Your Help Is Needed: Save the NCCIH!

Talking points on why NCCIH is foundational to the future of the patients we serve, every individual chiropractic practice and the future of the chiropractic profession.

It is time to become involved as much or as little as you can, but to do something. Recently, the federal government released plans for a reorganization of the agencies and institutes comprising the Department of Health and Human Services, proposing to slash funding for research activities by half and call for the disbanding of several organizations under this umbrella. One organization targeted for elimination is the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH).

The annual NCCIH budget has been flatlined at $170 million for the past several years, representing a mere 0.035% of the total annual $48 billion NIH budget. Therefore, this proposed budget cut will not lead to any substantial decrease in the total amount of annual NIH funding, but will cause irreparable harm to the entire chiropractic research enterprise.

If allowed to move forward, the shuttering of NCCIH would have a devastating and long-lasting impact on the patients we serve and the future of the chiropractic profession. Over the past 25 years, research supporting spinal manipulation for musculoskeletal conditions has grown dramatically. NCCIH and dedicated chiropractic researchers deserve much of the credit.

Since 1999, NCCIH has provided more than $186 million to fund 437 projects involving chiropractic researchers, educational institutions, and others studying the benefits of chiropractic and/or spinal manipulation. This represents 72% (437/605) of all projects (See Figure 1) and 84% of all funding ($186 million / $220 million) provided by the U.S. Department of Health and Human Services and the Veterans Health Administration.

Since the vast majority of funding from other government agencies/institutes has been co-funding for projects led by NCCIH, even these numbers are significant underestimates of NCCIH's impact. As a result of NCCIH support of chiropractic research, there has been exponential growth in both the quantity and quality of chiropractic research publications. (See Figure 2) This has led to more than two dozen clinical practice  recommendations supporting spinal manipulative therapy for a broad range of musculoskeletal conditions, which prior to that time was essentially ignored. (See Figure 3)

Chiropractic research has led to greater patient popularity and increased acceptance by the health care community. As a result of producing research evidence for the safety and effectiveness of chiropractic care, we have seen exponential growth in the number of chiropractors anow treating patients in the Veterans Health Administration, the Department of Defense, and academic health systems across the country.

Chiropractic researchers are now embedded within several major universities across the U.S., including Dartmouth, Harvard, Yale, the University of Minnesota and Duke University School of Medicine, and receive the majority of their funding from NCCIH. That research funding indirectly allowed for integration of chiropractic clinic service lines at those academic institutions. The University of Pittsburgh recently approved a new Doctor of Chiropractic program that has received a large NCCIH grant establishing it as a research resource center for all the chiropractic programs in the U.S.

The bottom line is that chiropractic research has played a critical role in enhancing the cultural and academic authority of the chiropractic profession. This would not have been possible without NCCIH funding.

The chiropractic contribution to health care delivery has never been more critical. Low back pain is a public health crisis, and the cause of three “number ones.” Back pain is the number-one cause of disability, impacting more than 600 million people worldwide. Low back pain is the number-one reason for an opioid to be prescribed in the primary care delivery system. Low back and neck pain are the number-one most costly medical conditions to treat, surpassing even the costs of treating heart disease and cancer.

The traditional medical care model of “take an aspirin and call me in a few days” is not the answer. Prescription medications, injections and surgery are not the answer for most patients, and should certainly not be the first line of treatment for back or neck pain. They are not always effective or necessary, and even the most benign treatments carry the risk of substantial harm.

For example, nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can cause internal bleeding, and users have a greater risk of heart attacks. Acetaminophen (Tylenol) carries the risk of liver damage, especially in people who drink alcoholic beverages. A recent guideline published in the prestigious BMJ recommended against more interventional procedures for low back pain. Most importantly, research shows that patients are less likely to transition from acute to chronic low back pain when they see a chiropractor as their first-contact provider.

The number of Americans who seek treatment from chiropractic and other types of complementary and integrative health care (CIH) providers has grown exponentially over the past few decades. It is estimated that over one-third of the adult U.S population has seen a chiropractor or CIH provider for a health-related condition.

This recognition of the enormous utilization of CIH within the U.S. is what led initially led the NIH to establish the Office of Alternative Medicine in 1992, which eventually became the Center for Complementary and Integrative Health (NCCIH) in 2014. This name change reflected the growing recognition that health care professions such as chiropractic were being integrated into interprofessional health care delivery systems and synergistic with – not alternative to – traditional medical health care procedures.

In fact, all current medical guidelines for the management of low back pain recommend that spinal manipulation and other CIH procedures should be the first line of treatment. Research evidence has shown that adherence to this clinical practice recommendation leads to faster recovery at lower cost, the ultimate goal of value-based health care.

The proposed elimination of NCCIH stands to knock back the gains made over the past 25 years by a decade or more. A thoughtfully constructed house of cards will be swept to the ground, with no one there to pick up the pieces. This would be devastating. Why?

• Critical research will be halted and never completed.
• Research infrastructure at chiropractic educational institutions nationwide will no longer be available.
• Junior chiropractic researchers will no longer have access to funds for training or the student loan repayment program that allows them the financial freedom to pursue a career in science.
• Seasoned investigators will retire early when funding is no longer available to support their work.

Big Pharma and medical device manufacturers can fund their own research and continue to prosper without NIH funding, but this is not true for the chiropractic profession. NCCIH is literally the lifeline to chiropractic research activity, and without it, the chiropractic research infrastructure will slowly unravel until it no longer exists.

This is a call for immediate action to reverse this counterproductive proposal to eliminate NCCIH. The U.S. health care system needs more – not less – funding for research projects that study the effectiveness of non-pharmacological and non-surgical treatments for back and neck pain. Here are three things you can do today:

1. Please contact anyone you know who has ties to the current administration and use the following talking points to argue on behalf of preserving NCCIH and its funding for chiropractic research.
2. Either financially support or join a coalition committed to saving NCCIH, such as the Coalition for Whole Person Health Research.
3. Contact your congressional representatives in DC. Here is a link if you do not know who these people are or how to contact them. Sending an email is much better than doing nothing. Making a phone call is better. A visit is best. Here is a sample script with talking points to guide you in these conversations: