FY 2020 Budget Page No. › pdfs › FY20 › 23-NCCIH.pdfcomplementary approaches together in a safe, coordinated way. According to a 2012 National Health Interview Survey (NHIS),

NCCIH-1

DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

National Center for Complementary and Integrative Health (NCCIH)

FY 2020 Budget Page No.

Organization Chart ...........................................................................................................................2

Appropriation Language ..................................................................................................................3

Amounts Available for Obligation ...................................................................................................4

Budget Mechanism Table ................................................................................................................5

Major Changes in Budget Request ..................................................................................................6

Summary of Changes .......................................................................................................................7

Budget Graphs .................................................................................................................................8

Budget Authority by Activity ..........................................................................................................9

Authorizing Legislation .................................................................................................................10

Appropriations History ..................................................................................................................11

Justification of Budget Request .....................................................................................................12

Budget Authority by Object Class .................................................................................................22

Salaries and Expenses ....................................................................................................................23

Detail of Full-Time Equivalent Employment (FTE) .....................................................................24

Detail of Positions ..........................................................................................................................25

NCCIH-2

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NCCIH-3


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.

NCCIH-4

Source of Funding FY 2018 Final FY 2019 EnactedFY 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)

Rescission 0 0 0

Sequestration 0 0 0

Secretary's Transfer -334 0 0

Subtotal, adjusted appropriation $141,850 $146,473 $126,081

OAR HIV/AIDS Transfers -166 0 0

Subtotal, adjusted budget authority $141,684 $146,473 $126,081

Unobligated balance, start of year 0 0 0

Unobligated balance, end of year 0 0 0

Subtotal, adjusted budget authority $141,684 $146,473 $126,081

Unobligated balance lapsing -17 0 0

Total obligations $141,667 $146,473 $126,081


National Center for Complementary and Integrative Health

Amounts Available for Obligation¹(Dollars in Thousands)

¹ Excludes the following amounts (in thousands) for reimbursable activities carried out by this account:

FY 2018 - $461 FY 2019 - $785 FY 2020 - $785

NCCIH-5

No. Amount No. Amount No. Amount No. Amount

104 $53,235 114 $58,240 119 $58,567 5 $327

(12) 1,423 (8) 900 (4) 450 (-4) -450

4 1,879 0 0 0 0 0 0

58 25,153 53 22,961 38 14,729 -15 -8,233

0 0 0 0 0 0 0 0

62 $27,032 53 $22,961 38 $14,729 -15 -$8,233

166 $81,690 167 $82,102 157 $73,746 -10 -$8,356

9 4,146 9 4,277 8 3,569 -1 -708

175 $85,836 176 $86,378 165 $77,314 -11 -$9,064

4 $5,129 4 $5,082 2 $2,000 -2 -$3,082

0 0 0 0 0 0 0 0

2 855 2 840 2 650 0 -190

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

6 $5,984 6 $5,922 4 $2,650 -2 -$3,272

39 $5,677 42 $6,135 34 $4,900 -8 -$1,235

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

9 2,828 10 3,061 7 2,175 -3 -887

48 $8,505 52 $9,196 41 $7,074 -11 -$2,122

229 $100,325 234 $101,497 210 $87,038 -24 -$14,458

FTTPs FTTPs FTTPs FTTPs

20 $920 20 $936 16 $760 -4 -$176

38 2,049 62 3,349 50 2,716 -12 -633

58 $2,969 82 $4,286 66 $3,476 -16 -$810

14 $11,342 13 $10,644 11 $9,047 -2 -$1,597

(0) (8) (0) (44) (0) (39) (0) (-6)

8 9,606 9 11,606 9 9,922 0 -1,684

60 17,441 64 18,440 64 16,596 0 -1,844

(0) (0) (0) (0) (0) (0) (0) (0)

0 0 0 0

0 0 0 0

68 $141,684 73 $146,473 73 $126,081 0 -$20,392

¹

(Dollars in Thousands)

MECHANISM FY 2018 Final FY 2019 EnactedFY 2020 President's

Budget

FY 2020

+/-

FY 2019

Research Projects:

Noncompeting

Administrative Supplements

Competing:

Renewal

New

Supplements

Subtotal, Competing

Subtotal, RPGs

SBIR/STTR

Research Project Grants

Research Centers:

Specialized/Comprehensive

Clinical Research

Biotechnology

Comparative Medicine

Research Centers in Minority

Research Centers

Other Research:

Research Careers

Cancer Education

Cooperative Clinical Research

Biomedical Research Support

Minority Biomedical Research Support

Research & Develop. Contracts

(SBIR/STTR) (non-add)

Intramural Research

Other

Other Research

Total Research Grants

Ruth L Kirchstein Training Awards:

Individual Awards

Institutional Awards

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



Budget Mechanism - Total¹

Res. Management & SupportRes. Management & Support (SBIR

Admin)

Construction

Buildings and Facilities

Total, NCCIH

Total Research Training

NCCIH-6

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.

NCCIH-7

FY 2019 Enacted

FY 2020 President's Budget

Net change

FTE

s

Budget

Authority

FTE

s

Budget

Authority

$3,218 $0

3,218 14

3,218 12

3,218 0

1,336 27

5,368 107

$160

$11,125 $0

11,125 45

11,125 42

11,125 0

171 3

5,301 106

$197

$357

No. Amount No. Amount

119 $59,017 5 -$123

38 14,729 -15 -8,233

8 3,569 -1 -708

165 $77,314 -11 -$9,064

4 $2,650 -2 -$3,272

41 7,074 -11 -2,122

66 3,476 -16 -810

11 9,047 -2 -1,597

$99,562 -$16,864

FTEs FTEs

9 $9,922 0 -$1,844

64 16,596 0 -2,041

0 0

0 0

73 $126,081 0 -$20,749

-$20,392



Summary of Changes


$146,473

$126,081

-$20,392

FY 2020 President's

Budget

Change from FY 2019

Enacted

CHANGES

A. Built-in:

1. Intramural Research:

a. Annualization of January 2019 pay increase & benefits

b. January FY 2020 pay increase & benefits

c. Paid days adjustment

d. Differences attributable to change in FTE

e. Payment for centrally furnished services

f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs

Subtotal

2. Research Management and Support:

a. Annualization of January 2019 pay increase & benefits

b. January FY 2020 pay increase & benefits

c. Paid days adjustment

d. Differences attributable to change in FTE

e. Payment for centrally furnished services

f. Cost of laboratory supplies, materials, other expenses, and non-recurring costs

Subtotal

Subtotal, Built-in

FY 2020 President's

Budget

Change from FY 2019

Enacted

CHANGES

B. Program:

1. Research Project Grants:

a. Noncompeting

b. Competing

c. SBIR/STTR

Subtotal, RPGs

2. Research Centers

3. Other Research

4. Research Training

5. Research and development contracts

Subtotal, Extramural

6. Intramural Research

Subtotal, Program

Total changes

7. Research Management and Support

8. Construction

9. Buildings and Facilities

NCCIH-8

Fiscal Year 2020 Budget Graphs

History of Budget Authority and FTEs:

Distribution by Mechanism:

Change by Selected Mechanism:

NCCIH-9

FTE Amount FTE Amount FTE Amount FTE Amount

$54,346 $52,908 $45,421 -$7,487

57,322 59,259 50,665 -8,595

2,969 4,259 3,476 -783

$114,637 $116,426 $99,562 -$16,864

8 $9,606 9 $11,606 9 $9,922 0 -$1,684

60 $17,441 64 $18,440 64 $16,596 0 -$1,844

68 $141,684 73 $146,473 73 $126,081 0 -$20,392

¹

Intramural Research

Research Management & Support

TOTAL

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

Extramural Research

Detail

Clinical Research

Basic Research

Extramural Research Training and Capacity Building

Subtotal, Extramural



Budget Authority by Activity¹


FY 2018 FinalFY 2019

Enacted

FY 2020

President's

Budget

FY 2020

+/-

FY2019

NCCIH-10

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NCCIH-11

Budget Estimate to

CongressHouse Allowance Senate Allowance Appropriation

$132,004,000 $131,796,000 $128,844,000

$1,131,327

$131,002,000 $131,002,000 $126,275,000 $128,299,000

$242,485

$127,930,000 $128,318,000 $128,056,515

$256,113

($6,427,556)

$129,041,000 $128,183,000 $124,296,000

$0

$124,509,000 $124,681,000

$0

$127,521,000 $127,585,000 $130,162,000 $130,789,000

$0

$129,941,000 $134,549,000 $136,195,000 $134,689,000

$0

$101,793,000 $136,741,000 $139,654,000 $142,184,000

$0

$130,717,000 $143,882,000 $146,550,000 $146,473,000

$0

$126,081,000

¹



Appropriations History

Fiscal Year

2011

Rescission

2012

Rescission

2013

Rescission

Sequestration

2014

Rescission

2015

Rescission

2016

Rescission

2017¹

Rescission

2020

Budget Estimate to Congress includes mandatory financing.

2018

Rescission

2019

Rescission

NCCIH-12

Justification of Budget Request


Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.

