Goals
The major investment of nccam's budget is the support and conduct of research, so Strategic Area 1, Investing in Research, represents the largest set of goals and objectives in the plan. Since its inception, nccam has funded more than 1,000 research projects at over 200 institutions, with grantees publishing widely in major peer-reviewed journals. Much of this research is clinically oriented, including studies of herbal/botanical products, acupuncture, Reiki, chiropractic manipulation, and a variety of mind-body practices. Depending on the cam approach selected for study, clinical research focuses on children, adults, or the elderly; men or women (including women in pregnancy); or members of racial or ethnic groups. Also of interest to nccam are the effects of cam practices on fertility and on the health of the fetus and mother during pregnancy.
The new plan specifies eight sets of research goals, organized by the four principal cam domains and whole medical systems, with an additional three sections on health services research, international health research, and ethical, legal, and social implications of cam research and integrated medicine. The latter is a newly articulated area of research investment for nccam. It is based on the realization that the integration of proven cam practices with mainstream medicine, while a desired outcome of cam research, is restrained by a number of ethical, legal, and social issues. As well, many of these same issues arise in the conduct of cam research itself.
The eight research sections are not represented equally in nccam's investment portfolio. The domain of biologically based practices has dominated nccam's research portfolio and will continue to do so in the future. High priority for nccam investment has also been assigned now to mind-body medicine. Not only do these two domains encompass a broad range of cam practices in widespread use, but at least for some practices, there is a considerable research base on which to build, trained investigators to do the work, and well-defined hypotheses that can be tested. Ultimately, nccam would like to see progress in all eight research sections, and it is with that aim in mind that each has been presented with its complement of goals and objectives.
A number of goals and objectives presented are a direct reflection of lessons learned over the past 5 years, such as the need for better quality control of the herbal/botanical products studied and the importance of conducting research to identify optimal doses and appropriate subject populations before investing in large clinical trials. Without these preliminary studies, there is a risk that clinical trials could prematurely conclude that a cam approach is ineffective.
Following is the list of the goals specified for the strategic areas of investing in research, research training, outreach, and governance in nccam's second strategic plan. The goals in the research area are organized according to the four cam domains and whole medical systems, with three additional areas on health services research, international health research, and ethical, legal, and social implications of cam research and integrated medicine. Note that goals stating a broad aim, such as "verify and define the composition of botanicals," are not intended to apply to the universe of all botanicals, but to selected products or practices of importance to cam research because of the need to explore safety and efficacy/benefits and risks to the public.
