine (NCCAM) is a critical reference point for NCCAM at this moment as the agency, under present director Josephine Briggs, MD, creates the strategic plan which will guide the spending of some $600-million by the agency from 2011-2015. The mandate is referenced and partially cited in 2009 NCCAM Strategic Planning White Paper #1. This article is meant to support your own participation, as a stakeholder, in NCCAM's strategic plan (click here to bypass this article and participate).

What is startling is how significantly Congress focused NCCAM on real world outcomes given that NCCAM, under founding director Stephen Straus, MD devoted just 0.4%-1.13% of its funding to effectiveness and cost-effectiveness research. (See
Making Amends: Studies of Effectiveness and Cost-Effectiveness Represent <1% of NCCAM Budget.) The question before us now is: Might NCCAM's work be more valuable if the next strategic plan embraced this Congressional charge?

This article begins with a section by section look at the brief 2 pages of NCCAM's Congressional mandate. (The entire document is appended at the bottom of this article, unmixed with my opinions.) I then list 14 healthcare, research and policy trends and changes that argue that the time is even more auspicious in 2010 for moving in the direction Congress, in its wisdom, urged in 1998. After you reflect on these - or before you do! - please weigh in. You are an NCCAM stakeholder. Be heard. Click here at the NCCAM strategic planning site.  

________________________

Part I: Analysis of NCCAM's 1998 Congressional Mandate

Note: NCCAM's first of 3 white papers on its current strategic plan focuses on Mandate and Mission. The paper directly cites subsections (a), (c) and (g) of the Congressional mandate, leaving sections (b), (d), (e), (f) and (h). I bolded the portions not included in the 2009 NCCAM white paper.

Image
NCCAM -- Included some but not other sections of the mandate
NCCAM's Introductory Comment
from the 2009 NCCAM Strategic Planning White Paper #1: "The legislative mandate of NCCAM has remained constant since the Center was created in 1998. Specifically, Congress felt that the public health and policy implications of the widespread use of complementary and alternative medicine (CAM) by the American public warranted a focused effort at the National Institutes of Health (NIH).
In 1998, NCCAM was established through legislation as an independent Center with an Advisory Council and grant-making authorities (Public Law 105–277, Title VI, Sec. 601).[1] The 1998 statute tasked NCCAM with the following specific major responsibilities (among others):
"(a) The general purposes of the National Center for Complementary and Alternative Medicine are the conduct and support of basic and applied research (including both intramural and extramural research), research training, the dissemination of health information, and other programs with respect to identifying, investigating, and validating complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The Center shall be headed by a director, who shall be appointed by the Secretary. The Director of the Center shall report directly to the Director of NIH."
Comment:  Note these foci: "treatment," "disciplines" and "systems." This language continues like a refrain throughout the mandate, continuously calling a reader to the broader, real world questions suggested by these research directions. Note also the focus on "prevention" in the phrase "prevention modalities, disciplines and systems." Congress knew that these "CAM" practices promised a preventive focus in treatment. Congress told NCCAM to go and learn about it. This language is repeated, in a similar form, 6 times in the 9 subsections of the mandate.
 