Budget Authority (BA):

FY 2018 Actual

FY 2019 Enacted

FY 2020 President's

Budget

FY 2020 + /-

FY 2019 BA $141,684,000 $146,473,000 $126,081,000 -$20,392,000 FTE 68 73 73 0

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 decision-

making 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

scientific inquiry. NCCIH strives to invest in research that will drive new discoveries, which

may lead to improved public health and health care.

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

95, 2016. PMID: 2735222

NCCIH-13

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.

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

2 Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Institute of

Medicine, 2011. 3 Dual leucine zipper kinase is required for mechanical allodynia and microgliosis after nerve injury. eLife, 2018. 4 Chronic neuropathic pain reduces opioid receptor availability with associated anhedonia in rat. Pain, 2018.

NCCIH-14

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

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

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

NCCIH-15

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.

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).

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

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-16

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.

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.

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 self-

defined goals.9 Scientific studies have shown a strong correlation between overall emotional

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

NCCIH-17

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, cutting-

edge 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

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.

NCCIH-18

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


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

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

NCCIH-19

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:



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

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.

NCCIH-20

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:



NCCIH-21

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:



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:



NCCIH-22

FY 2019 EnactedFY 2020 President's

Budget

FY 2020

+/-

FY 2019

Full-time equivalent 73 73 0

Full-time equivalent of overtime and holiday hours 0 0 0

Average ES salary $0 $0 $0

Average GM/GS grade 12.8 12.8 0.0

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

FY 2019 EnactedFY 2020 President's

Budget

FY 2020

+/-

FY 2019

Personnel Compensation

Full-Time Permanent 6,969 6,996 26

Other Than Full-Time Permanent 2,258 2,266 9

Other Personnel Compensation 345 347 1

Military Personnel 252 261 8

Special Personnel Services Payments 1,085 1,089 4

Subtotal Personnel Compensation $10,909 $10,958 $49

Civilian Personnel Benefits 3,199 3,259 60

Military Personnel Benefits 122 126 4

Benefits to Former Personnel 0 0 0

Subtotal Pay Costs $14,230 $14,343 $114

Travel & Transportation of Persons 500 379 -121

Transportation of Things 10 8 -2

Rental Payments to GSA 0 0 0

Rental Payments to Others 0 0 0

Communications, Utilities & Misc. Charges 81 61 -20

Printing & Reproduction 0 0 0

Consulting Services 0 0 0

Other Services 5,032 3,933 -1,099

Purchase of goods and services from government

accounts17,549 14,140 -3,409

Operation & Maintenance of Facilities 0 0 0

R&D Contracts 2,179 1,852 -327

Medical Care 40 32 -8

Operation & Maintenance of Equipment 285 216 -69

Subsistence & Support of Persons 0 0 0

Subtotal Other Contractual Services $25,086 $20,173 -$4,913

Supplies & Materials 233 177 -56

Equipment 551 425 -126

Land and Structures 0 0 0

Investments & Loans 0 0 0

Grants, Subsidies & Contributions 105,782 90,515 -15,268

Insurance Claims & Indemnities 0 0 0

Interest & Dividends 0 0 0

Refunds 0 0 0

Subtotal Non-Pay Costs $132,243 $111,738 -$20,506

Total Budget Authority by Object Class $146,473 $126,081 -$20,392

¹



Budget Authority by Object Class¹(Dollars in Thousands)

Total compensable workyears:

OBJECT CLASSES

11.1

11.3

11.5

11.7

11.8

11.9

12.1

12.2

13.0

21.0

22.0

23.1

23.2

23.3

24.0

25.1

25.2

25.3

25.4

25.5

25.6

25.7

25.8

25.0

26.0

31.0

32.0

33.0

41.0

42.0

43.0

44.0


NCCIH-23

OBJECT CLASSES FY 2019 EnactedFY 2020 President's

Budget

FY 2020

+/-

FY 2019

Personnel Compensation

Full-Time Permanent (11.1) $6,969 $6,996 $26

Other Than Full-Time Permanent (11.3) 2,258 2,266 9

Other Personnel Compensation (11.5) 345 347 1

Military Personnel (11.7) 252 261 8

Special Personnel Services Payments (11.8) 1,085 1,089 4

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) 122 126 4

Benefits to Former Personnel (13.0) 0 0 0

Subtotal Pay Costs $14,230 $14,343 $114

Travel & Transportation of Persons (21.0) $500 $379 -$121

Transportation of Things (22.0) 10 8 -2

Rental Payments to Others (23.2) 0 0 0

Communications, Utilities & Misc. Charges (23.3) 81 61 -20

Printing & Reproduction (24.0) 0 0 0

Other Contractual Services:

