FASEB J.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nahin, R. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nahin, R. L.
Related Collections
Right arrowRelated Articles
(The FASEB Journal. 2005;19:1209-1215.)
© 2005 FASEB

Identifying and pursuing research priorities at the National Center for Complementary and Alternative Medicine

Richard L. Nahin

National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Maryland, USA

Correspondence: Senior Advisor for Scientific Coordination and Outreach, National Center for Complementary and Alternative Medicine, National Institutes of Health, 9000 Rockville Pike, Bldg. 31, Room 2B-11, Bethesda, MD 20892-2182, USA. E-mail: nahinr{at}mail.nih.gov


   ABSTRACT
TOP
 ABSTRACT
PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
As part of its planning process, the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, periodically evaluates how well it applies its criteria for setting research priorities. For its most recent evaluation, NCCAM compared funding levels in fiscal years 2000 and 2003 for 18 diseases with a substantial public health burden including Alzheimer’s disease, arthritis, back pain, cancer, diabetes, coronary heart disease, HIV/AIDS, migraine, and stroke, with 7 measures of disease burden: 1) prevalence, 2) mortality, 3) years of life lost (YLL), 4) years lost to disability (YLD), 5) disability-adjusted life years (DALY’s), 6) direct costs of illness (COI), and 7) total COI. There is an increasing relationship between NCCAM research funding and disease burden over the 4-year study period that reflects funding of specific research initiatives. The strength of the individual correlations varied among measures, with the strongest correlations seen with total COI and the weakest seen with mortality. When applied with its other criteria, measures of disease burden aid identification and matching of NCCAM priorities with levels of support.—Nahin, R. L. Identifying and pursuing research priorities at the National Center for Complementary and Alternative Medicine.


Key Words: disease burden • NCCAM funding • public health


   PRIORITY SETTING AT NCCAM
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
The National Center for Complementary and Alternative Medicine (NCCAM), 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH), is the only United States federal agency dedicated entirely to supporting rigorous scientific research on complementary and alternative medicine (CAM). In developing its initial research agenda, NCCAM articulated four major criteria (in no particular order) to set research priorities (1) : 1) U.S. public health significance (with greatest weight given to those diseases associated with highest mortality or morbidity or for which conventional medicine has not proven optimal); 2) use of CAM by the U.S. public (with greatest weight given to those interventions in wide use); 3) scientific opportunity, which includes the level of preliminary data, the availability and interest of appropriate scientific expertise, and the availability and interest of appropriate patient populations; and 4) cost of the research. These criteria overlap with and expand upon those previously articulated by the National Institutes of Health as a whole (2) . The NCCAM criteria are pragmatically derived and explicit enough for periodic evaluation as suggested by the Institute of Medicine (IOM) (3) . As it marked the 5th anniversary of its founding, NCCAM began an evaluation of its progress that included how well it had applied its criteria for research prioritization.

The present report provides evidence on whether the first of these criteria, public health significance, is reflected in NCCAM’s research allocations to particular diseases and conditions. Following guidance developed by the IOM (3) and the World Health Organization (WHO) (4) , the public health significance of specific diseases was assessed using several measures of disease burden. Recommended core measures of disease burden include relatively straightforward measures such as disease prevalence, morality, and direct costs of illness (COI). Other recommended, albeit more subjective, measures include various assessments of health-adjusted life years (e.g., disability-adjusted life years or DALY) that assess the severity of disability or illness, as well as indirect COI. The IOM (3) has found these evaluative measures to be increasingly relevant to both the public’s health and individuals making healthcare policy decisions.

Since the purpose of this evaluation was to assess the relationship between NCCAM funding and disease burden at the time funding decisions were made, the evaluation compared fiscal year (FY) 2000 funding with seven measures of disease burden. FY 2000 was chosen as this was NCCAM’s first full year of issuing grant awards. In addition, changes in funding patterns over time were determined by comparing disease burden to funding in the most recent year for which complete data are now available, FY 2003.


   DATA
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
The following measures of disease burden were assessed: 1) prevalence; 2) mortality; 3) years of life lost (YLL); 4) years lost to disability (YLD); 5) DALY; 6) direct COI; and 7) total COI (direct plus indirect). Incidence data were not used in this evaluation because they are lacking for most diseases, as disease-specific population-based registries are uncommon.

While NCCAM research spans a very wide range of health conditions for which CAM approaches may be used, it was not possible to include all these diseases in this evaluation, as current data on measures of disease burden were not always available. To be included in this assessment, a disease or condition had to be among the top 15 rankings nationally for at least two of the following five criteria: prevalence (5) , mortality (6) , disability (7 , 8) , direct COI (9) , diseases and conditions for which CAM is used (10) . Based on these criteria, 18 diseases or conditions were included in this evaluation (see Table 1 ). These diseases represent a substantial portion of NCCAM’s total research grant and contract expenditures (see below), as well as the major diseases associated with mortality and morbidity in the U.S.


View this table:
[in this window]
[in a new window]
  		Table 1. NCCAM research funding and measures of disease burden for 18 conditions

Prevalence data for 2000 were provided by the CDC (5) for 11 diseases. For six diseases (Alzheimer’s disease, digestive diseases, HIV/AIDS, pneumonia, sleep disorders, and unipolar depression) CDC data were not available. Prevalence data for these diseases were identified in the published literature (see Appendix).

For 14 diseases, total mortality in 2000 was identified through the CDC (6) . For four diseases (arthritis, migraine headache, sleep disorders, and unipolar depression), values for total mortality were identified in the published literature (see Appendix). No mortality data were identified for back problems.

Direct and total (direct plus indirect) cost data were extracted from the published literature (see Appendix). All values were adjusted to calendar year 2000 dollars using a medical care consumer price index (CPI) data (12) . Total cost data were not available for kidney disease.

Data on YLL, YLD, and DALY were provided by WHO (8 , 13) and combine data from the U.S. and Canada. Calendar year 2000 data for the U.S. alone are not available. YLL data were not identified for back problems.

The NCCAM Budget Office provided data on NCCAM spending on specific diseases. The reported amounts contain overlaps consistent with how NIH reports its funding to Congress each year.


   EVALUATION
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
The data retrieved on disease-specific NCCAM funding and disease burden are presented in Table 1 . In FY2000, the total NCCAM funding for the 18 diseases was $24 million or ~41% of NCCAM’s research budget; this increased to 56% of NCCAM’s research budget in FY2003. In addition, the included diseases account for a substantial part of disease burden in the U.S. The total mortality from these diseases represented 73% of all deaths in the U.S. in 2000; the total costs of the diseases approached $1 trillion and 8 of the diseases were among the 15 most disabling diseases in the U.S. in 1999 (7) .

A moderate but statistically significant correlation was seen between FY2000 funding, YDL, DALY, and total COI (Table 2 ). No other measures of disease burden were statistically different from zero. For FY2003 funding, the strongest correlation was seen with direct and total COI, but moderate, statistically significant correlations were also seen with YLD and DALY.


View this table:
[in this window]
[in a new window]
  		Table 2. Association of measures of disease burden with NCCAM research funding

This evaluation revealed an increasing relationship between NCCAM research funding and several measures of disease burden over a 4-year period (FY2000 to FY2003). Larger coefficients were seen for FY2003 vs. FY2000 for mortality, YLL, DALY, direct COI, and total COI, with the greatest increase seen for direct COI and the least increase seen for DALY. These increases reached statistical significance for both direct and total COI (Table 2) .

The significant correlation of NCCAM funding with DALY and YLD is consistent with the general public’s disproportionate use of CAM for chronic diseases associated with high morbidity (10) . The analysis also found moderate, but significant, correlations between DALY and both measures of COI (rdirect=0.505, P<0.05; rtotal=0.612, P<0.01), reinforcing the economic impact of chronic disabling disease.

On the other hand, disease prevalence was not associated with NCCAM funding. This is not surprising given that several diseases on the list with high prevalence, such as back pain or migraine headache, are very frequent problems for which CAM treatments are sought (10) yet are rarely associated with severe or life-threatening outcomes, whereas some less prevalent diseases, such as Alzheimer’s disease or HIV/AIDS, are always severe and/or life threatening. In fact, the rank order of disease varied between the measures of disease burden used. These data are consistent with analyses of disease burden both nationally (14 , 15) and internationally (8) that demonstrate incongruity between rank order of prevalence, mortality, and morbidity for many different diseases. Thus, the use of only one disease burden measure as a funding criterion could lead to under- or over-allocations of resources. The finding that four of seven measures of disease burden were in general agreement strengthens the conclusion and demonstrates a clear relationship between disease burden and NCCAM’s research funding.


   NCCAM FUNDING VS. TOTAL NIH FUNDING AND DISEASE BURDEN
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
In an earlier evaluation, Gross et al. (16) examined the relationship of total NIH expenditures and disease burden for 29 diseases and conditions. Ten of these 29 diseases overlapped with the current analysis. Gross’s group listed seven types of cancer; for the present evaluation, data on all types of cancer were aggregated based on the availability of COI data. Other diseases examined in the Gross study were not included because they did not meet the study inclusion criteria.

Another difference between these two studies is that Gross’s group examined six measures of disease burden vs. seven in the current evaluation. Four measures were the same in both studies: prevalence, mortality, YLL, and DALY.

Like the current study, Gross et al. did not find a meaningful correlation between research funding and disease prevalence, but did find strong, statistically significant correlations between funding and DALY. However, unlike Gross et al., the present study did not find an association between funding and mortality but did see a strong correlation between funding and both COI measures. At least part of the discrepancy results from differences in the measures employed in the two studies. Gross et al. use "the number of hospital days" as a surrogate for COI. Hospitalization probably underestimates COI for many chronic diseases, such as arthritis or back pain, and does not consider indirect costs associated with disease.


   IMPACT ON NCCAM FUNDING
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 
Although most of NCCAM’s research portfolio is funded through investigator-initiated applications, NCCAM uses targeted initiatives to stimulate research in priority areas. For example, an earlier analysis of disease burden revealed that NCCAM’s portfolio underrepresented cardiovascular diseases associated with substantial burden, e.g., heart disease and stroke. Accordingly, NCCAM released several initiatives addressing cardiovascular disease between 1999 and 2003. In fact, 96% and 84% of FY2003 funding for coronary heart disease and stroke, respectively, was in response to specific NCCAM initiatives. Research funded through these and other initiatives directly accounts for much of the increased association between funding and disease burden seen between FY2000 and FY2003. Conversely, NCCAM, noting that it was proportionally overcommitted in cancer research, removed cancer as a priority area for its centers program in 2003. The present evaluation has been integrated into NCCAM’s research priorities for FY2005 (http://nccam.nih.gov/research/priorities/index.htm), and into our long-term planning process.


   DISEASE BURDEN VS. OTHER PRIORITIZATION CRITERIA
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
CONCLUSIONS
 Appendix
 REFERENCES
 
The lack of a meaningful correlation between funding and mortality in the present study reflects the influence of NCCAM’s other prioritization criteria. Public health significance as measured by disease burden is only one of four criteria NCCAM uses to help set its research priorities. All these criteria are considered during the priority-setting process. For example, a disease with substantial mortality, such as COPD or renal failure, may fall short on other criteria in that there may be minimal public use of CAM to treat the condition and little, if any, preliminary data supporting efficacy. Also, at any given time, some areas of research are more promising than others because recent advances have opened new lines of investigation. Prime examples are the application of state-of-the-art neuroimaging technology, such as fMRI, to investigate the underlying biology of acupuncture (17) , or the use of nuclear magnetic resonance spectroscopy (18) and gene microarrays (19) to identify the constituents and biological activity of commonly used herbal medicines.

In line with its prioritization criteria, NCCAM closely monitors the use of CAM by the U.S. Public. For instance, a comparison of the 1991 (26) and 1997 (27) national surveys of CAM use by Eisenberg and colleagues with the 2002 data of Barnes et al. (10) shows that the public’s use of CAM practitioners (e.g., acupuncturists, chiropractors, naturopathic physicians, etc.) has remained relatively stable on a percentage basis over time whereas use of dietary supplements greatly increased. Therefore, NCCAM’s largest research investments have emphasized the safety and efficacy of dietary supplements. NCCAM thinks that preclinical studies, pharmacokinetics testing, and developmental phase I/II trials are necessary before these products can be launched into definitive clinical trials (28) . NCCAM has encouraged research in these areas through a series of focused initiatives (http://nccam.nih.gov/research/announcements/past.htm), with the result that ~50% of NCCAM’s annual research budget has been used to support investigations of dietary supplements in each fiscal year since FY2000.

As suggested elsewhere (20) , it is not necessarily the level of burden that matters when setting national research priorities, but the ability of federally supported research to improve the publics’ health. Therefore, NCCAM places a priority on the most promising uses of CAM as identified in the literature (e.g., 21 22 23 24 25 ) in hopes of providing definitive evidence concerning safety, efficacy, and mechanisms of action. Thus, it can be seen that although disease burden is an important factor, it does not have a simple one-to-one relationship with NCCAM’s research funding.


   CONCLUSIONS
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
Appendix
 REFERENCES
 
The present evaluation confirmed that NCCAM differentially supports research in a variety of diseases according to their relative burden. Periodic evaluations such as this help NCCAM assess public health needs more accurately at the population level. When applied judiciously with NCCAM’s other prioritization criteria, the public health significance of disease aids NCCAM in focusing and prioritizing its research agenda within the extraordinarily diverse field of CAM. Through its transparent priority-setting process, NCCAM is able to assess its progress at regular intervals and lay the foundation for successive strategic plans in accord with its ultimate goal of improving the nation’s health.

