I think there’s a fair amount of turnover. Members of our advisory council have three or four year terms. We have 18 members, so each year we’re naming three or four new people. So that’s one aspect of turnover. The peer review panels are set up by a different part of the NIH, either by our own review branch or by the Center for Scientific Review. They pull in experts, partly determined by the grant flow. So if there are a lot of grant applications coming in on acupuncture, they would turn to acupuncture experts to review those grants. The composition of the panels changes depending on the grant submissions.

About how many studies has NCCAM funded in the past couple of years and how broad a range of topics is covered? You’ve mentioned chiropractic and acupuncture. Can you give us a broader sense of the areas addressed?

At any one time, we have about 300 active projects. Our investigators have published approximately 3300 papers and the projects are about half and half, with a little more on human subjects than basic science. They cover an incredibly wide range of projects, everything from individual natural products to Traditional Chinese Medicine to back pain management. We have a very strong portfolio in back pain management and we’re very proud of the back pain management area. This is an area where our research is really having an impact on practice.

NCCAM provides support for medical schools and CAM training institutions to develop centers of excellence. What does this involve? How important is building research infrastructure?

The Centers of Excellence program supports collaborative grants, typically three or four projects, and provides support for the investigators in those projects. We have centers of this sort, usually funded as program projects, in both CAM institutions and conventional institutions. I think it’s been incredibly important in building the research community. Actually, a pretty sizable part of our budget goes into program projects and centers, over 15 percent.

What is your overall budget for the coming year?

It’ll be 128.8 million dollars. Our grants are for four years on average, so each year we’re awarding new grants for about a quarter of that.

To what extent does current NCCAM-funded research involve studying the effects of a single intervention and to what extent are you funding whole systems research, which looks at health effects more comprehensively?

This is an important area that we’re working to strengthen as part of an effort across the NIH to do more research that falls in the category of what’s being called comparative effectiveness research. All of us recognize that assessing how modalities work in the real world is a very important area to strengthen in our research portfolio. And we are sponsoring several areas where we will be expanding the comparative effectiveness research.

Comparative effectiveness research is very important and some of the breakthrough studies involving chiropractic, for example, have involved head-to-head comparisons with conventional medical approaches to back pain or headaches. But comparative effectiveness research often involves comparing the effects of two single-agent therapies, with the sought-after effects very tightly defined.

It is, by its nature, real world research. It would be asking, “How well does this work?” in the real world. You know, NCCAM has invested, over the past several years, fairly sizably (nearly 10 percent of its budget) in clinical trials of herbals, plants, and other botanicals. And we just saw the completion of one of those recently, the study on ginkgo for cognitive decline in elderly people, for early dementia.