Visualizing your tumor as an enemy base being fired upon by your body's fleet of jet fighters or having tiny needles inserted all over your body may sound like strange ways to treat disease, but more and more often, patients are turning to unconventional treatments for a variety of ailments either instead of, or in addition to, mainstream medical practices.

But what do we really know about the efficacy of such interventions?

Anecdotal evidence suggests that some complementary and alternative practices work, but very few of these treatments have been studied systematically. This is precisely why two different entities, the Office of Cancer Complementary and Alternative Medicine (OCCAM) and the National Center for Complementary and Alternative Medicine (NCCAM), have been created within the National Institutes of Health (NIH).

What is the difference between OCCAM and NCCAM?

Quips Wendy Smith, OCCAM program director, “Even people at NIH get them confused!” But although OCCAM and NCCAM have similar acronyms, there are important differences in scale and scope.

NCCAM is one of NIH's 27 institutes and centers and was established by Congress in October 1998. The center was originally called the Office of Alternative Medicine, which was authorized by Congress in 1991. NCCAM sponsors both intramural and extramural clinical and basic research in complementary and alternative medicine (CAM).

NCCAM Director Stephen Straus, in a talk given earlier this year, explained that the center's mission is to “conduct rigorous research on CAM practices, educate and train CAM researchers, and inform consumers and health professionals.” Straus also pointed out that unlike most institutes, NCCAM's intramural program is “mostly clinical.” According to Straus, NCCAM has funded research on the efficacy and safety of numerous therapies, including St. John's Wort to treat depression, shark cartilage to treat lung cancer, and acupuncture to treat osteoarthritis. NCCAM has also supported investigations into herbal remedy-drug interactions.

Unlike NCCAM, which is interested in CAM treatments for all diseases and disorders, OCCAM is focused on CAM approaches to cancer. OCCAM was created in October 1998 as an office within the National Cancer Institute (NCI). Smith says that OCCAM was not created by Congress--it was established because “NCI itself recognized the need.” Part of the center's mission, she says, “is to help coordinate complementary and alternative medicine activities throughout the NCI.” In fact, although all institutes have a liaison to NCCAM, NCI is the only institute with an office devoted to CAM activities.

In addition to funding its own projects, OCCAM guides cancer investigators to appropriate funding opportunities and to other parts of NCI or NIH for grant support. Many divisions of NCI sponsor CAM research, both independently and in collaboration with other institutes and centers, including NCCAM. Currently, NCI is funding studies on such practices as using dietary soy to prevent prostate cancer and using massage therapy and acupuncture to treat the pain suffered by cancer patients.

One Investigator's View

GrantsNet spoke to Michael Irwin, director of the Cousins Center for Psychoneuroimmunology at the UCLA Neuropsychiatric Institute and NCCAM R21 grantee, in an e-mail interview about the impact of the center's funding on his own research. Below is a portion of that interview:

GN: What has NCCAM funding meant for your lab?
Irwin: Without NCCAM funding opportunities, it would have been very difficult to conduct an exploratory study to evaluate the effects of TCC [Tai Chi Chih] on immune function. Because of the NCCAM R21 mechanism and the NCCAM Special Emphasis Review Panel with expertise in CAM research, we were able to obtain funding to support these preliminary studies.

GN: Before NCCAM began awarding grants, do you think it was more difficult to get funding from NIH for the testing of CAM treatments?
Irwin: I do not have any data on this question, but my impression from sitting on a NIMH study panel in the mid-1990s is that CAM treatment studies would not have passed muster--not because of design flaws and lack of good experimental techniques--but rather because of the innovative nature of these treatments and limited pilot data, particularly for an R01 mechanism.

What funding opportunities are available right now?

Currently NCCAM and/or NCI are sponsoring three grant programs that specifically solicit applications for CAM projects:

  • Basic and Preclinical Research on Complementary and Alternative Medicine
    Because there are so few basic studies on CAM approaches, NCCAM, in collaboration with NCI, the National Institute of General Medical Sciences, and the National Institute of Mental Health, has recently announced this grant program. R01 (research project), R21 (exploratory/developmental grant), and R15 ( AREA grant) applications are encouraged. Relevant topics include: alternative medical systems, mind-body interventions, biologically based treatments, manipulative and body-based methods, and energy therapies. This PA will be in effect until 15 July 2005; the next deadline is 1 October 2002.

  • Developmental/Pilot Projects in Cancer Complementary and Alternative Medicine
    OCCAM's Smith says that this PA, recently issued by the NCI in collaboration with NCCAM, “is designed to help stimulate developmental and foundational work in the field.” A lot of basic information--such as how much of an herbal remedy to use--is not yet known and must be figured out before large-scale clinical trials can be established. Smith describes the response to this PA as “overwhelming.” Although she can't divulge how many applications NCI has received so far, she says she is “pleasantly surprised by the interest.” R21 applications will be accepted in alternative medical systems, pharmacological or biologically based therapies, herbal medicine, orthomolecular medicine (nutritional and food supplements), and mind-body medicine. Applicants for these R21 grants may request up to $150,000 a year for 2 years. The next application deadline is 21 October 2002.

  • Traditional, Indigenous Systems of Medicine
    Through this program, which is run by NCCAM, scientists may apply for funding to study the efficacy of traditional medical approaches, including those practiced by Native American, Chinese, and Latin American practitioners. NCCAM is seeking developmental projects (R01 and R21) that will help lay the groundwork for future large-scale clinical trials. The center encourages researchers to consider multifaceted projects that attempt to evaluate the complex interventions employed in these cultures. Instead of isolating and testing one chemical component in an herbal remedy, for instance, researchers are urged to tackle the whole herbal remedy, in conjunction with any other traditionally prescribed treatments for a particular ailment. Investigators must also consider the cultural context in which the traditional medical approaches are used. Specific funding amounts have not been set for R01 grants under this program, but R21 applications must not exceed $125,000 a year for 2 years. Marguerite Evans, the NCCAM contact for this program, says that “unless otherwise stated, PAs are active for 3 years from the date of issue,” which would mean that this PA will expire in 2003. The next deadline for applications is 1 October 2002.

Are there any tips for applying for CAM funding at NIH?

Smith has a few words of advice for CAM scientists who are looking for NIH grant support:

Tip #1: Talk to Program Staff
“The importance of contacting program staff can't be understated!” Smith says. In fact, she explains that “the people who do well are those who called me early [in the process].” At OCCAM, Smith is there to provide cancer investigators with strategies for applying, as well as technical assistance. She can also help scientists find open grant competitions that best match their research interests. (Program staff at NCCAM also advise applicants to contact them with any questions about their center's programs.)

Tip #2: Don't Limit Yourself
Although researchers interested in CAM should definitely take note of the programs listed above that are specific for these approaches, Smith also urges potential applicants to expand their search for funding. She says scientists should consider submitting CAM applications in response to other, more general Program Announcements (PAs) and Requests for Applications (RFAs). “A lot of CAM is eligible [under other announcements] even though 'CAM' may not be in the title,” explains Smith.

NCCAM and OCCAM are committed to helping researchers test alternative and complementary medical practices at the basic and clinical levels. Rigorous studies on the safety and efficacy of CAM approaches are needed so that health care providers and patients can make informed decisions. If you are a scientist searching for CAM funding, keep NCCAM and OCCAM in mind. If you want to learn more about careers in the field, be sure to visit Science's Next Wave August feature, which will be available on 2 August 2002.