The author is indebted to Dr. Kimberly McFann for statistical advice and to numerous staff of NCCAM and the NIH Office of Science Policy for their helpful comments on earlier versions of this manuscript


   Appendix
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
REFERENCES
 
Relevant articles containing data on one or measure of disease burden used in the evaluation

1. Prevalence of arthritis—United States, 1997. MMWR Morb. Mortal. Wkly. Rep. 2001;50,334-336[Medline]

2. Adams, P. F., Marano, M. A. (1995) Current estimates from the National Health Interview Survey, 1994. 10(193) National Center for Health Statistics. Vital Health Stat.

3. Adelmann, P. K. (2003) Mental and substance use disorders among Medicaid recipients: prevalence estimates from two national surveys. Adm. Policy Ment. Health 31,111-129[CrossRef][Medline]

4. . Agency for Healthcare Research and Quality (2004) 1996 Expenditures by Condition Agency for Healthcare Research and Quality Rockville, MD.

5. American Heart Association Heart Disease and Stroke Statistics—2004 Update 2004 American Heart Association Dallas, TX.

6. Blazer, D. G., Kessler, R. C., McGonagle, K. A., Swartz, M. S. (1994) The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am. J. Psychiatry 151,979-986[Abstract/Free Full Text]

7. Bolen, J., Helmick, C. G., Sacks, J. J., Langmaid, G. (2002) Prevalence of self-reported arthritis or chronic joint symptoms among adults—United States, 2001. MMWR Morb. Mortal. Wkly. Rep. 51,948-950[Medline]

8. Bozzette, S. A., Berry, S. H., Duan, N., Frankel, M. R., Leibowitz, A. A., Lefkowitz, D., et al (1998) The care of HIV-infected adults in the United States. HIV Cost and Services Utilization Study Consortium. N. Engl. J. Med. 339,1897-1904[Abstract/Free Full Text]

9. Bozzette, S. A., Joyce, G., McCaffrey, D. F., Leibowitz, A. A., Morton, S. C., Berry, S. H., et al (2001) Expenditures for the care of HIV-infected patients in the era of highly active antiretroviral therapy. N. Engl. J. Med. 344,817-823[Abstract/Free Full Text]

10. Brookmeyer, R., Gray, S., Kawas, C. (1998) Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am. J. Public Health 88,1337-1342[Abstract/Free Full Text]

11. Brown, M. L., Lipscomb, J., Snyder, C. (2001) The burden of illness of cancer: economic cost and quality of life. Annu. Rev. Public Health 22,91-113[CrossRef][Medline]

12. Brown, M. L., Riley, G. F., Schussler, N., Etzioni, R. (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med. Care 40,IV-17

13. Burton, W. N., Conti, D. J., Chen, C. Y., Schultz, A. B., Edington, D. W. (2002) The economic burden of lost productivity due to migraine headache: a specific worksite analysis. J. Occup. Environ. Med. 44,523-529[CrossRef][Medline]

14. . Centers for Disease Control and Prevention (2000) Persons Reported to be Living with HIV Infection and AIDS. HIV/AIDS Surveillance Report 12(2)

15. . Centers for Disease Control and Prevention (2001) Characteristics of Persons Living with AIDS at the End of 1999. HIV/AIDS Surveillance Supplemental Report 7(1)

16. . Centers for Disease Control and Prevention (2002) AIDS Cases and Persons Living with AIDS. HIV/AIDS Surveillance Report 8(3)

17. Chilcott, L. A., Shapiro, C. M. (1996) The socioeconomic impact of insomnia. An overview. Pharmacoeconomics 10(Suppl. 1),1-14[Medline]

18. Cisternas, M., Yelin, E., Trupin, L. (2003) Direct and indirect costs of arthritis and other rheumatic conditions—United States, 1997. MMWR Morb. Mortal. Wkly. Rep. 52,1124-1127[Medline]

19. Cohen, J. W., Krauss, N. A. (2003) Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Aff. (Millwood) 22,129-138[Abstract/Free Full Text]

20. Colice, G. L., Morley, M. A., Asche, C., Birnbaum, H. G. (2004) Treatment costs of community-acquired pneumonia in an employed population. Chest 125,2140-2145[CrossRef][Medline]

21. Coresh, J., Astor, B. C., Greene, T., Eknoyan, G., Levey, A. S. (2003) Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am. J. Kidney Dis. 41,1-12[Medline]

22. Druss, B. G., Marcus, S. C., Olfson, M., Tanielian, T., Elinson, L., Pincus, H. A. (2001) Comparing the national economic burden of five chronic conditions. Health Aff. (Millwood) 20,233-241[Free Full Text]

23. Druss, B. G., Marcus, S. C., Olfson, M., Pincus, H. A. (2002) The most expensive medical conditions in America. Health Aff. (Millwood) 21,105-111[Abstract/Free Full Text]

24. Dunlop, D. D., Manheim, L. M., Yelin, E. H., Song, J., Chang, R. W. (2003) The costs of arthritis. Arth. Rheum. 49,101-113[CrossRef][Medline]

25. Ernst, R. L., Hay, J. W. (1994) The US economic and social costs of Alzheimer’s disease revisited. Am. J. Public Health 84,1261-1264[Abstract/Free Full Text]

26. Fried, V. M., Prager, K., MacKay, A. P., Xia, H. (2003) Chartbook on Trends in the Health of Americans Health, United States, 2003. Hyattsville, Maryland, National Center for Health Statistics Health, United States.

27. Greenberg, P. E., Stiglin, L. E., Finkelstein, S. N., Berndt, E. R. (1993) The economic burden of depression in 1990. J. Clin. Psychiatry 54,405-418[Medline]

28. Greenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., et al (2003) The economic burden of depression in the United States: how did it change between 1990 and 2000?. J. Clin. Psychiatry 64,1465-1475[Medline]

29. Hellinger, F. J., Fleishman, J. A. (2000) Estimating the national cost of treating people with HIV disease: patient, payer, and provider data. J. Acquir. Immune Defic. Syndr. 24,182-188[Medline]

30. Hodgson, T. A., Cohen, A. J. (1999) Medical care expenditures for selected circulatory diseases: opportunities for reducing national health expenditures. Med. Care 37,994-1012[CrossRef][Medline]

31. Hodgson, T. A., Cohen, A. J. (1999) Medical care expenditures for diabetes, its chronic complications, and its comorbidities. Prev. Med. 29,173-186[CrossRef][Medline]

32. Hodgson, T. A., Cohen, A. J. (1999) Medical expenditures for major diseases, 1995. Health Care Financ. Rev. 21,119-164[Medline]

33. Hodgson, T. A., Cai, L. (2001) Medical care expenditures for hypertension, its complications, and its comorbidities. Med. Care 39,599-615[CrossRef][Medline]

34. Hogan, P., Dall, T., Nikolov, P. (2003) Economic costs of diabetes in the US in 2002. Diabetes Care 26,917-932[Abstract/Free Full Text]

35. Hu, X. H., Markson, L. E., Lipton, R. B., Stewart, W. F., Berger, M. L. (1999) Burden of migraine in the United States: disability and economic costs. Arch. Intern. Med. 159,813-818[Abstract/Free Full Text]

36. Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., et al (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch. Gen. Psychiatry 51,8-19[Abstract]

37. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J. Am. Med. Assoc. 289,3095-3105[Abstract/Free Full Text]

38. Lawrence, R. C., Helmick, C. G., Arnett, F. C., Deyo, R. A., Felson, D. T., Giannini, E. H., et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arth. Rheum. 41,778-799[CrossRef][Medline]

39. Levey, A. S., Coresh, J., Balk, E., Kausz, A. T., Levin, A., Steffes, M. W., et al (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann. Intern. Med. 139,137-147[Abstract/Free Full Text]

40. Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., Reed, M. (2001) Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache 41,646-657[CrossRef][Medline]

41. Luo, X., Pietrobon, R., Sun, S. X., Liu, G. G., Hey, L. (2004) Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 29,79-86[CrossRef][Medline]

42. Mannino, D. M., Homa, D. M., Akinbami, L. J., Ford, E. S., Redd, S. C. (2002) Chronic obstructive pulmonary disease surveillance—United States, 1971-2000. Respir. Care 47,1184-1199[Medline]

43. Mannino, D. M., Homa, D. M., Akinbami, L. J., Moorman, J. E., Gwynn, C., Redd, S. C. (2002) Surveillance for asthma—United States, 1980-1999. MMWR Surveill. Summ. 51,1-13[Medline]

44. Mathews, W. C., McCutchan, J. A., Asch, S., Turner, B. J., Gifford, A. L., Kuromiya, K., et al (2000) National estimates of HIV-related symptom prevalence from the HIV Cost and Services Utilization Study. Med. Care 38,750-762[CrossRef][Medline]

45. McNeil, J. M., Binette, J. (2001) Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR Morb. Mortal. Wkly. Rep. 50,120-125[Medline]

46. Michaud, C. M., Murray, C. J., Bloom, B. R. (2001) Burden of disease-implications for future research. J. Am. Med. Assoc. 285,535-539[Abstract/Free Full Text]

47. Minino, A. M., Arias, E., Kochanek, K. D., Murphy, S. L., Smith, B. L. (2002) Deaths: final data for 2000. Natl. Vital Stat. Rep. 50,1-119[Medline]

48. Narrow, W. E., Rae, D. S., Robins, L. N., Regier, D. A. (2002) Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys’ estimates. Arch. Gen. Psychiatry 59,115-123[Abstract/Free Full Text]

49. . National Center for Health Statistics CDC (1999) Impact of arthritis and other rheumatic conditions on the health-care system—United States, 1997. MMWR Morb. Mortal. Wkly. Rep. 48,349-353[Medline]

50. . National Heart, Lung and Blood Institute National Institutes of Health (2004) 2004 Chart Book on Cardiovascular, Lung, and Blood Diseases 5-1-2004

51. . National Institutes of Health (2000) Disease-specific Estimates of Direct and Indirect Costs of Illness and NIH support: Fiscal Year 2000 Update. 2-1-2000 National Institutes of Health Bethesda, Maryland. 2-1-2000

52. Niederman, M. S., McCombs, J. S., Unger, A. N., Kumar, A., Popovian, R. (1998) The cost of treating community-acquired pneumonia. Clin. Ther. 20,820-837[CrossRef][Medline]

53. Pleis, J. R., Benson, V., Schiller, J. S. (2003) Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2000. Vital Health Statistic 10(215) National Center for Health Statistics

54. Rizzo, J. A., Abbott, T. A., III, Berger, M. L. (1998) The labor productivity effects of chronic backache in the United States. Med. Care 36,1471-1488[CrossRef][Medline]

55. Rost, K., Zhang, M., Fortney, J., Smith, J., Smith, G. R., Jr (1998) Expenditures for the treatment of major depression. Am. J. Psychiatry 155,883-888[Abstract/Free Full Text]

56. Russell, M. W., Huse, D. M., Drowns, S., Hamel, E. C., Hartz, S. C. (1998) Direct medical costs of coronary artery disease in the United States. Am. J. Cardiol. 81,1110-1115[CrossRef][Medline]

57. Sandler, R. S., Everhart, J. E., Donowitz, M., Adams, E., Cronin, K., Goodman, C., et al (2002) The burden of selected digestive diseases in the United States. Gastroenterology 122,1500-1511[CrossRef][Medline]

58. Thom, T. J. (1996) Economic costs of neoplasms, arteriosclerosis, and diabetes in the United States. In Vivo 10,255-259[Medline]

59. Trupin, L., Earnest, G., San Pedro, M., Balmes, J. R., Eisner, M. D., Yelin, E., et al (2003) The occupational burden of chronic obstructive pulmonary disease. Eur. Respir. J. 22,462-469[Abstract/Free Full Text]

60. . U.S.Census Bureau (2004) Statistical Abstract of the United States, Section 4: Health and Nutrition, 4-6-2004

61. Walsh, J. K., Engelhardt, C. L. (1999) The direct economic costs of insomnia in the United States for 1995. Sleep 22(Suppl. 2),S386-S393[Medline]

62. Ward, M. M., Javitz, H. S., Smith, W. M., Bakst, A. (2000) Direct medical cost of chronic obstructive pulmonary disease in the U. S.A. Respir.Med. 94,1123-1129

63. Wilson, L., Devine, E. B., So, K. (2000) Direct medical costs of chronic obstructive pulmonary disease: chronic bronchitis and emphysema. Respir. Med. 94,204-213[CrossRef][Medline]

64. . World Health Organization (2002) The World Health Report, 2002. Reducing Risks, Promoting Healthy Life ,228-231 World Health Organization Geneva.

65. Yelin, E., Trupin, L., Cisternas, M., Eisner, M., Katz, P., Blanc, P. (2002) A national study of medical care expenditures for respiratory conditions. Eur. Respir. J. 19,414-421[Abstract/Free Full Text]

66. Yelin, E., Cisternas, M., Pasta, D. J., Trupin, L. (2003) Direct and Indirect Costs of Musculoskeletal Conditions in 1997: Total and Incremental Estimates Report on Project for Aging Studies Branch, Centers for Disease Control and Prevention

Received for publication February 4, 2005. Accepted for publication March 30, 2005.