NCCAM, in its 2009 white paper, cites just 3 of the subsections, leaving out these that I include here in bold.
"(b) Advisory Council.-The Secretary shall establish an advisory council for the Center in accordance with section 406, except that at least half of the members of the advisory council who are not ex officio members shall include practitioners licensed in one or more of the major systems with which the Center is concerned, and at least 3 individuals representing the interests of individual consumers of complementary and alternative medicine."
Image
US Senator Tom Harkin: key visionary on the NCCAM mandate
Comment
Notable here is that Congress wished to set a very high level of influence from clinician-researchers as differentiated from PhD basic science researchers on the National Advisory Council for Complementary and Alternative Medicine. Such a block of CAM-experienced clinicians might keep NCCAM focused on the practical, clinical agenda described in the rest of the mandate, and protect it from the predispositions of business-as-usual basic scientists. (Interestingly, just 3 of NCCAM'S 18 members are presently from the licensed CAM disciplines, which would seem to be the main discipline and systems NCCAM was charged to explore, particularly since "integrative medicine" was merely emerging at the time.) Congress also wanted NCCAM well-connected with consumers and their practical questions, reinforcing this through the requirement for 3 consumer representatives. In short, subsection (b) may be viewed as an effort to protect this new entity from the customary, basic-science orientation of NIH culture.
"(c) Complement to Conventional Medicine [This heading is in bold as it was not in the NCCAM white paper.] - In carrying out subsection (a), the Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States."
Comment:  Again we see an extraordinary, practical, real world focus: " ... the integration of alternative treatment ... into healthcare delivery systems in the United States."  Congress knew that CAM was already a $33-billion industry, and that hospitals, health systems and insurers across the US were asking questions about how to integrate these therapies and disciplines. Similarly, the charge, repeated elsewhere, to look at "prevention systems" was because Congress knew these fields claimed expertise in this area and that the nation was in need of a shift in that direction. The research challenges are clearly in the outcomes and health-services arena as prioritized in (f) below.

The 2009 NCCAM white paper does not cite the following sub-sections (d), (e) and (f), all of which indicate Congress' clarity that non-conventional expertise needed to inform the new Center's mission.  
"(d) Appropriate Scientific Expertise and Coordination With Institutes and Federal Agencies.- The Director of the Center, after consultation with the advisory council for the Center and the division of research grants, shall ensure that scientists with appropriate expertise in research on complementary and alternative medicine are incorporated into the review, oversight and management processes of all research projects and other activities funded by the Center. In carrying out the subsection, the Director of the Center, a necessary, may establish review groups with appropriate scientific expertise. The Director of the Center shall coordinate efforts with other Institutes and Federal agencies to ensure appropriate scientific input and management."
Comment:  Finding such "appropriate expertise" was a challenge in 1998 as few federal funds had supported research in CAM and integrative practice prior to that date; thus there was not a readily available infrastructure for accessing such expertise. The challenge was similar to that in naming members to NACCAM in subsection (b) above. Yet now, as we move into the 2010-2015 strategic plan, thanks to the experience of the last decade, we have available subsets of new researchers from the licensed CAM fields to fill these positions. We also have a few score of clinically-experienced MDs from the field of integrative medicine which has emerged in this past decade, as well as integratively-oriented nurses with significant clinical experience in integrative practice. NCCAM can more readily find the "appropriate expertise" to inform the real world charge in the 1998 Congressional prioritization as noted in (f).
"(e) Evaluation of Various Disciplines and Systems.- In carrying out subsection (a), the Director of the Centers shall identify and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and systems which the Center is concerned, including each discipline and system in which accreditation, national certification, or a State license is available."
Comment: Notably, in 1998, "integrative medicine" was an emerging phrase but did not yet exist as an organized field. Therefore the chief disciplines that fit the description of "accreditation, national certification, or a State license is available" are chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy and direct-entry (homebirth) midwifery and the hundred of thousands of licensed practices these professions represented. (For more information on these professions and their recognized agencies, go to the Organizational Members page of the Academic Consortium for Complementary and Alternative Health Care and click into the member names or click on the logos on the left side.)  A very few among NCCAM's hundreds of grants directly explore the whole practices of these licensed disciplines even as a limited number were granted to explore the whole practices engaged by integrative medical doctors, in integrative clinics and in hospitals and community clinics. NCCAM has generated very little cost or clinical evidence about the disciplines and systems which can give the delivery systems, noted in (c) above, information about optimal use of these practitioners and integrative practices.
"(f) Ensuring High Quality, Rigorous Scientific Review.- In order to ensure high quality, rigorous scientific review of complementary and alternative, diagnostic and prevention modalities, disciplines and systems, the Director of the Center shall conduct or support the following activities:
(1) Outcomes research and investigations.
(2) Epidemiological studies.
(3) Health services research.
(4) Basic science research.
(5) Clinical trials.
(6) Other appropriate research and investigational activities."
Image
Congress knew that integration begged cost issues
Comment
: Congress, in its wisdom, listed these types of investigations in this order. This list does not follow the classic sequence of basic research then clinical trials then effectiveness and outcomes and costs. Nor
is it alphabetical. Rather, Congress deliberately expressed its mandate in this order. In essence, Congress urged NCCAM to jump, with both feet, into the real world of effectiveness (#1) and cost (a likely interpretation of #3, especially if NCCAM takes seriously the mandate to explore "integration ... into delivery systems"). This focus may explain why NACCAM was to be loaded with experienced clinicians. In practice, NCCAM has not prioritized this order of research investment, nor has it made an attempt to even give each equal measure. Rather, the types of research listed as #4 and #5 have dominated, as is typical the NIH Institutes.

Most important for our purposes is to consider what the exclusion of this section (f) from Paper #1 means about NCCAM's anticipated direction for 2010-2015. Certainly, if one were attempting to build a case for moving to a real world and outcomes focus, as Briggs has sometimes articulated, bringing this portion of Congressional intent forward would be supportive. However, the list of "promising leads" for future research in 2009 Paper #2: NCCAM Priority Setting-Framework and Other Considerations, shows just how far from this Congressional prioritization NCCAM anticipates sending its money in 2010-2025. These are the leads as listed:
  • "Potential application of specific CAM approaches to management of chronic pain
  • "Molecular targets of dietary small molecules (e.g., quercetins, curcumin, and other polyphenols and flavonoids)
  • "Anti-inflammatory actions of omega-3 fatty acids at clinically relevant concentrations
  • "Effects of cranberry juice on bacterial adherence
  • "Availability of tools and methods to study the effects of probiotics on the human microbiome
  • "Apparent relationships between acupuncture or placebo analgesia and known and well-characterized endogenous opioid pathways
  • "Apparent engagement of major pathways of emotion regulation by meditative practices
  • "Importance of the practitioner-patient interaction, context effects, and the placebo response."
Bullet #1 on pain is potentially on target, depending on how "specific" (read "reduced to something other than real world practices") the strategy is. Bullets #2, #3, #4 and #5 are all basic science questions relative to natural products.  Bullet #6 and #7 both look like examinations of treatments but are basic science rather than real-world outcomes oriented. The last bullet engages some questions of the "whole system of care," though without a focus on effectiveness or cost-effectiveness and the integration into the current delivery system. The suggestion from this list, and the exclusion of (f) from Paper #1, is that the momentum inside NCCAM on the 2010-2015 strategic plan is not presently toward the outcomes and health services prioritization Congress urged.
"(g) Data System; Information Clearinghouse.—
(1) Data Systems.—The Director of the Center shall establish a bibliographic system for the collection, storage, and retrieval of worldwide research relating to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. Such a system shall be regularly updated and publicly accessible.
(2) Clearinghouse.—The Director of the Center shall establish an information clearinghouse to facilitate and enhance, through the effective dissemination of information, knowledge and understanding of alternative medical treatment, diagnostic and prevention practices by health professionals, patients, industry, and the public."
Comment:  NCCAM has significantly engaged this area of the mandate and it is once again a focus of the 2010-2015 strategic plan, as evidence in the Paper #3: Information and Communication about CAM Research and Decision-Making About CAM Use.
(h) Research Centers.- The Director of the Center, after consultaton with the advisory council for the Center, shall provide support for the development and operation of multipurpose centers to conduct research and other activities describes in subsection (a) with respect to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The provision of support for the development and operation of such centers shall include accredited complementary and alternative medicine research and education facilities.
Comment:  The Center approach has recently been downplayed, strategically, as I understand it, in recent years. Part of what is important here, again, is the way Congress specifically included language that some of the centers shall be at accredited CAM facilities. Just two of over two dozen listed here were. Also notable is the inclusion of language that all centers, regardless of location, shall focus on "diagnostic and prevention modalities, disciplines and systems," not merely individual agents. Of the other centers established, to my understanding, few engaged these areas of inquiry to a significant extent.
(i) Availability of Resources.-After consultation with the Director of the Center, the Director of NIH shall ensure that resources of the National Institutes of Health, including laboratory and clinical facilities, fellowships (including research training fellowships and junior and senior clinical fellowships), and other resources are sufficiently available to enable the Center to appropriately and effectively carry out its duties as described in subsection (a). The Director of the NIH, in coordination with the Director of ht Center, shall designate specific personnel in each Institute to serve as full-time liaisons with the Center in facilitiating appropriate coordination and scientific input.
Comment:  Credit NCCAM for creating an array of grant programs and fellowships which have been made available to support new researchers in the CAM fields, both from the distinctly licensed CAM disciplines and from conventional academic centers. They have also funded a series of R-25 education grants which directly supported the development of research culture in the accredited CAM schools, and another set of R-25 grants through which relationships were created between accredited CAM schools and conventional academic health centers. These directions, while relatively minor portions of NCCAM's funding, need to be enhanced and carried forward. It would serve Congressional intent if new fellowships particularly targeted developing the kinds of expertise needed to do the outcomes and health services research on disciplines, systems and integration into delivery systems which Congress intended.

The final section (j) was not included in 2009 NCCAM Paper #1 and is not important for our purposes, referring as it does only to mechanisms of 1998 appropriations.
____________________________

Part II: 14 Reasons Why 2010 is Auspicious for a Real World NCCAM Agenda

Image
NCCAM's Briggs: Will she put real money behind Congress' real world agenda?
Numerous developments this past decade in healthcare, in research and in the complementary and alternative medicine and integrative healthcare world make 2010 even more auspicious than 1998 for the approach Congress mandated. Here are 14.

  • Cost crisis in US medicine  As the portion of the GNP which is consumed by medical expenditures grows, all research which helps us understand costs and particularly potential contributions to cost savings rises in priority.

  • Comparative effectiveness research This field, slowly emerging in recent years, gained a huge boost through its embrace by the Obama administration and signals a focus on findings which will influence decision processes on inclusion. The orientation toward comparative research strategies is aligned with the real world questions that are asked if NCCAM follows the Congressional mandate to evaluate CAM integration into conventional medicine and mainstream delivery systems. Decisions about integration are typically about comparative effectiveness, and comparative cost-effectiveness. One good sign: NCCAM director Briggs is on a key NIH committee on the topic.

  • Growing respect for the multi-factorial treatment of chronic diseases The scientific and clinical community is increasingly aware that the optimal treatment plans for individuals with the chronic conditions which are the most significant contributors to the cost crisis integrate diverse inputs (diet, exercise, pharmacological interventions, etc.) and typically various practitioners. From the perspective of research methodology, these multi-factorial approaches ask similar questions as must be asked to evaluate the disciplines and systems involved in integrative healthcare and integrative medical practices. NCCAM’s strategies for examining whole practices or whole systems can both advance, and gain from the parallel efforts to develop appropriate research modeling for chronic conditions.

  • Prevention, and creating a “society of wellness” A sub-conversation among leading healthcare reform advocates in Congress is the assertion that controlling costs must begin with focusing more on prevention and, more generally, building what US Senator Tom Harkin calls a society of wellness. NCCAM’s engagement of the mandate to evaluate “prevention" as it relates to "modalities, disciplines and systems” presently enjoys a heightened profile as part of the general health care dialogue.

  • Appreciation that the best prevention is the same as the best treatment for chronic conditions in primary care Researcher-clinician Edward Wagner, MD, the developer of the chronic care model, argues that primary care must “increasingly recognize that, for the 40 to 50% of the population suffering from chronic conditions, the distinctions between prevention and treatment begin to break down since the interventions are much the same.” (As paraphrased in Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit, Institute  of Medicine, November 2009, page11.) This perspective is philosophically aligned with the clinical approach in integrative practice/integrative medicine which has been articulated as treating disease by restoring health. The research needs in the chronic care model, and the related medical home model would both inform, and be informed by, a prioritization of research on whole disciplines and whole systems.

  • New employer initiatives relative to integrative medicine In the last decade, two significant employer initiatives began focusing on the potential value of complementary, alternative and integrative medicine in their efforts to create health in their workforces. The most significant is the Corporate Health Improvement Program, based at the Arizona Center for Integrative Medicine, which is focusing on integrative medicine in its present, third phase. The other is the Institute for Health and Productivity Management. These initiatives combine interest in outcomes, cost and health creation and may create additional stakeholder partners for NCCAM health services research relative to effectiveness, cost and productivity gains.

  • Emergence of the dialogue on whole systems research Another factor which supports increased focus on the exploration of whole disciplines and systems in the 1998 mandate is the emergence of a formal dialogue in the integrative medicine community over what is generally known as “whole systems research.” The dialogue and limited, funded research experience are creating a community of scientists in integrative medicine and in the licensed CAM disciplines who are readily available to help shape and carry out a research focus on “prevention modalities, disciplines and systems.”

  • Easy availability of resources on outcomes research Researchers on CAM and integrative healthcare/integrative medicine who are targeting the #1 research activity identified in the Congressional mandate, outcomes research, now have resources available which were not in 1998, including the rich set of instruments and dialogue developed by IN-CAM and available at www.outcomesdatabase.org.

  • Emergence of the field of “integrative medicine” NCCAM’s white paper #1 includes a significant section on the emergence of the field of integrative medicine, and in particular “integrative medicine centers located at research-intensive institutions can be important venues for the collaborative multidisciplinary approaches needed to fully investigate and develop promising CAM interventions.” This emergence is of a significant new stakeholder which is philosophically and clinically committed to clinical prevention, whole practices (integrative medicine MDs who use a combination of conventional and complementary and alternative modalities and agents in their individual practices) and whole systems (integrative medicine MDs who work in systems that integrate an array of conventional and CAM practitioners). The field speaks of a preventive focus in clinical practice and is also challenged with proving its value economically in order to gain coverage.

  • Deepening dialogue on the need for more appropriate research methodology A 2009 report from the British King’s Fund links the challenges in researching complementary and alternative medicine with those for health enhancement: "It is our belief that the specific difficulties we grappled with (relative to complementary practices) reflect a more generic challenge: the challenge to use a scientific approach to understand and test those things that we, as members of the public, do to manage our health." A similar theme was repeated in the IOM February 2009 Summit on Integrative Medicine and the Health of the Public. This emerging consensus underscores the potential value of NCCAM leadership in exploring the health-focused whole practice model.

  • Creation of CAM and integrative medicine oriented practice-based research networks Another part of the landscape which is in early stages of development, but which support the effectiveness and cost agenda is the beginning of the development of practice-based research networks in integrative medicine, via the Bravewell Collaborative, a chiropractic network, via a HRSA grant, and a development of such a network in the naturopathic medical profession.

  • Emergence of research capacity and advanced expertise in the licensed CAM disciplines Finally, a significant trend in the last decade which can support the real world focus of the Congressional mandate, is the maturation of the research community inside the CAM disciplines. This decade of first significant NIH investment in the CAM institutions, researchers and institutes associated with CAM schools, and the inclusion of researchers from these fields and review panels has created a body of recognized leaders and a shift in the culture of all the disciplines. (The member of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care have been investigators on over 50 NCCAM grants.) While NCCAM’s minimal investment in effectiveness and cost-effectiveness research has limited the experience of the this research community in carrying out studies on outcomes, such an investment is believed by most to quickly draw significant interest and increased participation from the integrative practice fields.

Closing comments – weighing NCCAM’s futures  


As noted in NCCAM’s white paper #1, the Center is pulled in many different directions amidst a “spectrum of political opinion.” On one side are conservative, skeptical, conventional academic medical critics. The strategic plan through which NCCAM can best please these critics is to shut its door; short of that, try to get along by going along. The strategy would be to adopt an agenda which looks like the basic science and RCT approach which has dominated NCCAM investment in the first decade. 


   
 
Yes, at the "other end of the spectrum"
are those who ask NCCAM to engage
the real world agenda which
Congress mandated.

We need to prioritize this agenda
with a fixed allocation of at least
45% of NCCAM funds.

Yet what has this Straus program got us? The child of these 10 years of chosen parenting is a paradoxical creature. On one hand, the Straus method is saluted by the NIH establishment and certain academics for giving CAM research legitimacy. Note that it is "research legitimacy" rather than legitimacy as a part of health care. For on the other hand, the outcomes of Straus strategy suggest that the 40% of adult Americans who spend these billions on these therapies and practitioners are utterly loony. As MSNBC routinely editorializes in recent months: "Ten years and $2.5 billion in research have found no cures from alternative medicine." NCCAM's antagonists still want to shut it down.

In truth, there can be great value from basic sciences. For instance, a leading researcher, on hearing my rant, recently used this argument: "Basic
science of acupuncture, including neuroimaging etc. has done more to get people to accept the value of acupuncture than all the interventional trials to date."

But we really don't have to worry whether basic science research will be in the next strategic plan. It will be. The question is
“at the other end of the spectrum,” in the words of the 2009 NCCAM white paper, where we find those who believe that:
“ ... NCCAM research fails to evaluate CAM as it is actually used in ‘real-world’ CAM practice settings, that there is insufficient support of CAM practitioner involvement in the research process, that the field is dominated by reductionist scientific approaches or inappropriate methodology, that the peer-review process is biased against CAM … and that there has been insufficient focus on health and wellness.”
   
 By prioritizing this agenda, NCCAM
can involve itself, and CAM, in some
of the most
exciting and potentially
valuable health
care initiatives
of our time.


 
I would reframe this statement this way: At the other end of the spectrum are those who ask NCCAM to engage the real world agenda which Congress mandated. We need to prioritize this agenda with a fixed target of at least 45% of NCCAM funds.

 

By prioritizing this agenda, NCCAM can involve itself, and CAM, in some of the most exciting and potentially valuable health care initiatives of our time: the chronic care model, medical homes, comparative effectiveness, multi-factorial and team care strategies, lifestyle change, prevention and health creation. Such an agenda is likely to prove a more direct path toward proving NCCAM’s value as an agency, and for drawing more resources to it, than to embrace a strategic plan which is reduced to a few limited, if important, questions.

 

Send your comments to
for inclusion in a future Integrator. More importantly,
send your stakeholder comments to NCCAM.



Part III: The NCCAM Mandate Straight Up

112 STAT. 2681–387 PUBLIC LAW 105–277—OCT. 21, 1998
TITLE VI—NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE
SEC. 601. ESTABLISHMENT OF NATIONAL CENTER FOR COMPLEMENTARY
AND ALTERNATIVE MEDICINE.


IN GENERAL.—Title IV of the Public Health Service Act (42 U.S.C. 281 et seq.) is amended—(1) by striking section 404E; and (2) in part E, by adding at the end the following:‘‘Subpart 5—National Center for Complementary and Alternative
Medicine

‘‘SEC. 485D. PURPOSE OF CENTER.

‘‘(a) IN GENERAL.—The general purposes of the National Center for Complementary and Alternative Medicine (in this subpart referred to as the ‘Center’) are the conduct and support of basic and applied research (including both intramural and extramural research), research training, the dissemination of health information, and other programs with respect to identifying, investigating, and validating complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The Center shall be headed by a director, who shall be appointed by the Secretary. The Director of the Center shall report directly to the Director of NIH.

‘‘(b) ADVISORY COUNCIL.—The Secretary shall establish an advisory council for the Center in accordance with section 406, except that at least half of the members of the advisory council who are not ex officio members shall include practitioners licensed in one or more of the major systems with which the Center is concerned, and at least 3 individuals representing the interests of individual consumers of complementary and alternative medicine.

‘‘(c) COMPLEMENT TO CONVENTIONAL MEDICINE.—In carrying out subsection (a), the Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States.

‘(d) APPROPRIATE SCIENTIFIC EXPERTISE AND COORDINATION WITH INSTITUTES AND FEDERAL AGENCIES.—The Director of the Center, after consultation with the advisory council for the Center and the division of research grants, shall ensure that scientists with appropriate expertise in research on complementary and alternative medicine are incorporated into the review, oversight, and management processes of all research projects and other activities funded by the Center. In carrying out this subsection, the Director of the Center, as necessary, may establish review groups with appropriate scientific expertise. The Director of the Center shall coordinate efforts with other Institutes and Federal agencies to ensure appropriate scientific input and management.

‘‘(e) EVALUATION OF VARIOUS DISCIPLINES AND SYSTEMS.—In carrying out subsection (a), the Director of the Center shall identify and evaluate alternative and complementary medical treatment, diagnostic and prevention modalities in each of the disciplines and systems with which the Center is concerned, including each discipline and system in which accreditation, national certification, or a State license is available.

‘‘(f) ENSURING HIGH QUALITY, RIGOROUS SCIENTIFIC REVIEW.— In order to ensure high quality, rigorous scientific review of complementary and alternative, diagnostic and prevention modalities, disciplines and systems, the Director of the Center shall conduct or support the following activities:
‘‘(1) Outcomes research and investigations.
‘‘(2) Epidemiological studies.
‘‘(3) Health services research.
‘‘(4) Basic science research.
‘‘(5) Clinical trials.
‘‘(6) Other appropriate research and investigational activities.
The Director of NIH, in coordination with the Director of the Center, shall designate specific personnel in each Institute to serve as full-time liaisons with the Center in facilitating appropriate coordination and scientific input.

‘‘(g) DATA SYSTEM; INFORMATION CLEARINGHOUSE.—
‘‘(1) DATA SYSTEM.—The Director of the Center shall establish a bibliographic system for the collection, storage, and retrieval of worldwide research relating to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. Such a system shall be regularly updated and publicly accessible.
‘‘(2) CLEARINGHOUSE.—The Director of the Center shall establish an information clearinghouse to facilitate and enhance, through the effective dissemination of information, knowledge and understanding of alternative medical treatment, diagnostic and prevention practices by health professionals, patients, industry, and the public.

‘‘(h) RESEARCH CENTERS.—The Director of the Center, after consultation with the advisory council for the Center, shall provide support for the development and operation of multipurpose centers to conduct research and other activities described in subsection (a) with respect to complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems. The provision of support for the development and operation of such centers shall include accredited complementary and alternative medicine research and education facilities.

‘‘(i) AVAILABILITY OF RESOURCES.—After consultation with the Director of the Center, the Director of NIH shall ensure that resources of the National Institutes of Health, including laboratory and clinical facilities, fellowships (including research training fellowship and junior and senior clinical fellowships), and other resources are sufficiently available to enable the Center to appropriately and effectively carry out its duties as described in subsection (a). The Director of NIH, in coordination with the Director of the Center, shall designate specific personnel in each Institute to serve as full-time liaisons with the Center in facilitating appropriate coordination and scientific input.

‘‘(j) AVAILABILITY OF APPROPRIATIONS.—Amounts appropriated to carry out this section for fiscal year 1999 are available for obligation through September 30, 2001. Amounts appropriated to carry out this section for fiscal year 2000 are available for obligation through September 30, 2001.’’.

(k) TECHNICAL AND CONFORMING AMENDMENT.—Section 401(b)(2) of the Public Health Service Act (42 U.S.C. 281(b)(2) is amended by adding at the end the following: 112 STAT. 2681–389 PUBLIC LAW 105–277—OCT. 21, 1998
‘‘(F) The National Center for Complementary and Alternative Medicine.’’’.



Last Updated ( Sunday, 05 September 2010 )
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Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
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