Volume 4, Issue 3 , Pages 165-167, May 2008
Josephine Briggs, MD, Named Director of NCCAM
Article Outline
- Evidence Increasing About the Health Benefits of Good Nutrition and Targeted Dietary Supplements
- NCCAM Advisory Council Adds New Members
- Biography
- Copyright
Josephine Briggs, MD
Why is translational research so important?
I see translational research as essential to the future of medical research—creating teams of researchers that draw upon the expertise of clinicians in the field and researchers at the bench and who understand the critical steps to more effectively build a CAM evidence base.
How will translational research help develop our understanding of which CAM therapies should or should not be used and how.
There are special challenges inherent in the conduct of rigorous CAM research. As NCCAM began to build the CAM research enterprise, many stakeholders argued that the Center should focus its resources on large-scale clinical trials of CAM therapies already in widespread use. Experience has taught us, however, that basic, nonclinical, and translational CAM research, including mechanistic, dose-ranging, pharmacokinetic, and bioavailability studies, are essential building blocks in designing successful trials that can yield clear results concerning the efficacy, optimal application, and safety of CAM interventions. CAM research needs scientists trained in research methodology and practitioners skilled in delivering CAM interventions working together.
Earlier you said, “Some of the real excitement in CAM research over the next decade will come, I believe, from powerful new scientific methods that will allow better understanding of biological complexity and give us answers to how CAM interventions work.” What are these new methods that you referred to?
As with conventional medicine, modern scientific technology holds great promise in advancing CAM research. For example, NCCAM recently launched an initiative, Omics and Variable Responses to CAM: Secondary Analysis of CAM Clinical Trials, to support genomics, proteomics, and metabolomics studies on the biological basis for differences in individual responses to CAM. Results from this initiative will provide predictive insights and the basis for a more rational and personalized approach to the use of CAM therapies. Another example is using functional MRI to visualize the brain's response to acupuncture.
What's the most promising research to date? Where have we demonstrated the strongest results?
As I mentioned in my Director's Message online, I am going to start by listening, then working on developing some priority areas, and in a year I hope to come back to Council with some new initiatives. I do not know what the focus of those initiatives will be at this time. I am, however, intrigued by a variety of areas in CAM research, such as the mind-body connection, the use of CAM for symptom management, for example, for back pain, and the application of new research methods and techniques that focus on biocomplexity to this fascinating area.
Is there any benefit in researching the “integrative approach” that involves more than one intervention over just single therapies?
One of the challenges of CAM research is how to most effectively study complex interventions, such as those from naturopathy, Traditional Chinese Medicine, Ayurvedic medicine, which often employ individualized approaches and may incorporate many therapies. Again, I am hopeful that some of the biocomplexity approaches will assist us in understanding the basis for differences in individual responses to CAM.
How will wellness and prevention fit into the NCCAM program or does that domain belong to some other NIH institute?
My experience as a clinician-researcher in the area of kidney disease has given me a sense of what patients with chronic disease deal with on a regular basis and how technological advances that are lifesaving can also have the effect of isolating the patient. So, I understand the need for a “whole person” approach in medicine and I know that patients are seeking practices that promote health and wellness. I think CAM approaches and programs of integrative care can play a role in meeting these needs. To me, these are very important aspects of health that need to be examined.
Josephine P. Briggs, MD, has been named as the new Director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH). An accomplished researcher and physician, Dr Briggs brings extensive experience in translational research to the study of complementary and alternative medicine (CAM), which will help build a fuller understanding of the usefulness and safety of CAM practices.
“We are pleased to have Dr Briggs return to NIH to lead NCCAM,” said NIH Director Elias A. Zerhouni, MD. “Her in-depth understanding of NIH and translational research will bring new opportunities to the study of CAM.”
“I am honored to be selected to lead NCCAM and welcome the opportunity to develop further the NIH investment in this exciting field of biomedical investigation,” Dr Briggs said. “Alternative approaches to health and wellness are of enormous public interest, and we need a strong portfolio of science in this area. I look forward to working with scientists and the CAM community as well as my colleagues across the NIH to strengthen our understanding of the potential of CAM and to examine the opportunities for integration of proven CAM approaches into our nation's healthcare delivery.”
Dr Briggs received her AB cum laude in biology from Harvard-Radcliffe College and her MD from Harvard Medical School. She completed her residency training in internal medicine and nephrology at the Mount Sinai School of Medicine, followed by a research fellowship in physiology at Yale School of Medicine. She was a professor of internal medicine and physiology at the University of Michigan from 1993 to 1997. From 1997 to 2006, she was director of the Division of Kidney, Urologic, and Hematologic Diseases in the National Institute of Diabetes and Digestive and Kidney Diseases. Most recently, she served as senior scientific officer at the Howard Hughes Medical Institute.
For further information about Dr Briggs and her appointment as Director of the National Center for Complementary and Alternative Medicine, please visit http://www.nih.gov/news/health/jan2008/nccam-24.htm.
Evidence Increasing About the Health Benefits of Good Nutrition and Targeted Dietary Supplements
The recent conference—Natural Supplements: An Evidenced- Based Update—produced by the Scripps Center for Integrative Medicine in January 2007 (Mimi Guarneri, MD, and Robert Bonakdar, MD, course directors) provided an in-depth briefing on the most recent research findings regarding nutrition and dietary supplements.
The overall take-home message was that working with patients to individualize what they eat and what supplements they use can stimulate the body's natural healing processes, and in the case of some health challenges, even facilitate a cure.
Although each person requires an individualized plan based on a medical assessment of their unique physiology, lifestyle, and disease state, following are some of the top recommendations highlighted at the conference:
A regulatory update, and the latest findings on reactions and interactions were also presented at the conference.
Resources for Dietary Supplements
Paula Gardiner, MD, MPH, assistant professor in the Department of Family Medicine at Boston University Medical School, and Rebecca Costello, PhD, from the Office of Dietary Supplements at the National Institutes of Health presented a session on the current dietary and supplement resources available to healthcare providers. An abridged version of their presentation, printed with permission, is given below.
Web Sites By Subscription
More than 300 supplements are covered in excellent monographs, summaries, and consults, as well as entries on toxicological management. Patient information sheets on dietary supplements and medical conditions are included.
Lexi-Natural Products, published by LexiComp, is a palm-based, online or desktop software product that covers 175 commonly used dietary supplements including herbs, vitamins, minerals, and other dietary supplements. Each monograph includes dosage and standardization, reported uses, active forms, pharmacology, general warnings, and other key information.
This database is searchable by supplement or commercial product name. Over 1,000 monographs include extensive information about common uses, evidence of efficacy and safety, mechanisms, interactions, and dosage. Monographs are extensively referenced and updated daily. There is a drug/supplement interactions checker. CME, listserv, effectiveness checker, and personalized interaction profiles information are also available.
Natural Standard is an independent collaboration of international clinicians and researchers who create evidence-based monographs on dietary supplements and other modalities available online. This extensive database can be searched by subject or by medical condition. There is a drug/supplement interactions checker, and brand name database.
HerbMed is an herbal database that provides scientific data underlying the use of herbs. HerbMedPro, an enhanced version of HerbMed, is available for subscription, licensing, and data streaming. The public site has 40 herbs; HerbMedPro has an additional 128 herbs and continuous updating.
Free Web Sites
Created in Canada, CAMline is an evidence-based nonprofit Web site on complementary and alternative medicine for healthcare professionals and the public. It represents a successful collaboration of conventional and integrative medicine organizations, their interests, and expertise. It has 35 monographs on dietary supplements, written for the consumer and healthcare professional. Patient information sheets available.
Free Government Resources
PubMed is a service of the National Library of Medicine that includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources and a number of very helpful online tutorials. For dietary supplement research, we recommend you use the clinical queries search on PubMed located on the left hand tool bar. PubMed can be helpful for looking up rare or unusual dietary supplements.
This consumer health database from the National Library of Medicine offers extensive information on CAM treatments. Links to CAM sites are organized using the same alternative medicine medical subject headings used by the National Library of Medicine. Some of the Natural Standard abridged monographs are available under the dietary supplements link http://www.nlm.nih.gov/medlineplus/druginformation.html.
The National Center for Complementary and Alternative Medicine (NCCAM) is the federal government's lead agency for scientific research on complementary and alternative medicine (CAM). Look for the Alerts and Advisories, treatment information, resources, and links to other organizations (FDA, AHRQ, ODS etc.) Herbs at a Glance, a series of patient information sheets, is listed at http://nccam.nih.gov/health/herbsataglance.htm.
The Office of Dietary Supplements strengthens knowledge and understanding of dietary supplements by supporting research, disseminating research results, and educating the public to foster an enhanced quality of life and health for the US population. This is a very helpful site; under Health Information you will find excellent dietary supplement fact sheets: http://ods.od.nih.gov/Health_Information/Information_About_Individual_Dietary_Supplements.aspx (free, patient information sheets available).
IBIDS is produced by the Office of Dietary Supplements, NIH, along with the Food and Nutrition Information Center, National Agricultural Library, and USDA. The IBIDS database provides access to bibliographic citations and abstracts from published, international, and scientific literature on dietary supplements. IBIDS contains over 750,000 citations on the topic of dietary supplements from four major database sources: biomedical-related articles from MEDLINE, botanical and agricultural science from AGRICOLA, worldwide agricultural literature through AGRIS, and selected nutrition journals from CAB abstracts and CAB Health.
Many of the World Health Organizations herbal monographs are available on the internet for free. They are very comprehensive monographs compiled and reviewed by scientific experts.
NCCAM Advisory Council Adds New Members
The National Center for Complementary and Alternative Medicine (NCCAM) recently welcomed six new members to the National Advisory Council for Complementary and Alternative Medicine. The Council, which serves as the principal advisory body to NCCAM, is composed of physicians, scientists, licensed CAM practitioners, and members of the public who contribute their time and expertise over a four-year term. Members meet three times per year, offering advice and recommendations on prioritization, conduct, and support of CAM research.
The new NCCAM members are
For further information, please visit: http://nccam.nih.gov/news/2008/020108.htm.
Matters of Note is written by Bonnie J. Horrigan, editorial director for EXPLORE and author of Voices in Integrative Medicine: Conversations and Encounters (Elsevier 2003).
PII: S1550-8307(08)00087-6
doi:10.1016/j.explore.2008.02.008
© 2008 Elsevier Inc. All rights reserved.
Volume 4, Issue 3 , Pages 165-167, May 2008