   REFERENCES
TOP
 ABSTRACT
 PRIORITY SETTING AT NCCAM
 DATA
 EVALUATION
 NCCAM FUNDING VS. TOTAL...
 IMPACT ON NCCAM FUNDING
 DISEASE BURDEN VS. OTHER...
 CONCLUSIONS
 Appendix
 REFERENCES
 

  1. Nahin, R. L., Straus, S. E. (2001) Research into complementary and alternative medicine: problems and potential. Br. Med. J. 322,161-164[Free Full Text]
  2. . National Institutes of Health (1997) Setting Research Priorities at the National Institutes of Health. NIH publication no.97-4265 National Institutes of Health Bethesda, MD.
  3. . Institute of Medicine (1998) Scientific Opportunities and Public Needs. Improving Priority Setting and Public Input at the National Institutes of Health National Academy Press Washington, D.C..
  4. . World Health Organization (1997) Major Findings and Recommendations of the Ad Hoc Committee on Health Research Relating to Future Intervention Options. 1-10-1997. Health for All in the 21st Century
  5. Pleis, J. R., Benson, V., Schiller, J. S. (2003) Summary health statistics for U.S. adults: National Health Interview Survey, 2000 10 (215) National Center for Health Statistics. Vital Health Stat
  6. Minino, A. M., Arias, E., Kochanek, K. D., Murphy, S. L., Smith, B. L. (2002) Deaths: final data for 2000. Natl. Vital Stat. Rep. 50,1-119[Medline]
  7. Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR Morb. Mortal. Wkly. Rep. 2001;50,120-125[Medline]
  8. Mathers, C. D., Stein, C., Fat, D. M., Rao, C., Inoue, M., Tomijima, N., Bernard, C., Lopez, A. D., Murray, C. J. (2002) Global Burden of Disease 2000: Version 2 methods and results. Global Programme on Evidence for Health Policy Discussion Paper No. 50 World Health Geneva, Switzerland.
  9. . Agency for Healthcare Research and Quality (2004) 1996 Expenditures by Condition Agency for Healthcare Research and Quality
  10. Barnes, P. M., Powell-Griner, E., McFann, K., Nahin, R. L. (2004) Complementary and alternative medicine use among adults: United States, 2002. Adv. Data ,1-19
  11. Snedecor, G. W., Cocran, W. G. (1968) Statistical methods Iowa State Univ. Press Ames.
  12. Wilson, T. (2004) Consumer Prices During 2003. Monthly Labor Review 127 (4) 3-8. 4-16-2004. Bureau of Labor Statistics, U.S. Department of Labor Washington, D.C..
  13. . World Health Organization (2002) The World Health Report, 2002. Reducing Risks, Promoting Healthy Life ,228-231 World Health Organization Geneva.
  14. Druss, B. G., Marcus, S. C., Olfson, M., Pincus, H. A. (2002) The most expensive medical conditions in America. Health Aff. (Millwood) 21,105-111[Abstract/Free Full Text]
  15. Brown, M. L., Lipscomb, J., Snyder, C. (2001) The burden of illness of cancer: economic cost and quality of life. Annu. Rev. Public Health 22,91-113[CrossRef][Medline]
  16. Gross, C. P., Anderson, G. F., Powe, N. R. (1999) The relation between funding by the National Institutes of Health and the burden of disease. N. Engl. J. Med. 340,1881-1887[Abstract/Free Full Text]
  17. Hui, K. K., Liu, J., Makris, N., Gollub, R. L., Chen, A. J., Moore, C. I., et al (2000) Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum. Brain Mapping 9,13-25[CrossRef][Medline]
  18. Bedir, E., Tatli, I. I., Khan, R. A., Zhao, J., Takamatsu, S., Walker, L. A., Goldman, P., Khan, I. (2002) Biologically active secondary metabolites from Ginkgo biloba. J. Agric. Food Chem. 50,3150-3155[CrossRef][Medline]
  19. Watanabe, C. M., Wolffram, S., Ader, P., Rimbach, G., Packer, L., Maguire, J. J., Schultz, P. G., Gohil, K. (2001) The in vivo neuromodulatory effects of the herbal medicine ginkgo biloba. Proc. Natl. Acad. Sci. USA 98,6577-6580[Abstract/Free Full Text]
  20. Varmus, H. (1999) Evaluating the burden of disease and spending the research dollars of the National Institutes of Health. N. Engl. J. Med. 340,1914-1915[Medline]
  21. . NIH Consensus Conference (1998) Acupuncture. J. Am. Med. Assoc. 280,1518-1524[Abstract/Free Full Text]
  22. . Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia (1996) NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. J. Am. Med. Assoc. 276,313-318[Abstract]
  23. Lin, M. C., Nahin, R., Gershwin, M. E., Longhurst, J. C., Wu, K. K. (2001) State of complementary and alternative medicine in cardiovascular, lung, and blood research: executive summary of a workshop. Circulation 103,2038-2041[Abstract/Free Full Text]
  24. Hardy, M., Coulter, I., Morton, S. C., Joya Favreau, J., Venuturupalli, S., Chiappelli, F., et al (2002) S-Adenosyl-L-Methionine for Treatment of Depression, Osteoarthritis, and Liver Disease. Evidence Report/Technology Assessment Number 64. (Prepared by Southern California Evidence-based Practice Center under Contract No. 290-97-0001) AHRQ Publication No. 02-E034 Agency for Healthcare Research and Quality Rockville, MD.
  25. Guess, H. A., Kleinman, A., Kusek, J. W., Engel, L. W. (2002) The Science of the Placebo: Toward and interdisciplinary research agenda BMJ Books London.
  26. Eisenberg, D. M., Kessler, R. C., Foster, C., Norlock, F. E., Calkins, D. R., Delbanco, T. L. (1993) Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N. Engl. J. Med. 328,246-252[Abstract/Free Full Text]
  27. Eisenberg, D. M., Davis, R. B., Ettner, S. L., Appel, S., Wilkey, S., Van Rompay, M., Kessler, R. C. (1998) Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. J. Am. Med. Assoc. 280,1569-1575[Abstract/Free Full Text]
  28. Berman, J. D., Straus, S. E. (2004) Implementing a research agenda for complementary and alternative medicine. Annu. Rev. Med. 55,239-254[Medline]

Related Articles

Renaming the DSCR1/Adapt78 gene family as RCAN: regulators of calcineurin
Kelvin J. A. Davies, Gennady Ermak, Beverley A. Rothermel, Melanie Pritchard, Joseph Heitman, Joohong Ahnn, Flavio Henrique-Silva, Dana Crawford, Silvia Canaider, Pierluigi Strippoli, Paolo Carinci, Kyung-Tai Min, Deborah S. Fox, Kyle W. Cunningham, Rhonda Bassel-Duby, Eric N. Olson, Zhuohua Zhang, R. Sanders Williams, Hans-Peter Gerber, Mercè Pérez-Riba, Hisao Seo, Xia Cao, Claude B. Klee, Juan Miguel Redondo, Lois J. Maltais, Elspeth A. Bruford, Sue Povey, Jeffery D. Molkentin, Frank D. McKeon, Elia J. Duh, Gerald R. Crabtree, Martha S. Cyert, Susana de la Luna, and Xavier Estivill
FASEB J 2007 21: 3023-3028. [Full Text] [PDF]

Can medical schools teach high school students to be scientists?
James T. Rosenbaum, Tammy M. Martin, Kendra H. Farris, Richard B. Rosenbaum, and Edward A. Neuwelt
FASEB J 2007 21: 1954-1957. [Abstract] [Full Text] [PDF]

NASA—has its biological groundwork for a trip to Mars improved?
Francis J. Haddy
FASEB J 2007 21: 643-646. [Abstract] [Full Text] [PDF]

Conflicts of interest in biomedical research— the FASEB guidelines
Laura M. Brockway and Leo T. Furcht
FASEB J 2006 20: 2435-2438. [Abstract] [Full Text] [PDF]

The science and ethics of making part-human animals in stem cell biology
Jason Scott Robert
FASEB J 2006 20: 838-845. [Abstract] [Full Text] [PDF]

N6-isopentenyladenosine arrests tumor cell proliferation by inhibiting farnesyl diphosphate synthase and protein prenylation
Chiara Laezza, Maria Notarnicola, Maria Gabriella Caruso, Caterina Messa, Marco Macchia, Simone Bertini, Filippo Minutolo, Giuseppe Portella, Laura Fiorentino, Stefania Stingo, and Maurizio Bifulco
FASEB J 2006 20: 412-418. [Abstract] [Full Text] [PDF]

Research contribution of different world regions in the top 50 biomedical journals (1995–2002)
Elpidoforos S. Soteriades, Evangelos S. Rosmarakis, Konstantinos Paraschakis, and Matthew E. Falagas
FASEB J 2006 20: 29-34. [Abstract] [Full Text] [PDF]

ets-1 is transcriptionally up-regulated by H2O2 via an antioxidant response element
Leigh A. Wilson, Adam Gemin, Raissa Espiritu, and Gurmit Singh
FASEB J 2005 0: 05-4401fjev1-1111. [Abstract] [PDF]

From conference abstract to full paper: differences between data presented in conferences and journals
Evangelos S. Rosmarakis, Elpidoforos S. Soteriades, Paschalis I. Vergidis, Sofia K. Kasiakou, and Matthew E. Falagas
FASEB J 2005 19: 673-680. [Abstract] [Full Text] [PDF]




This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Nahin, R. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Nahin, R. L.
Related Collections
Right arrowRelated Articles

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS