Debating the Worth of NCCAM Research.

Marcus and Grollman miss the mark in their critique of the National Center for Complementary and Alternative Medicine (NCCAM) (“Review for NCCAM is overdue,” D. M. Marcus and A. P. Grollman, Policy Forum, 21 July, p. 301). We believe that NCCAM, under the leadership of Stephen Straus and Margaret Chesney, has made remarkable progress in laying the groundwork and advancing rigorous research in complementary and alternative medicine (CAM). They have brought definition, a conceptual framework, strategic plans and goals, and scientific standards to the field of CAM research. The processes through which proposals are submitted, reviewed, funded, and managed are all consistent with standard NIH practice. The disciplinary diversity of the NCCAM study section members and NCCAM councils is in keeping with the breadth of CAM research. The broad representation is also consistent with current practice in other centers and institutes. NIH advisory bodies regularly include members who are grantees, and well-tested procedures are in place for managing conflicts of interest. The same procedures are used for the study sections and advisory councils for NCCAM. Marcus and Grollman's comment that the NCCAM research agenda is shaped more by politics than by science is gratuitous, as is their suggestion that the Institute of Medicine (IOM) report, Complementary and Alternative Medicine in the United States ([1][1]), was flawed because some of the members of the panel were NCCAM grantees. In fact, like NIH, the IOM has procedures for recognizing and managing conflicts of interest. Those of us who participated in it were very mindful of any potential conflicts of interest and guarded against them in our deliberations. Further, the report was carefully reviewed by external, independent reviewers before publication. Because CAM is already in the public domain, used by millions of people at a cost of billions of dollars each year and with health effects that largely have not yet been scientifically evaluated, it is appropriate that a significant focus be on clinical research. As is true in clinical trials with new conventional drugs, we should expect that many trials of CAM treatments will not show definitive efficacy, and as with most research on understudied agents, multiple studies are often needed to develop a research base adequate for mature judgment concerning efficacy or the lack thereof. We need to be patient and use our best tool, that is, science, to understand and evaluate these widely used health practices. We believe that NCCAM has established a standard not for advocacy, but rather for rigorous objectivity. 1. 1.[↵][2]Committee on the Use of Complementary and Alternative Medicine by the American Public, Complementary and Alternative Medicine in the United States (Institute of Medicine, National Academy Press, Washington, DC, 2005). # Response {#article-title-3} The main point of the letter from Folkman et al. and the response to our Policy Forum by S. E. Straus and M. A. Chesney (“In defense of NCCAM,” Policy Forum, 21 July, p. [303][3]) is that NCCAM uses standard NIH procedures for review of proposals, appointments to advisory and review groups, and management of conflict of interest. That is formally true but misleading. Because of its charter, NCCAM advisory and review groups include many individuals whose scientific credentials would not qualify them for appointment to other NIH institutes. Of greater importance, the continued funding of poor-quality proposals refutes Straus and Chesney's claim that NCCAM applies the same review standards as other NIH institutes. Except for Bondurant, the signatories of the Folkman et al. letter all hold leadership positions in CAM or integrative medicine centers supported by NCCAM. Bondurant is a senior academic officer at Georgetown University Medical Center, which has a CAM center, and he was chairman of the IOM Committee that issued the report on CAM. Berman, Eisenberg, and Folkman also served on the IOM committee. The NCCAM appropriation for 2005, $123 million, understates NIH expenditures on CAM research. In 2004, the NCCAM budget was $117.8 million, and the total NIH expenditure on CAM research was estimated at $305 million, much of which represented projects that were co-funded by NCCAM and other institutes. NCCAM recently announced the creation of five new centers that will conduct research on multicomponent traditional African and Chinese herbal medicines. Each center will receive approximately $1 million per year, which is the equivalent of 20 RO-1 research grants. Some of this research is meritorious, but much of it is not. An independent review is urgently needed to bring the evaluation of proposals by NCCAM into line with the rest of NIH and to ensure that the limited funds available for biomedical research support the best science. [1]: #ref-1 [2]: #xref-ref-1-1 "View reference 1. in text" [3]: /lookup/doi/10.1126/science.1131608