Consultant Services (25.1) 0 0 0

Other Services (25.2) 5,032 3,933 -1,099

Purchases from government accounts (25.3) 10,083 7,756 -2,327

Operation & Maintenance of Facilities (25.4) 0 0 0

Operation & Maintenance of Equipment (25.7) 285 216 -69

Subsistence & Support of Persons (25.8) 0 0 0

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



Salaries and Expenses(Dollars in Thousands)

NCCIH-24

Civilian Military Total Civilian Military Total Civilian Military Total

Office of Scientific Review

Direct: 6 - 6 6 - 6 6 - 6

Reimbursable: - - - - - - - - -

Total: 6 - 6 6 - 6 6 - 6

Basic and Mechanistic Research in

Complementary and Integrative Health

Branch

Direct: 2 - 2 2 - 2 2 - 2

Reimbursable: - - - - - - - - -

Total: 2 - 2 2 - 2 2 - 2

Clinical Research in Complementary and

Integrative Health Branch

Direct: 3 - 3 4 - 4 4 - 4

Reimbursable: - - - - - - - - -

Total: 3 - 3 4 - 4 4 - 4

Division of Extramural Activities

Direct: 4 - 4 4 - 4 4 - 4

Reimbursable: - - - - - - - - -

Total: 4 - 4 4 - 4 4 - 4

Division of Extramural Research

Direct: 9 - 9 10 - 10 10 - 10

Reimbursable: - - - - - - - - -

Total: 9 - 9 10 - 10 10 - 10

Division of Intramural Research Program

Direct: 7 1 8 8 1 9 8 1 9

Reimbursable: - - - - - - - - -

Total: 7 1 8 8 1 9 8 1 9

Office of Administrative Operations

Direct: 14 - 14 13 1 14 13 1 14

Reimbursable: - - - - - - - - -

Total: 14 - 14 13 1 14 13 1 14

Office of Clinical and Regulatory Affairs

Direct: 3 - 3 4 - 4 4 - 4

Reimbursable: - - - - - - - - -

Total: 3 - 3 4 - 4 4 - 4

Office of Communications and Public Liaison

Direct: 8 - 8 8 - 8 8 - 8

Reimbursable: - - - - - - - - -

Total: 8 - 8 8 - 8 8 - 8

Office of Grants Management

Direct: 4 - 4 4 - 4 4 - 4

Reimbursable: - - - - - - - - -

Total: 4 - 4 4 - 4 4 - 4

Office of Policy, Planning, and Evaluation

Direct: 3 - 3 3 - 3 3 - 3

Reimbursable: - - - - - - - - -

Total: 3 - 3 3 - 3 3 - 3

Office of the Director

Direct: 3 1 4 5 - 5 5 - 5

Reimbursable: - - - - - - - - -

Total: 3 1 4 5 - 5 5 - 5

Total 66 2 68 71 2 73 71 2 73

FTEs supported by funds from Cooperative

Research and Development Agreements.0 0 0 0 0 0 0 0 0

FISCAL YEAR

2016

2017

2018

2019

2020 12.8

Average GS Grade

12.8

12.9

12.8

12.8



Detail of Full-Time Equivalent Employment (FTE)

OFFICE/DIVISION

FY 2018 Final FY 2019 Enacted FY 2020 President's Budget


NCCIH-25

FY 2018 Final FY 2019 EnactedFY 2020 President's

Budget

0 0 0

0 0 0

9 9 9

14 14 14

19 20 20

10 12 12

3 5 5

0 0 0

0 0 0

1 1 1

2 2 2

0 0 0

0 0 0

1 1 1

0 0 0

0 0 0

0 0 0

59 64 64

0 0 0

0 0 0

1 1 1

0 0 0

1 1 1

0 0 0

0 0 0

2 2 2

9 9 9

60 65 65

70 75 75

68 73 73

0 0 0

12.8 12.8 12.8

117,420 117,420 117,420

¹

Average ES salary

Average GM/GS grade

Average GM/GS salary


Total permanent positions

Total positions, end of year

Total full-time equivalent (FTE) employment, end of year

Senior Grade

Full Grade

Senior Assistant Grade

Assistant Grade

Subtotal

Ungraded

GS-1

Subtotal

Grades established by Act of July 1, 1944 (42 U.S.C. 207)

Assistant Surgeon General

Director Grade

GS-7

GS-6

GS-5

GS-4

GS-3

GS-2

GM/GS-13

GS-12

GS-11

GS-10

GS-9

GS-8



Detail of Positions¹

GRADE

Total, ES Positions

Total, ES Salary

GM/GS-15

GM/GS-14

Documents

FY 2020 Budget Page No. › pdfs › FY20 › 23-NCCIH.pdfcomplementary approaches together in a safe, coordinated way. According to a 2012 National Health Interview Survey (NHIS),