A Conversation with Stephen E. Straus

Photo: Courtesy of National Center for Complementary and Alternative Medicine Stephen E. Straus is the director of the National Center for Complementary and Alternative Medicine (NCCAM), which was formally established in 1999. Prior to this appointment, he was chief of the Laboratory of Clinical Investigation at the National Institute of Allergy and Infectious Diseases. He recently chatted with reporters Brendan A. Maher and Eugene Russo. Q: Do you think there's lingering skepticism about NCCAM's creation? A: I think there's very little skepticism left. Over the past few years, the debate went from 'Why would anyone want to study these things?' to 'How can you study these things?' to 'What are the studies showing?' The reality is the scientific community by and large has been enormously supportive of this. Our fellow institutes have been very eager to collaborate with us. From the side of advocates for complementary and alternative medicine, their initial skepticism that we would be able to do a fair and open-minded job of assessing their claims rather than attempting to purposefully go out and dismantle them... is [gone] because we've proven the fact that we're open, that we're funding people to do good work, and we have studies coming out with credible data. Q: How much money is devoted to basic science? A: For the National Institutes of Health as a whole, it's about a third clinical and two-thirds basic. For NCCAM, it's about two-thirds clinical, one-third basic, but that is going to be a dynamic relationship. ... We're funding research on basic mechanisms of acupuncture at many universities using things that didn't exist 30 years ago, like PET [positron emission tomography] scans, functional magnetic resonance imaging, and the like. The only thing different between our approach and that of most of the other institutes is that our relative emphasis on clinical research is somewhat larger, and the modalities that we're studying are already in the public domain. We have to do basic research because ultimately for any modality, the pragmatic answer, 'does it work or not,' is not sufficient. Q: Why such an emphasis on expensive clinical trials? How is that cost-effective? A: What's different in complementary and alternative medicine is that [consumers] are already spending billions of dollars. So, you have a choice. You can ... leave them to their own devices. Or, you can say, 'Well we're going to admire the problem for several years in the laboratory at very little cost and maybe a decade or two from now we'll get back to asking whether the current public health investment is wise or not.' Q: The NCCAM budget has more than doubled since 1999. Is that more a representation of political support, public support, or support from the scientific community? A: I think it reflects the correct vision that there's a scientific opportunity--a public health opportunity. Certainly the level of funding we have has given us opportunities that never existed before. At the NIH as a whole, between one in three and one in four applications get funded. At our center it's between one in 10 and one in 12. And that's because the number of applications [submitted] to us since I became director has increased 25-fold. We have many, very good grants that we're not going to be able to reach. And our sister institutes have picked several of them up. If they thought that what we're doing was crap, why would they need to do that? Do they need to throw their money somewhere else? Q: So competition is stiff for the money? A: People who are twirling acupuncture needles in their garage are not going to be competitive. And, I can tell you that people at major universities who have a tremendous sense of entitlement become stunned thinking that we should be an easy take.

A Conversation with Stephen E. Straus

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