Congressional Justification FY 2020

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

On this page:

• Organization Chart
• Appropriation Language
• Amounts Available for Obligation
• Budget Mechanism Table
• Major Changes in Budget Request
• Summary of Changes
• Budget Graphs
• Budget Authority by Activity
• Authorizing Legislation
• Appropriations History
• Justification of Budget Request
• Budget Authority by Object Class
• Salaries and Expenses
• Detail of Full-Time Equivalent Employment (FTE)
• Detail of Positions

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)

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Budget Mechanism - Total ¹

(Dollars in Thousands)

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)

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

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Budget Authority by Activity ¹

(Dollars in Thousands)

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Authorizing Legislation

	PHS Act/Other Citation	U.S. Code Citation	2019 Amount Authorized		FY 2019 Annualized CR	2019 Amount Authorized		FY 2020 President’s Budget
Research and Investigation	Section 301	42§241	Indefinite			Indefinite
					$146,473,000			$126,081,000
National Center for Complementary and Integrative Health	Section 401(a)	42§281	Indefinite			Indefinite
Total, Budget Authority					$126,081,000			$126,081,000

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Appropriations History

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):

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.

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.

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)

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Salaries and Expenses

(Dollars in Thousands)

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Detail of Full-Time Equivalent Employment (FTE)

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health

Detail of Positions¹