Stephen Straus

Stephen Straus is discovering quickly what a mixed blessing the directorship of the National Center for Complementary and Alternative Medicine (NCCAM) can be. He took up the position last October, only days after Congress approved a substantial hike in the center's budget for the second year running (Nature Med. 6, 7; 2000), but his department is now being pilloried in the press over a $1.4 million trial to evaluate a pancreatic cancer regimen consisting of vitamins, a restricted diet and coffee enemas.

A report in The Washington Post pointed to a suspicion that the trial of an alternative medicine regimen, known as the Gonzalez treatment, was funded because of political pressure from congress. But NCCAM supporters defend the study, saying that at least Gonzalez is willing to have his therapy tested with a Phase III trial—something that many alternative medicine advocates shy away from. The trial was set up based on a controversial prospective study that showed patients on the regimen survived almost three times longer than the standard for those with advanced pancreatic cancer. Although it was initiated by the National Cancer Institute before Straus' arrival, his center has to foot the bill.

Straus, a 23 year career clinician at the NIH, is acutely aware of the attention focused on his department, and intends to emphasize clinical over basic research, starting with trials of alternative medicines for which there is already some evidence of efficacy in treating medical problems—a trial comparing St. John's wort, Zoloft and placebo for the treatment of mild-to-moderate depression is one example. The market value of St. John's wort was $6 billion last year, according to Straus, yet clinical trials have always been too small to definitively answer how effective it is as an antidepressant. He predicts the NCCAM trial will settle the question.

Other NCCAM trials will test whether an extract of ginkgo biloba, a botanical medicine, can prevent dementia in the elderly, and whether glucosamine and condroitin sulfate are useful in treating knee osteoarthritis. “Nobody has done studies that are as definitive as the ones we're doing,” he says. “We have just scratched the surface in terms of this kind of clinical trial.” He also intends to make his mark by opening NCCAM's doors as wide as possible to clinical investigations of the more than 1,500 botanical medicines used around the world, and is willing to fund foreign investigators who want to test their countries' indigenous medicines in clinical trials.

However, unless Congress steps in a third time, NCCAM will not enjoy the sizable gains in budget that it has in the past two years since the NIH's FY01 estimate for the center is an around $3 million compared with $20 million for FY00.