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Congressional Justification FY 2020

DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
National Center for Complementary and Integrative Health (NCCIH)

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2020 Organizational Chart


NATIONAL INSTITUTES OF HEALTH

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, [$146,473,000]$126,081,000.

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Amounts Available for Obligation 1

(Dollars in Thousands)

Source of FundingFY 2018 FinalFY 2019 Annualized CRFY 2020 President's Budget
Appropriation$142,184$146,473$126,081
Mandatory Appropriation: (non-add)   
     Type 1 Diabetes(0)(0)(0)
     Other Mandatory financing(0)(0)(0)
Rescission000
Sequestration000
Secretary's Transfer-33400
Subtotal, adjusted appropriation$141,850$146,473$126,081
OAR HIV/AIDS Transfers-16600
Subtotal, adjusted budget authority$141,684$146,473$126,081
Unobligated balance, start of year000
Unobligated balance, end of year000
Subtotal, adjusted budget authority$141,684$146,473$126,081
Unobligated balance lapsing-1700
   Total obligations$141,667$146,473$126,081
1 Excludes the following amounts for reimbursable activities carried out by this account:
FY 2018 — $461         FY 2019 — $785         FY 2020 — $785

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Budget Mechanism - Total 1

(Dollars in Thousands)

MechanismFY 2018 finalFY 2019 EnactedFY 2020 President's BudgetFY 2020 -/+ FY 2019
No.AmountNo.AmountNo.AmountNo.Amount
Research Projects:        
Noncompeting104$53,235114$58,240119$58,5675$327
Administrative Supplements(12)1,423(8)900(4)450(-4)-450
Competing        
Renewal41,879000000
New5825,1535322,9613814,729-15-8,233
Supplements00000000
Subtotal, Competing62$27,03253$22,96138$14,729-15-$8,233
Subtotal, RPGs166$81,690167$82,102157$73,746-10-$8,356
SBIR/STTR94,14694,27783,569-1-708
Research Project Grants175$85,836176$86,378165$77,314-11-$9,064
Research Centers:        
Specialized/Comprehensive4$5,1294$5,0822$2,000-2-$3,082
Clinical Research00000000
Biotechnology2855284026500-190
Comparative Medicine00000000
Research Centers in Minority00000000
Research Centers6$5,9846$5,9224$2,650-2-$3,272
Other Research:        
Research Centers in Minority39$5,67742$6,13534$4,900-8-$1,235
Cancer Education00000000
Cooperative Clinical Research00000000
Biomedical Research Support00000000
Minority Biomedical Research Support00000000
Other92,828103,06172,175-3-887
Other Research48$8,50552$9,19641$7,074-11-$2,122
Total Research Grants229$100,325234$101,497210$87,038-24-$14,458
Ruth L Kirchstein Training Awards:FTTPs FTTPs FTTPs FTTPs 
Individual Awards20$92020$93616$760-4-$176
Institutional Awards382,049623,349502,716-12-633
Total Research Training58$2,96982$4,28666$3,476-16-$810
Research & Develop. Contracts14$11,34213$10,64411$9,047-2-$1,597
(SBIR/STTR) (non-add)(0)(8)(0)(44)(0)(39)(0)(-6)
Intramural Research89,606911,60699,9220-1,684
Res. Management & Support6017,4416418,4406416,5960-1,844
Res. Management & Support (SBIR Admin)(0)(0)(0)(0)(0)(0)(0)(0)
Construction 0 0 0 0
Buildings and Facilities 0 0 0 0
Total, NCCIH68$141,68473$146,47373$126,0810-$20,392

1 All items in italics and brackets are non-add entries.

Major Changes in the Fiscal Year 2020 President's Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanisms and activity detail and these highlights will not sum to the total change for the FY 2020 budget request for the NCCIH, which is $126.1 million, a decrease of $20.4 million from the FY 2019 Appropriated Level. The FY 2020 President’s Budget reflects the Administration’s fiscal policy goals for the Federal Government. Within that framework, NCCIH will pursue its highest research priorities through strategic investments and careful stewardship of appropriated funds.
Research Project Grants (-$9.1 million; total $77.3 million): NCCIH will support a total of 165 Research Project Grant (RPG) awards in FY 2020. Noncompeting RPGs will increase by $0.3 million. Competing RPG awards will decrease by $8.2 million.
R&D Contracts (-$1.6 million; total $9.0 million): Although the number of contracts awarded is estimated to decrease, NCCIH will continue its annual support to the National Health Interview Survey (NHIS).
Intramural Research (-$1.7 million; total $9.9 million): NCCIH will continue to support Dr. Langevin’s Research Lab.
Research Management and Support (-$1.8 million; total $16.6 million): NCCIH will maintain a flat full-time equivalent staff level and pay inflation-related costs.

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Summary of Changes 1

(Dollars in Thousands)

FY 2019 Enacted$146.473
FY 2020 President's Budget$126.081
Net Change-$20.302
ChangesFY 2020 President's BudgetChanges from FY 2019 Enacted
FTE'sBudget AuthorityFTE'sBudget Authority
A. Built-in:    
1. Intramural Research:    
a. Annualization of January 2019 pay increase & benefits $3,218 $0
b. January FY 2020 pay increase & benefits 3,218 14
c. Paid days adjustment 3,218 12
d. Differences attributable to change in FTE 3,218 0
e. Payment for centrally furnished services 1,336 27
f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs 5,368 107
Subtotal   $160
2. Research Management and Support:    
a. Annualization of January 2019 pay increase & benefits $11,125 $0
b. January FY 2020 pay increase & benefits 11,125 45
c. Paid days adjustment 11,125 42
d. Differences attributable to change in FTE 11,125 0
e. Payment for centrally furnished services 171 3
f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs 5,301 106
Subtotal   $197
Subtotal, Built-in   $357

ChangesFY 2020 President's BudgetChanges from FY 2019 Enacted
No.Budget AuthorityNo.Budget Authority
B. Program:    
1. Research Project Grants:    
a. Noncompeting119$59,0175-$123
b. Competing3814,729-15-8,233
c. SBIR/STTR83,569-1-708
Subtotal, RPGs165$77,314-11-$9,064
2. Research Centers4$2,650-2-$3,272
3. Other Research417,074-11-2,122
4. Research Training663,476-16-810
5. Research and development contracts119,047-2-1,597
Subtotal, Extramural $99,562 -$16,864
 FTEs FTEs 
6. Intramural Research9$9,9220-$1,844
7. Research Management and Support6416,5960-2,041
8. Construction 0 0
9. Buildings and Facilities 0 0
Subtotal, Program73$126,0810-$20,749
Total changes   -$20,392

Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

graphs

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Budget Authority by Activity 1

(Dollars in Thousands)

 FY 2018 finalFY 2019 EnactedFY 2019 President's BudgetFY 2020 +/FY2019
Extramural ResearchFTEAmountFTEAmountFTEAmountFTEAmount
Detail        
Clinical Research $54,346 $52,908 $45,421 -$7,487
Basic Research 57,322 59,259 50,665 -8,595
Extramural Research Training and Capacity Building 2,969 4,259 3,476 -783
Subtotal, Extramural $114,637 $116,426 $99,562 -$16,864
Intramural Research8$9,6069$11,6069$9,9220-$1,684
Research Management & Support60$17,44164$18,44064$16,5960-$1,844
TOTAL68$141,68473$146,47373$126,0810-$20,392

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Authorizing Legislation

 PHS Act/Other CitationU.S. Code Citation2019 Amount AuthorizedFY 2019 Annualized CR2019 Amount AuthorizedFY 2020 President’s Budget
Research and InvestigationSection 30142§241IndefiniteCombined IndefiniteCombined 
    $146,473,000 $126,081,000
National Center for Complementary and Integrative HealthSection 401(a)42§281Indefinite Indefinite 
Total, Budget Authority    $126,081,000  $126,081,000

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Appropriations History

Fiscal YearBudget Estimate
to Congress
House AllowanceSenate AllowanceAppropriation

1 Budget Estimate to Congress includes mandatory financing.

2011$132,004,000 $131,796,000$128,844,000
Rescission   $1,131,327
2012$131,002,000$131,002,000$126,275,000$128,299,000
Rescission   $242,485
2013$127,930,000 $128,318,000$128,056,515
Rescission   $256,113
Sequestration   ($6,427,556)
2014$129,041,000 $128,183,000$124,296,000
Rescission   $0
2015$124,509,000  $124,681,000
Rescission   $0
2016$127,521,000$127,585,000$130,162,000$130,789,000
Rescission   $0
20171$129,941,000$134,549,000$136,195,000$134,689,000
Rescission   $0
2018$101,793,000$136,741,000$139,654,000$142,184,000
Rescission   $0
2019$130,717,000$143,882,000$146,550,000$146,473,000
Rescission   $0
2020$126,081,000   

Justification of Budget Request

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):

 FY 2018 ActualFY 2019 EnactedFY 2020 President's BudgetFY 2020 +/- FY 2019
BA$141,684,000$146,473,000$126,081,000-$20,392,000
FTE6873730

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

Director's Overview

The mission of National Center for Complementary and Integrative Health (NCCIH) is to define, through rigorous scientific investigation, the safety and effectiveness of complementary and integrative health approaches, which are a group of practices and products that originate outside of conventional medicine. This diverse group of health practices includes natural products, such as dietary supplements, plant-based products, and probiotics, as well as mind-body approaches, such as yoga, massage therapy, meditation, mindfulness-based stress reduction, spinal manipulation, and acupuncture. While these approaches originate outside of conventional medicine, they are considered complementary because they are typically used in conjunction with conventional medicine. Integrative health care seeks to bring conventional and complementary approaches together in a safe, coordinated way.

According to a 2012 National Health Interview Survey (NHIS), Americans are spending approximately $30.2 billion per year on complementary approaches to improve their overall health, manage symptoms of chronic diseases, and/or counter the side effects of conventional medicine. 1 Consumers often use complementary health approaches without understanding whether they work, or if they’re safe, and without talking with a health care provider. Much of the information available to consumers is biased, promotional, or not rooted in peer-reviewed, scientific evidence. Therefore, NCCIH works to expand and share science-based evidence regarding complementary and integrative health approaches to inform health care decisionmaking by consumers, health care professionals, and policymakers. As a responsible steward of resources, NCCIH is highly selective and supports a broad range of scientifically meritorious basic, clinical, and translational research. The Center focuses on areas with the greatest impact by prioritizing research topics that show scientific promise and are amenable to rigorous

1 Expenditures on complementary health approaches: United States, 2012. National Health Statistics Reports; no.95, 2016. PMID: 2735222

scientific inquiry. NCCIH strives to invest in research that will drive new discoveries, which may lead to improved public health and health care.

Five-Year Strategic Priorities and Program Highlights:

NCCIH works strategically to evaluate existing programs and set priorities based on the growing scientific-evidence base, research capacity, scientific opportunities and public health needs. The Center’s top priorities for the next five years are to explore nonpharmacologic approaches for pain management, advance research on natural products, promote health and wellness, train the next generation of complementary and integrative health researchers with an emphasis on increasing clinician-scientists, and disseminate objective evidence-based information on complementary and integrative health approaches.

Exploring nonpharmacologic approaches for pain management:

Effective management of pain is a major medical challenge in the U.S. An estimated 11.2 percent of the U.S. adult population, or over 25 million Americans, suffers from daily chronic pain. This is an enormous public health problem that costs more than $600 billion per year in treatments and lost productivity. 2 Current drug-based treatment options are only partially effective and can have serious side effects. As a result, pain is one of the leading reasons Americans turn to complementary health approaches. 1 NCCIH devotes approximately 40 percent of its budget to pain-related research.

NCCIH works to advance knowledge on the basic biology of pain. The Center’s Intramural Research Program conducts basic, clinical, and translational research focusing on the role of the brain in perceiving, modifying, and managing pain (see program description below). One group of intramural scientists is investigating the mechanisms of neuropathic pain, a condition that causes severe pain in the absence of painful stimuli. Recently, these researchers identified a key molecule, dual leucine zipper kinase (DLK), which regulates biological processes that promotes chronic neuropathic pain following nerve injury. This study demonstrated a reduction in DLK activity resulted in decreased pain sensitivity following traumatic nerve injury, a common cause of chronic neuropathic pain. The researchers noted the findings may also extend to other situations such as neurodegenerative disease. The results indicate a potential mechanism that could help in designing and testing new ways to treat chronic pain. 3 Another group of intramural scientists are investigating how the brain responds to pain and opioids. These researchers recently identified chronic pain-induced changes in the brain’s internal opioid system resulting in decreased opioid receptor availability. These results help to explain why opioids are less effective in patients with chronic pain compared to acute pain. If an opioid receptor is not available, then opioid medications cannot work. Changes in the opioid system may also play a role in the depression often associated with chronic pain. These findings enhance our understanding of the impact of chronic pain on the brain, its relation to depression, and the effects of opioids. 4 NCCIH also supports extramural research on the basic biology of pain. A new area of interest for the Center is in understanding how pain transitions from acute to chronic.

NCCIH-funded research has provided insight into how pain is transmitted and interpreted by the body. Recently, scientists discovered a new class of sensory nerve cells that respond to high-threshold (intense) mechanical stimuli, such as hair pulling. 2 This work provides insights into how our bodies encode and transmit pain sensations. Another study co-funded by NCCIH mapped the regions of the brain activated during pain to establish a “pain signature.” This study found that specific regions of the brain respond to pain intensity, while other regions mediate the psychological effect, and yet another region showed increased activity related to pain relief. 3 This work not only provides insights into how pain is interpreted, but could lead to the development of new methods to detect, quantify, or target pain.

NCCIH-supported research evaluates the benefits of mind and body approaches as an integrative pain management strategy. One study investigated the effect of acupuncture on carpal tunnel syndrome and found that it improved function and nerve conduction, decreased associated pain, and affected activity of pain centers in the brain. 4 Another study mapped the impact of mindfulness meditation on brain activity and found that it activates the same region of the brain as opioids; however, it reduces pain independently of opioid neurotransmitter mechanisms. These results suggest that greater pain control could be achieved through the combination of mindfulness meditation and pharmacologic or nonpharmacologic approaches that involve opioid signaling. 5 These results and others supported by the NCCIH led to the formation of a new multi-agency partnership led by NCCIH, with participation by NIAAA, NICHD, NIDA, NINDS, NINR, OBSSR, and the NIH ORWH, as well as the Department of Defense and Department of Veterans Affairs, to study nondrug approaches for pain management within the military and veteran health care systems (see Program Portrait).


  1. 2 Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of Medicine, 2011.
  2. 3 Dual leucine zipper kinase is required for mechanical allodynia and microgliosis after nerve injury. eLife, 2018
  3. 4 Chronic neuropathic pain reduces opioid receptor availability with associated anhedonia in rat. Pain, 2018.

All chronic pain patients begin with acute pain that becomes persistent. What causes pain to become chronic and why some patients are more susceptible, are two big unanswered questions. These are questions NCCIH and other NIH Institutes, Centers and Offices (ICOs) are hoping to answer. By helping to understand the biology of pain, these types of studies may lead to the development and improvement of pain management approaches.

NCCIH supports research to understand the effect of nonpharmacologic approaches on pain processing. A growing body of evidence suggests that complementary approaches, such as acupuncture, hypnosis, massage therapy, mindfulness meditation, spinal manipulation, tai chi, and yoga, help to manage some painful conditions. NCCIH is working to understand how these approaches are effective, for whom, and under what conditions. A recent study sought to identify how mindfulness impacts brain activity in response to pain. Mindfulness is a form of meditation focusing on paying attention to the present moment without reacting to it. Previous studies have demonstrated that people who are naturally more mindful tend to have less pain; however, the mechanisms underlying this relationship had not been identified. This new study showed that the greatest difference in brain activity between naturally high- and low-mindful participants was in regions of the brain involved in processing attention and emotional responses to sensations.5 These results suggest that the psychological interpretation of pain signals impacts how much pain an individual “feels,” and it is this aspect of pain processing that is affected by mindfulness. The findings of this study may be useful for the development of improved nonpharmacologic approaches to pain management, such as biofeedback, mindfulness meditation, or behavioral therapies, that specifically target increases in mindfulness and reductions in the activity of this brain region.

NCCIH funds research evaluating the safety and real-world efficacy of nonpharmacologic approaches. A recent study investigated the effectiveness of tai chi for management of fibromyalgia. Tai chi is a traditional Chinese mind and body practice that combines meditation with deep breathing, relaxation, and gentle movements. Past research found that tai chi lessened pain and improved physical and mental health in patients with fibromyalgia – a disorder characterized by widespread pain, tenderness, fatigue, and other symptoms. In this new study, researchers compared the effects of tai chi to standard aerobic exercise for treatment of fibromyalgia. Aerobic exercise is a core part of standard fibromyalgia treatment and is the most commonly prescribed nonpharmacologic treatment for the disorder; however due to the strenuousness of aerobic exercise, some patients struggle with the programs. This study showed that tai chi was as effective or better for managing fibromyalgia, that a longer duration of tai chi resulted in greater benefits, and that patients were more likely to attend tai chi classes than aerobic exercise sessions. The researchers therefore concluded that tai chi may be a therapeutic option in the multidisciplinary management of fibromyalgia.

The Center is also working to expand pragmatic clinical trials to determine how nonpharmacologic approaches could be integrated into healthcare systems. Pragmatic clinical trials are human effectiveness trials that can be embedded into standard healthcare. These studies are beneficial because they are conducted in a real-world setting with a real-world distribution of patients. In 2012, the NIH Health Care Systems Research Collaboratory was established and is co-led by NCCIH. This NIH Common Fund project supports pragmatic trials and is working to advance knowledge on how to conduct and interpret results from this type of

5 Neural Mechanisms Supporting the Relationship between Dispositional Mindfulness and Pain. Pain, 2018.

study. Using knowledge gained from the NIH Health Care Systems Research Collaboratory, NCCIH along with other NIH, DoD and VA partners launched the NIH-DoD-VA Pain Management Collaboratory (PMC) in 2017. The PMC focuses on implementing and testing cost-effective, large-scale, real-world research on nonpharmacologic approaches for pain management and related conditions in military and veteran health care delivery organizations. The PMC currently funds 11 pragmatic clinical trial research project grants and a resource coordinating center, totaling approximately $81 million over 6 years, with the NCCIH contributing more than half of these funds. These research projects will provide valuable information about the effectiveness of nonpharmacologic approaches in treating pain within VA and DoD health care systems. The studies will not only show if these approaches are effective for pain management, but also how they can be integrated into a healthcare system and may lead to new pain management practices within the DoD and VA and support the use of nonpharmacologic approaches for pain management in the general population.

NCCIH also plans to expand efforts in pediatric pain research. Pain affects children as well as adults; however, most pain management techniques are developed and optimized for adults. This is problematic because the pediatric population responds to pharmacologic and nonpharmacologic approaches differently than adults. The Center organized a Trans-NIH roundtable discussion to identify the knowledge gaps, challenges, obstacles, and opportunities in pediatric pain research. NCCIH and other NIH Institutes are planning joint outreach efforts to the research community to increase grant applications within in this area and combining efforts to fund meritorious studies.

Promoting health and wellness:

Individual behavior plays a key role in health promotion and disease prevention. It is well established that adopting and maintaining healthy behaviors (e.g., good eating habits and regular physical exercise) and modifying unhealthy behaviors (e.g., quitting smoking) reduce risks of major chronic diseases. Additionally, a small but growing evidence base suggests a potential benefit of complementary health approaches for the purposes of wellness, health promotion, and disease prevention. More research is needed to better understand how certain complementary health approaches can be useful in encouraging better self-care, improving a personal sense of well-being, promoting a greater commitment to a healthy lifestyle, and preventing the onset of mental health conditions (e.g., anxiety and depression). The support of health and wellness is a priority of NCCIH.

Music has been associated with several positive benefits. For example, music may enhance child development, improve adult function and well-being, and optimize the quality of life during aging. Many studies have shown that music may ameliorate the symptoms of a broad range of diseases and disorders that occur throughout the lifespan. However, more research is needed to determine where music, in its many forms, can be beneficial and under what conditions. The exciting potential of this research has led to the formation of a trans-NIH Working Group, led by NCCIH. Together this working group developed a funding opportunity entitled “Music and the Brain: Research Across the Lifespan.” The aim of this initiative is to increase understanding of how music can affect health, with an emphasis on what happens at the neuroscience level, and potential clinical applications

6 Complete biosynthesis of noscapine and halogenated alkaloids in yeast. PNAS, 2018

Emotional well-being has been defined as an overall positive state of one’s emotions, life satisfactions, sense of meaning and purpose and social connectedness, and ability to pursue selfdefined goals.9 Scientific studies have shown a strong correlation between overall emotional well-being and health. For example, emotional well-being has been associated with reduced risk of death from all causes by almost 20 percent;10 while having a sense of purpose in life reduces the risk of heart attack and stroke by 17 percent.11 To gain a deeper insight into the existing research on the role of emotional well-being in health and the implications for public understanding, NCCIH in collaboration with other NIH ICOs sponsored a roundtable discussion with scientific experts to discuss the scientific opportunities and gaps in research areas. To capitalize on this area of opportunity, the NCCIH, with other ICOs, will further support research to increase understanding of the fundamental constituents of well-being across the lifespan and among various subgroups, refine and implement scientifically based prevention strategies to enhance emotional well-being, and develop measurement methodologies to optimize and scale up well-being interventions for treatment and prevention of burnout, stress, pain, and mental health symptoms in at-risk populations (e.g., caregivers, military personnel, minority groups, individuals with substance abuse), as well as children and adolescents.

Training the next generation of complementary and integrative health researchers:

One of NCCIH’s primary strategic goals is to support research training and career development opportunities to increase the number and quality of scientists trained to conduct rigorous, cuttingedge research on complementary and integrative practices. In pursuit of this goal, NCCIH has hosted several training workshops to help early stage investigators connect NIH funding opportunities across stages of their career development, understand how to interact with NIH staff to develop proposals, successfully navigate the NIH review process, develop resilience to overcome career roadblocks, and develop a plan for a successful research career. In addition to these training workshops, NCCIH supports a funding opportunity aimed at providing an intensive, supervised research experience for complementary health practitioners (e.g., licensed acupuncturists, massage therapists; chiropractic doctors; and naturopathic or osteopathic physicians) that will lead to a better understanding of, and practical experience in, complementary and integrative health research. The Center recently developed an additional program that provides funds for clinicians trained in complementary medicine to get research training early in their academic career. The hope is that together these programs will help develop a pipeline of qualified clinician-scientist investigators with complementary and integrative health degrees who are able to advance clinical and/or translational research on complementary interventions

Disseminate objective evidence-based information on complementary and integrative health approaches:

NCCIH faces several challenges in translating and disseminating complex scientific information to an interested and engaged public. First, the landscape of complementary and integrative health is inundated with information, some of it overtly promotional, and much of it either not based on scientific evidence or based on information of questionable quality and reliability. Second, there is evidence that individuals who use complementary health approaches often do not discuss their use with conventional health care providers. Instead, they rely on other sources, including family and friends, practitioners of complementary health approaches, and information gleaned from the Internet, popular media, and advertising. A priority of NCCIH is to provide unbiased, reliable, authoritative resources on complementary and integrative health approaches and research results for health care providers, researchers, policymakers, the health industry, and the public. The Center uses a variety of communication techniques and technologies to bring evidence-based information about complementary health approaches to these audiences and to provide a scientifically accurate perspective on the potential promise, as well as the risks, of using these interventions. NCCIH provides information to its audiences through multiple channels, including the Web, broadcast and print media, a research blog, and social media platforms. In addition, NCCIH recently developed and released a mobile app called “HerbList,” which provides evidence-based information about herbs and dietary supplements in an easy-to-use and understand format. The FY 2020 President’s Budget request is $126.1 million, a decrease of $20.4 million or 13.9% percent compared with the FY 2019 Enacted level.

9 Community Translational Science Team (CTST). Policy Report: Building A Public Health Model for Promoting Emotional Well-Being. Los Angeles: University of California, Los Angeles; 2016.

10 Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic Medicine. 2008.

11 Purpose in life and its relationship to all-cause mortality and cardiovascular events: A meta-analysis. Psychosomatic Medicine. 2016.

Advancing research on natural products:

There are thousands of natural products/dietary supplements on the market and readily available to purchase. Consumers often use these products without adequate science-based information about safety and effectiveness. This is dangerous because “natural” does not always mean “safe.” Adverse events related to dietary supplements are estimated to contribute to 23,000 emergency department visits in the U.S. each year. 6 In addition, natural products can interact with prescription medications and alter their effectiveness or create dangerous side effects. To better inform consumers and their health care providers, NCCIH supports rigorous research on promising natural products with the goal of improving the body of knowledge available to healthcare providers and patients.

NCCIH has a broad interest in studying the biological activities of natural products, including their effects on clinical conditions, and their potential to promote health, wellness and/or resilience. The Center seeks to streamline natural product clinical research through a phased research pipeline starting with early phase studies exploring the mechanism of action. The most promising natural products advance to the later research phases that support investigations comparing clinical outcomes and biological effects through randomized controlled efficacy trials. In a recent study supported by NCCIH, researchers identified two chemicals found in grapes that significantly reduce depression-like behaviors in mice. The systems targeted by these compounds are not the same as current pharmaceutical antidepressants and may provide novel insights into the biology of depression and could lead to new therapeutic agents.7 NCCIH continues to support studies like this though the CARBON program (see program portrait).

6 Emergency department visits for adverse events related to dietary supplements. N Engl J Med, 2015.

7 Epigenetic modulation of inflammation and synaptic plasticity promotes resilience against stress in mice. Nature Communications, 2018

NCCIH plans to expand efforts around natural products for pain management. Natural products have historically been a source of novel pain-relieving compounds developed into pharmaceuticals (e.g., willow bark into aspirin). A growing body of literature suggests that the cannabis plant has pain-relieving properties; however, as a schedule I substance with known psychoactive effects, research on the potential pain-relieving properties of cannabis has been slow. NCCIH plans to release a funding opportunity to support research on the diverse components of cannabis to explore if the pain-relieving properties can be separated from the psychoactive properties and to further characterize those components that may reduce pain.

NCCIH supports research to improve technologies, methods and techniques for evaluating and producing natural products. Natural products have a long and impressive history as sources of medicine and as important resources for biological research. However, many of the techniques for studying complex mixtures of natural products have remained unchanged for many years and have yet to leverage advances in biological and chemical methodologies. To move the field forward, NCCIH is placing a renewed emphasis on overcoming methodological and technological hurdles that hinder advances in natural products research. In a recent study supported by NCCIH, researchers determined how to synthesize noscapine, a natural product with potential as an anticancer drug, in yeast cells.8 Prior to this study, noscapine could only be harvested from the poppy plant. Because environmental factors such as pests, disease, and climate can threaten the poppy crop, the ability to produce noscapine in yeast will help ensure a stable supply. In addition, the knowledge gained from this study could help with the synthesis and characterization of other natural products.

Advancing research on natural products:

Individual behavior plays a key role in health promotion and disease prevention. It is well established that adopting and maintaining healthy behaviors (e.g., good eating habits and regular physical exercise) and modifying unhealthy behaviors (e.g., quitting smoking) reduce risks of major chronic diseases. Additionally, a small but growing evidence base suggests a potential benefit of complementary health approaches for the purposes of wellness, health promotion, and disease prevention. More research is needed to better understand how certain complementary health approaches can be useful in encouraging better self-care, improving a personal sense of well-being, promoting a greater commitment to a healthy lifestyle, and preventing the onset of mental health conditions (e.g., anxiety and depression). The support of health and wellness is a priority of NCCIH.

Music has been associated with several positive benefits. For example, music may enhance child development, improve adult function and well-being, and optimize the quality of life during aging. Many studies have shown that music may ameliorate the symptoms of a broad range of diseases and disorders that occur throughout the lifespan. However, more research is needed to determine where music, in its many forms, can be beneficial and under what conditions. The exciting potential of this research has led to the formation of a trans-NIH Working Group, led by NCCIH. Together this working group developed a funding opportunity entitled “Music and the Brain: Research Across the Lifespan.” The aim of this initiative is to increase understanding of how music can affect health, with an emphasis on what happens at the neuroscience level, and potential clinical applications.

8 Complete biosynthesis of noscapine and halogenated alkaloids in yeast. PNAS, 2018

Emotional well-being has been defined as an overall positive state of one’s emotions, life satisfactions, sense of meaning and purpose and social connectedness, and ability to pursue selfdefined goals.9 Scientific studies have shown a strong correlation between overall emotional well-being and health. For example, emotional well-being has been associated with reduced risk of death from all causes by almost 20 percent; 10 while having a sense of purpose in life reduces the risk of heart attack and stroke by 17 percent. 11 To gain a deeper insight into the existing research on the role of emotional well-being in health and the implications for public understanding, NCCIH in collaboration with other NIH ICOs sponsored a roundtable discussion with scientific experts to discuss the scientific opportunities and gaps in research areas. To capitalize on this area of opportunity, the NCCIH, with other ICOs, will further support research to increase understanding of the fundamental constituents of well-being across the lifespan and among various subgroups, refine and implement scientifically based prevention strategies to enhance emotional well-being, and develop measurement methodologies to optimize and scale up well-being interventions for treatment and prevention of burnout, stress, pain, and mental health symptoms in at-risk populations (e.g., caregivers, military personnel, minority groups, individuals with substance abuse), as well as children and adolescents.

Training the next generation of complementary and integrative health researchers:

One of NCCIH’s primary strategic goals is to support research training and career development opportunities to increase the number and quality of scientists trained to conduct rigorous, cuttingedge research on complementary and integrative practices. In pursuit of this goal, NCCIH has hosted several training workshops to help early stage investigators connect NIH funding opportunities across stages of their career development, understand how to interact with NIH staff to develop proposals, successfully navigate the NIH review process, develop resilience to overcome career roadblocks, and develop a plan for a successful research career. In addition to these training workshops, NCCIH supports a funding opportunity aimed at providing an intensive, supervised research experience for complementary health practitioners (e.g., licensed acupuncturists, massage therapists; chiropractic doctors; and naturopathic or osteopathic physicians) that will lead to a better understanding of, and practical experience in, complementary and integrative health research. The Center recently developed an additional program that provides funds for clinicians trained in complementary medicine to get research training early in their academic career. The hope is that together these programs will help develop a pipeline of qualified clinician-scientist investigators with complementary and integrative health degrees who are able to advance clinical and/or translational research on complementary interventions

Disseminate objective evidence-based information on complementary and integrative health approaches:

NCCIH faces several challenges in translating and disseminating complex scientific information to an interested and engaged public. First, the landscape of complementary and integrative health is inundated with information, some of it overtly promotional, and much of it either not based on scientific evidence or based on information of

9 Community Translational Science Team (CTST). Policy Report: Building A Public Health Model for Promoting Emotional Well-Being. Los Angeles: University of California, Los Angeles; 2016.

10 0 Positive psychological well-being and mortality: A quantitative review of prospective observational studies. Psychosomatic Medicine. 2008.

11 Purpose in life and its relationship to all-cause mortality and cardiovascular events: A meta-analysis. Psychosomatic Medicine. 2016

questionable quality and reliability. Second, there is evidence that individuals who use complementary health approaches often do not discuss their use with conventional health care providers. Instead, they rely on other sources, including family and friends, practitioners of complementary health approaches, and information gleaned from the Internet, popular media, and advertising. A priority of NCCIH is to provide unbiased, reliable, authoritative resources on complementary and integrative health approaches and research results for health care providers, researchers, policymakers, the health industry, and the public. The Center uses a variety of communication techniques and technologies to bring evidence-based information about complementary health approaches to these audiences and to provide a scientifically accurate perspective on the potential promise, as well as the risks, of using these interventions. NCCIH provides information to its audiences through multiple channels, including the Web, broadcast and print media, a research blog, and social media platforms. In addition, NCCIH recently developed and released a mobile app called “HerbList,” which provides evidence-based information about herbs and dietary supplements in an easy-to-use and understand format.

The FY 2020 President’s Budget request is $126.1 million, a decrease of $20.4 million or 13.9% percent compared with the FY 2019 Enacted level.

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 epidemiologic studies, including several collaborations between NIH ICs and other Federal agencies.

Budget Policy:

The FY 2020 President’s Budget request is $45.4 million, a decrease of $7.5 million or 16.5 percent compared with the FY 2019 Enacted level.

Program Portrait: NCCIH partnership with SAMHSA to combat opioid use disorder

More than 4 million people in the U.S. report using opioids for non-medical purposes in the past month, and almost 2 million report symptoms consistent with an opioid use disorder (OUD). Fewer than half of those with an OUD receive treatment and even fewer receive treatment of adequate duration. The number of drug overdose deaths involving opioids has quadrupled between 1999 and 2015, to more than 33,000 annually.

Chronic pain is an important co-morbidity in patients with OUD. Twenty to 30 percent of U.S. adults report chronic pain. Treatment of acute and chronic pain conditions with opioids is contributing to the OUD epidemic. Patients at increased risk of developing OUD are those with pain that is inadequately controlled, exposed to opioids during acute pain episodes, and/or chronic pain in individuals with a history of substance abuse. Among patients with OUD treatment and chronic pain, barriers to actively engaging in treatment include fear of inadequately treated pain and depression. Many behavioral interventions have shown value for management of chronic pain. Recent American College of Physician guidelines for management of chronic back pain include recommendations to consider interventions including mindfulness-based stress reduction, multidisciplinary rehabilitation, meditative exercise such as tai chi and yoga, progressive relaxation, operant therapy and cognitive behavioral therapy. However, there are relatively few studies evaluating their effectiveness for the comorbidity of OUD and chronic pain. In addition, despite the proven effectiveness of medication-assisted treatment (MAT) for OUD, approximately 50 percent of people who begin Methadone Maintenance Therapy, for example, discontinue within twelve months, and 50 percent of people retained have an opioid relapse within 6 months. Research also suggests that pain, which is highly prevalent, may be an important contributor to MAT dropout, opioid relapse, and opioid overdose.

NCCIH has partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to study the impact of behavioral interventions for primary or secondary prevention of OUD, or as a complement to MAT of NCCIH-19 OUD. Researchers will examine whether select behavioral interventions such as mindfulness meditation, cognitive behavioral therapy, or multidisciplinary rehabilitation improve adherence to and retention in MAT or reduce resumption of drug use in individuals with OUD. NCCIH has awarded six research grants, totaling $9.4 million over 3 years. In addition to support from NCCIH, funding for these awards will come from the National Institutes of Health’s HEAL (Helping to End Addiction Long-term) Initiative. The NCCIH-administered grants will support research around the treatment supported by the $1 billion SAMHSA State Targeted Response (STR) to the Opioid Crisis Grants initiative, also known as Opioid STR grants.

As part of the 21st Century Cures Act, Opioid STR grants have been distributed to all 50 U.S. states, U.S. territories, and free-associated states to expand access to evidence-based prevention, treatment, and recovery support services; reduce unmet treatment needs; and to help prevent opioid overdose death. The six research awards supported by NCCIH will examine the impact of behavioral and complementary health interventions within the context of states’ plans for use of Opioid STR grant funds. As such, each of the funded research projects includes relevant state agency staff to ensure adequate input on study design from the SAMHSA-funded projects. The overarching idea of this collaboration is that researchers, health professionals, and community members all have a role in implementing evidence-based prevention and treatment strategies for OUD. In addition, this collaboration provides an opportunity to study, in a clinical setting, whether complementary approaches in combination with certain psychosocial interventions and medications can further improve treatment outcomes and/or help manage co-occurring pain.

Extramural Basic Research:

Basic research on the fundamental biological effects of 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. While NCCIH continues its broad support of investigator-initiated research, the Center will also support translational research to optimize therapeutic effects through targeted initiatives. For example, NCCIH supports translational research to ascertain the biological effects of nonpharmacologic therapies on the brain and to optimize their effects. NCCIH is also energizing the research community to overcome the methodologic and technologic obstacles hindering basic research on natural products and nonpharmacologic therapies, as well as encouraging the incorporation of cutting-edge technologies to monitor and enhance these interventions.

Budget Policy:

The FY 2020 President’s Budget request is $50.7 million, a decrease of $8.6 million or 17.0 percent compared with the FY 2019 Enacted level.

Program Portrait: The Microbiome Program

The human body is home to trillions of microorganisms (e.g., bacteria, fungi and other microbes), referred to as the microbiota. While the microbiota within the intestine outnumber human cells by a factor of 10, most of these microorganisms live in harmony with their human host. These microorganisms collectively express thousands of unique genes, referred to as the microbiome. Like how the microbiota outnumber human cells, the microbiome also outnumbers the human genome. This suggests that the microbiome may contribute to and influence human physiology. In fact, there is growing evidence that the gut microbiota help digest food, make necessary vitamins, and enhance the immune system. However, very little is known about the role of the microbiota and the microbiome in human health and disease. To help fill this knowledge gap, the NIH launched the Human Microbiome Project in 2007 and NCCIH is an active participant with specific interests in understanding how probiotics and diet influence the microbiome.

Since the launch of the Human Microbiome Project, researchers have learned more about the microbiota that help keep us healthy and how subtle imbalances in our microbial populations can promote disease. NCCIH supports research on probiotics and how they influence gut microbial populations. Probiotics are live microorganisms (in most cases, bacteria) that are like the beneficial microorganisms found in the human gut. Products sold as probiotics include foods (such as yogurt), dietary supplements, and products that are not used orally, such as skin creams. Researchers have studied probiotics to find out whether they might help prevent or treat a variety of health problems, including digestive disorders, allergic disorders, Colic, and liver disease. There is evidence to suggest NCCIH-20 that some probiotics are helpful in preventing diarrhea caused by infections and antibiotics and in improving symptoms of irritable bowel syndrome, but there is much more to learn. NCCIH is funding research to identify which probiotics are helpful, under what conditions, and for what types of disorders. Even for the conditions that have been studied the most, researchers are still working toward finding the answers to these questions.

Another interest for NCCIH is the connection between diet and the microbiome. Evidence has begun to build that the foods we eat (including the natural compounds in fruits and vegetables), the microbes in our digestive systems, and our basic biological functions all intersect to influence our overall health. Recently, NCCIH released a Funding Opportunity Announcement entitled “Biological Signatures of Diet-Derived Microbial Metabolites,” for projects to study several aspects of this question. In FY2018 NCCIH funded ten new awards, totaling nearly $204 million over 5 years to study the possible links between the gut microbiome and the transformation of dietary compounds into substances known as metabolites, which are made or used when the body breaks down food, drugs, or chemicals. This process creates energy and the materials needed for growth, reproduction, and maintaining health; it also helps to eliminate toxic substances. NCCIH seeks to systematically identify the metabolites in the diet-microbiome interaction, the bacteria that produce them, and their related biological activities. Those activities could be, for example, anti-anxiety, anti-depressant, and/or anti-inflammatory in nature. Small, gut-derived metabolites may ultimately explain the widely acknowledged health benefits of diets high in fruits and vegetables. This research may fill current gaps in understanding the abundance and variety of gut-derived metabolites and possible biological signatures associated with improved measures of health and resilience.

Program Portrait: The CARBON Program

Plants and plant-derived products are widely consumed for basic nutrition, to promote health and well-being, and for medicinal purposes, worldwide and in the U.S. Despite this prevalent use, the mechanisms of action and efficacy of many of these products have not been rigorously evaluated; and, the challenges of doing research on these complex materials continue to slow progress toward understanding their contributions to public health. The Centers for Advancing Research on Botanicals and Other Natural Products (CARBON) Program was launched in 1999 to support research into the safety, effectiveness, and mechanisms of action of botanical dietary supplements that have a high potential to benefit human health.

The CARBON program had its origins with a small number of Botanical Research Centers funded originally in 1999 in response to a Congressional mandate to the Office of Dietary Supplements (ODS) to initiate a program to support botanical research. NCCIH has been a partner on this program from the beginning. Together NCCIH and ODS funded Botanical Research Centers that were tasked with identifying and characterizing botanicals, assessing the chemical components of botanicals, exploring their mechanisms of action, conducting preclinical and clinical evaluations, and training the next generation of scientific researchers. NCCIH and ODS continue to shape the program to tackle the scientific gaps in the field while also addressing shared research priorities. In 2015, a new component was added to the program focusing on development of novel technology that could break through existing bottlenecks that hampered progress in natural products research. This addition has ushered in a more collaborative environment for the program where the Centers work closely with each other on specific projects.

In the 20-year history of the program, the Centers have provided rigorous scientific data on the usefulness of a wide range of botanical products, generated research resulting in hundreds of peer-reviewed publications and trained numerous early-stage scientists. Many of the botanical supplements studied in these centers — such as black cohosh, bitter melon, chasteberry, fenugreek, grape seed extract, hops, maca, milk thistle, resveratrol, licorice, and valerian — are among the top 100 supplements consumed in the U.S. based on sales data. The data generated from these and other studies have helped expand our knowledge of natural products. Research results from the Centers are summarized and available for the public on the NCCIH website, the ODS website, and thru NCCIH’s new mobile app, HerbList.

Extramural Research Training and Capacity Building:

Improving the capacity of the field to carry out rigorous research on complementary and integrative health approaches is a priority for the NCCIH. To increase the number, quality, and diversity of investigators conducting research on complementary and integrative health approaches, NCCIH supports a variety of training and career development activities for pre- and post-doctoral students, and early career investigators.

Budget Policy:

The FY 2020 President’s Budget request is $3.5 million, a decrease of $0.8 million or 18.9 percent compared with the FY 2019 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 nonpharmacologic approaches. Among topics of interest are the pathways and mechanisms by which expectations, emotions, attention, environment, and genetics 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 2020 President’s Budget request is $9.9 million, a decrease of $1.7 million or 14.5 percent compared with the FY 2019 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. The Center is migrating to Qlik Sense which provides interactive reports and enhanced dashboards to provide NCCIH leadership with trend data and performance indicators to ensure responsible stewardship of public funds. The Center continues to improve onboarding and new employee orientation to ensure smooth transition of incoming staff. As part of its outreach efforts, NCCIH disseminates objective, evidence-based information to the public, scientists, and health care providers to help them make informed decisions about the use of complementary and integrative health practices.

Budget Policy:

The FY 2020 President’s Budget request is $16.6 million, a decrease of $1.8 million or 10.0 percent compared with the FY 2019 Enacted level.


NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Budget Authority by Object Class 1

(Dollars in Thousands)

 FY 2019 EnactedFY 2020 President's BudgetFY 2020 +/FY 2019
Total compensable workyears:   
Full-time equivalent of overtime and holiday hours73730
Full-time equivalent000
Average ES salary$0$0$0
Average GM/GS grade12.812.80.0
Average GM/GS salary$117$117$0
Average salary, grade established by act of July 1, 1944 (42 U.S.C. 207)$117$117$0
Average salary of ungraded positions$198$198$0
OBJECT CLASSESFY 2019 EnactedFY 2020 President's BudgetFY 2020 +/FY 2019
Personnel Compensation   
11.1 Full-Time Permanent6,9696,99626
11.3 Other Than Full-Time Permanent2,2582,2669
11.5 Other Personnel Compensation3453471
11.9 Subtotal Personnel Compensation$10,909$10,958$49
12.1 Civilian Personnel Benefits3,1993,25960
12.2 Military Personnel Benefits1221264
13.0 Benefits to Former Personnel000
Subtotal Pay Costs$14,230$14,343$1149
21.0 Travel & Transportation of Persons500379-121
22.0 Transportation of Things108-2
23.1 Rental Payments to GSA000
23.2 Rental Payments to Others000
23.3 Communications, Utilities & Misc. Charges8161-20
24.0 Printing & Reproduction000
25.0 Consulting Services000
25.2 Other Services5,0323,933-1,099
25.3 Purchase of goods and services from government accounts17,54914,140-3,409
25.4 Operation & Maintenance of Facilities000
25.5 R&D Contracts2,1791,852-327
25.6 Medical Care4032-8
25.7 Operation & Maintenance of Equipment285216-69
25.8 Subsistence & Support of Persons000
25.0 Subtotal Other Contractual Services$25,086$20,173-$4,913
26.0 Supplies & Materials233177-56
31.0 Equipment551425-126
32.0 Land and Structures000
33.0 Investments & Loans000
41.0 Grants, Subsidies & Contributions105,78290,515-15,268
42.0 Grants, Subsidies & Contributions000
43.0 Interest & Dividends000
44.0 Refunds000
Subtotal Non-Pay Costs$132,243$111,738-$20,506
Total Budget Authority by Object Class$146,473$126,081-$20,392
1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Salaries and Expenses

(Dollars in Thousands)

OBJECT CLASSESFY 2019 EnactedFY 2020 President's BudgetFY 2020 +/FY 2019
Personnel Compensation   
Full-Time Permanent (11.1)$6,969$6,996$26
Other Than Full-Time Permanent (11.3)2,2582,2669
Other Personnel Compensation (11.5)3453471
Military Personnel (11.7)2522618
Special Personnel Services Payments (11.8)1,0851,0894
Subtotal Personnel Compensation (11.9)$10,909$10,958$49
Civilian Personnel Benefits (12.1)$3,199$3,259$60
Military Personnel Benefits (12.2)1221264
Benefits to Former Personnel (13.0)000
Subtotal Pay Costs$14,230$14,343$114
Travel & Transportation of Persons (21.0)$500$379-$121
Transportation of Things (22.0)108-2
Rental Payments to Others (23.2)000
Communications, Utilities & Misc. Charges (23.3)8161-20
Printing & Reproduction (24.0)000
Other Contractual Services:   
Consultant Services (25.1)000
Other Services (25.2)5,0323,933-1,099
Purchases from government accounts (25.3)10,0837,756-2,327
Operation & Maintenance of Facilities (25.4)000
Operation & Maintenance of Equipment (25.7)285216-69
Subsistence & Support of Persons (25.8)000
Subtotal Other Contractual Services$15,400$11,905-$3,496
Supplies & Materials (26.0)$233$177-$56
Subtotal Non-Pay Costs$16,224$12,529-$3,695
Total Administrative Costs$30,454$26,873-$3,582
1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.


NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Detail of Full-Time Equivalent Employment (FTE)

OFFICE/DIVISIONFY 2018 FinalFY 2019 Annualized CRFY 2020 President’s Budget
CivilianMilitaryTotalCivilianMilitaryTotalCivilianMilitaryTotal
Office of Scientific Review         
Direct:6-66-66-6
Reimbursable:---------
   Total:6-66-66-6
Basic and Mechanistic Research in Complementary and Integrative Health Branch         
Direct:2-22-22-2
Reimbursable:---------
   Total:2-22-22-2
Clinical Research in Complementary and Integrative Health Branch         
Direct:3-34-44-4
Reimbursable:---------
   Total:3-34-44-4
Division of Extramural Activities         
Direct:4-44-44-4
Reimbursable:---------
   Total:4-44-44-4
Division of Extramural Research         
Direct:9-910-1010-10
Reimbursable:---------
   Total:9-910-1010-10
Division of Intramural Research Program         
Direct:718819819
Reimbursable:---------
   Total:718819819
Office of Administrative Operations         
Direct:14-141311413114
Reimbursable:---------
   Total:14-141311413114
Office of Clinical and Regulatory Affairs         
Direct:3-34-44-4
Reimbursable:---------
   Total:3-34-44-4
Office of Communications and Public Liaison         
Direct:8-88-88-8
Reimbursable:---------
   Total:8-88-88-8
Office of Grants Management         
Direct:4-44-44-4
Reimbursable:---------
   Total:4-44-44-4
Office of Policy, Planning and Evaluation         
Direct:3-33-33-3
Reimbursable:---------
   Total:3-33-33-3
Office of the Director         
Direct:3145-55-5
Reimbursable:---------
   Total:3145-55-5
Total662687127371273
Includes FTEs whose payroll obligations are supported by the NIH Common Fund.
FTEs supported by funds from Cooperative Research and Development Agreements.000000000
FISCAL YEARAverage GS Grade
201612.8
201712.9
201812.8
201912.8
202012.8

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Detail of Positions1

GRADEFY 2018 FinalFY 2019 Annualized CRFY 2020 President’s Budget
Total, ES Positions000
Total, ES Salary000
GM/GS-15999
GM/GS-14141414
GM/GS-13192020
GS-12101212
GS-11355
GS-10000
GS-9000
GS-8111
GS-7222
GS-6000
GS-5000
GS-4111
GS-3000
GS-2000
GS-1000
Subtotal596464
Grades established by Act of July 1, 1944 (42 U.S.C. 207)000
Assistant Surgeon General000
Director Grade111
Senior Grade000
Full Grade111
Senior Assistant Grade000
Assistant Grade000
Subtotal222
Ungraded999
Total permanent positions606565
Total positions, end of year707575
Total full-time equivalent (FTE) employment, end of year687373
Average ES salary000
Average GM/GS grade12.812.812.8
Average GM/GS salary117,420117,420117,420
1 Includes FTEs whose payroll obligations are supported by the NIH Common Fund.