How Congress named alternative medicine and then renamed it twice

The words sound clinical. Complementary, alternative and integrative turn up in hospital program names, insurance paperwork and product marketing as if a medical textbook had defined them long ago. None did. The federal vocabulary for care outside the mainstream was written by Congress, mostly inside spending bills, and the law that uses it has never said what any of the words mean.

That last point is not an outside critique. In February 2015, the director of the federal research center that carries these words in its name told her own advisory council that the center’s legal charge does not define complementary or alternative. Seven weeks earlier, Congress had given the center its third name.

This article traces that record: who chose each word, when, through what legislation, and for what stated reasons, which changed more than once. The practical meaning of the terms for a patient is set out in our explainer on what complementary care means. What follows is how the government arrived at them, and where that history stands in October 2026.

A $2 million line in a spending bill

The story starts with an illness. In February 2009, Senator Tom Harkin of Iowa told a Senate health committee hearing how the federal effort began. A former House colleague, Berkley Bedell, had left Congress because he was very ill, sought out alternative care and recovered. Harkin said that experience got him thinking, and that after talking with Bedell he set up an office through the Appropriations Committee, the Senate panel that writes spending bills.

The money came first. The center that grew out of this, today called the National Center for Complementary and Integrative Health, or NCCIH, keeps a list of its founding laws. It shows that Public Law 102-170 provided $2 million to the National Institutes of Health for fiscal 1992, to set up an office and an advisory panel to recommend research on promising unconventional medical practices. Note the word. The founding money was for the unconventional.

The office took shape over the next two years. NIH records show that Joseph Jacobs became the first director of the Office of Alternative Medicine in October 1992. In June 1993 the NIH Revitalization Act formally placed the office inside the NIH director’s office, charged with helping evaluate alternative medical treatment modalities and sharing information with the public. Somewhere between the appropriation and the appointment, the label had changed from unconventional to alternative.

That sequence explains why federal sources disagree about the founding year. The funding law was signed on November 26, 1991, by the statute’s own date line, though NCCIH’s page on its public laws and the NIH Almanac both say October 1991. NCCIH’s appropriations history says Congress established the office in 1992, which is also the year Harkin gave. The statute that formally created it passed in 1993. All three years are defensible, so any history that gives a single founding year without saying which event it means is choosing one.

A medical journal was drawing similar lines at the same moment. In January 1993, the New England Journal of Medicine published a national survey, led by Eisenberg at Beth Israel Hospital in Boston, of what the team called unconventional therapies, defined as 16 common interventions not widely taught in US medical schools or generally available in US hospitals. It was a definition by absence. A practice stopped qualifying the moment schools began teaching it or hospitals began offering it.

What the founding sponsor said he wanted

Harkin was candid in 2009 about the office’s purpose. When the legislation was drafted in 1992, and again in 1998, he said, one aim was to investigate and validate alternative approaches. He then told the committee the center had fallen short, adding that “most of its focus has been on disproving things rather than seeking out and approving things.”

That sentence describes a tension built in from the start. The political sponsor wanted validation. A research center that applies scientific methods will sometimes produce negative results, and on the sponsor’s own account, it did. The current statute still lists validating among the center’s purposes, alongside identifying and investigating.

Those three verbs have survived every rewrite since 1998. The 2014 amendment changed the nouns in the purposes clause and left the verbs alone.

Critics pressed from the opposite direction. In a 2006 policy forum in Science, Donald Marcus and Arthur Grollman argued that the center’s research agenda was shaped more by politics than by science, and that its charter kept it from independent review of its performance, according to excerpts reproduced on a blog of the American Association for the Advancement of Science. The center’s founding sponsor thought it was too skeptical. Its two critics thought it was not rigorous enough.

1998: from office to center, inside an omnibus

The second word arrived through another spending law. Harkin said he and then-Senator Frist sponsored legislation in 1998 to elevate the office. The vehicle was Public Law 105-277, the Omnibus Consolidated and Emergency Supplemental Appropriations Act, which amended the Public Health Service Act on October 21, 1998 to create the National Center for Complementary and Alternative Medicine, known as NCCAM.

Complementary was now in the name, first in line. The statute described the center’s subject as complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems, wording that survives in the record because the 2014 amendment shows exactly which phrases it replaced.

The money changed scale too. NCCIH’s appropriations table shows the office receiving $19.5 million in fiscal 1998 and the new center $50.0 million in fiscal 1999. William Harlan became acting director in January 1999, and Stephen Straus became the first director that October.

Here again the government’s own pages diverge. NCCIH’s public laws page and the NIH Almanac date the center’s creation to October 1998, as the statute does. NCCIH’s appropriations page says Congress established it in 1999, the first year it was funded. Law created it in 1998. Money arrived in 1999.

The definitions came from panels, not statutes

With no legal definition, the working ones came from advisory panels and indexers. A 2011 paper by members of Cochrane’s complementary medicine field credits an expert panel convened by the Office of Alternative Medicine in April 1995 with the most widely cited version: complementary and alternative medicine is everything outside the politically dominant health system of a particular society in a particular period. The National Library of Medicine’s subject heading similarly describes practices not currently considered an integral part of conventional medicine. NCCAM itself sorted the field into four domains plus whole medical systems, with energy medicine among them, a scheme Cochrane’s complementary medicine field adopted for its own catalogue.

Both definitions are relative. Each makes a practice’s status depend on what the mainstream accepts at the moment, which means a practice can leave the category without any new evidence at all. The Cochrane field’s own working rules pulled the other way: a therapy that originated outside conventional medicine, such as acupuncture or chiropractic, stayed in the category even where health insurance covered it. One test looks at where a practice came from, the other at where it is now, and they do not always agree.

2014: a rename with several explanations

On May 16, 2014, the journal Nature’s news blog reported that NCCAM was proposing a new name, the National Center for Research on Complementary and Integrative Health, and taking public comments. Josephine Briggs, then the director, told the reporter, Sara Reardon, that she worried about people choosing something completely unproven, and pointed to the proposed name’s advantage directly: it had research in it. An undated AAAS blog post quoted her saying the old name was not explicit about the research mission and could be misread as advocacy or promotion of unproven practices.

Integrative was not a new word on Capitol Hill. Harkin’s 2009 hearing was titled Integrative Care: A Pathway to a Healthier Nation, and in it he described the goal as integration between conventional and alternative therapies, leading to what he called truly integrative health. Five years before the rename, the founding sponsor was already using the word that would replace his.

Congress did not adopt the proposed name. The Consolidated and Further Continuing Appropriations Act, 2015, signed by President Obama on December 16, 2014, renamed the center in Division G, Title II, Section 224. The enacted name was the National Center for Complementary and Integrative Health. The word Research was gone.

The same section rewrote the statute subsection by subsection, swapping phrases built on alternative, such as alternative medicine research and alternative medical treatment, for wording built on integrative health. Alternative left the center’s name and much of its statute in one omnibus provision. The money did not move with it. NCCIH’s appropriations table shows $124.0 million in fiscal 2014 and $124.1 million in fiscal 2015, and $170.3 million by fiscal 2024.

The explanations then kept moving. At the advisory council’s 54th meeting on February 6, 2015, Briggs said that “this is a change of name, not mission,” and noted the change was still awaiting the final signature of Health and Human Services Secretary Burwell. Six years later, NCCIH’s strategic plan for fiscal 2021 to 2025 gave a retrospective reason: the center had worked to advance the position that evidence-based complementary therapies should be integrated with conventional medicine rather than used as an alternative to it, and the 2014 change was made to reinforce that position.

The same plan states the mission in language noticeably different from the founder’s. Where Harkin spoke of validating, the plan commits the center to determining, through rigorous scientific investigation, the fundamental science, usefulness and safety of these approaches. It also added a fourth term to the federal vocabulary, whole person health, describing it as helping individuals, families, communities and populations improve their health across interconnected biological, behavioral, social and environmental domains. The plan is frank about one reason the focus narrowed: earlier attempts to study whole systems of care, such as traditional Chinese medicine, proved hard to carry out, and many of those studies yielded no clear results.

So the stated rationale moved from research identity, in May 2014, to continuity of mission in early 2015, to a position on how therapies should be used, in the 2021 plan. None contradicts the others. They are three different answers to the question of what the new name was for. The author of the AAAS post argued that there are simply treatments that work and treatments that do not, whatever they are called.

Why alternative was easy to drop

Survey data had long suggested that true alternative use, meaning nonmainstream care in place of conventional care, was uncommon. Eisenberg’s 1993 survey found that 83 percent of people using unconventional therapy for a serious condition also saw a medical doctor for it. A 1998 national survey by Astin, a Stanford researcher, published in JAMA, found that only 4.4 percent of respondents relied primarily on alternative therapies, and that dissatisfaction with conventional medicine did not predict use. People chose these approaches mainly because they fit their values and beliefs about health.

Briggs cited the same pattern when defending the rename: large population surveys showed that genuinely alternative use was rare. The agency’s current explainer says much the same: people who try nonmainstream approaches overwhelmingly keep their regular care too.

What the law defines, and what it leaves to others

Read the current statute, Section 287c-21 of Title 42 of the US Code, and you will find the center’s purposes: research, training and public information about identifying, investigating and validating complementary and integrative health approaches, along with diagnostic and prevention methods, disciplines and systems. You will not find a definition of complementary, alternative or integrative anywhere in the section. When Briggs told the advisory council in 2015 that the charge leaves those words undefined, she also described the center’s legal authority as very broad in the kinds of research it allows. The two facts go together. An undefined subject is also an elastic one.

The definitions consumers meet come from agency web pages. NCCIH’s current explainer, dated April 2021, draws its line by how an approach is used, together with conventional care or in place of it, and calls integrative health a coordinated combination. That use-based distinction and what it means for a patient are covered in our article on the word complementary and why it misleads. The same page retired NCCAM’s older taxonomy. Approaches are now grouped by how they are taken in or delivered, as nutritional, psychological, physical or combinations, with the old headings of natural products and mind and body practices folded into those groups.

Integrative also became an institution. The Academic Consortium for Integrative Medicine and Health says it began with eight academic medical institutions at a 1999 meeting at the Fetzer Institute in Kalamazoo, Michigan, and now counts more than 80 members across five countries. Its definition calls integrative care informed by evidence. That phrase describes a way of delivering care, not a grade of proof, and the evidence scale in this library treats them as separate questions.

One practice, several categories

Because none of these words is defined by the substance itself, the same treatment can change category depending on how and for what it is used. The 2011 Cochrane field paper gave clean examples. Hyperbaric oxygen is standard treatment for carbon monoxide poisoning and an alternative one for multiple sclerosis. Transcranial magnetic stimulation had FDA backing for treatment-resistant depression but not for Parkinson disease.

The same paper noted that, depending on the definition chosen, surveys of how many people use these approaches have produced figures anywhere from 10 percent to 100 percent. A 2022 effort by researchers at McMaster University and the Ottawa Hospital Research Institute to build a systematic list compiled 604 distinct therapy terms from 101 sources, and its authors observed that any working definition shifts with time and place. In 2025, two ethicists at Martin Luther University Halle-Wittenberg in Germany argued in Medicine, Health Care and Philosophy that any useful definition must be tied to specific diseases and must say openly how a practice’s status can change.

Where the center stands in October 2026

The newest chapter is a budget proposal, and it should be read as exactly that.

The president’s budget request for fiscal 2026, released in 2025, left NCCIH out. At the advisory council meeting on September 19, 2025, the center’s director reported that the House Appropriations Committee bill kept NCCIH’s funding unchanged from fiscal 2025 and proposed no consolidation or elimination of any NIH institute or center.

The request for fiscal 2027 goes further. NCCIH’s own congressional justification page for that year, as read in October 2026, states that the president’s budget proposes to eliminate the center. The NIH Office of Budget’s summary of the request lists NCCIH for elimination alongside the Fogarty International Center and the National Institute on Minority Health and Health Disparities, proposes merging the drug abuse and alcohol institutes, and would move the environmental health institute to the Centers for Disease Control and Prevention. The reasons it gives are general: streamlining processes, funding more efficiently, and a need to reestablish trust in NIH and realign its priorities toward the conditions afflicting the nation. None is specific to NCCIH. The request puts total NIH funding at $41.5 billion.

A budget request is the administration’s proposal. Appropriations are written by Congress, and this article makes no forecast about what Congress will do with this one.

Reading the words when you meet them

When a clinic, a product or a study uses one of these terms, four questions sort out what it is telling you.

1. Who is defining it? The federal statute does not. Whatever definition is in play comes from an agency page, a professional body or the speaker.
2. Is it describing use or evidence? Complementary and alternative describe how something is used. Integrative describes how care is organized. None of the three tells you whether a treatment works.
3. What is the date? NCCIH’s definitions page dates from April 2021, and the center itself is the subject of a 2026 proposal to eliminate it.
4. Is anything being replaced? That is the distinction the 2021 strategic plan drew, and it is the one with clinical consequences.

That fourth question is also where professional help comes in. If a plan described as integrative involves stopping, reducing or postponing a medication, a scheduled test or a treatment someone else prescribed, the clinician who prescribed it needs to hear about it before anything changes. The same goes for new symptoms, or old ones getting worse, while you are using any nonmainstream approach.

The Takeaway

The three words describe administrative history and patterns of use, not the quality of evidence. They were chosen by legislators and agency officials, carried through spending bills, never defined in law, and explained differently in different years. When you meet one, the useful step is to set the label aside and ask what is being used, alongside what, and with what evidence for that specific purpose.

Sources

1. National Center for Complementary and Integrative Health, National Institutes of Health. “Public Laws Establishing NCCIH (P.L. 102-170, P.L. 103-43, P.L. 105-277 and the 2014 renaming).” nccih.nih.gov
2. US Government Publishing Office (GovInfo), United States Statutes at Large. “Public Law 102-170, 105 Stat. 1107 (H.R. 3839), appropriations for the Departments of Labor, Health and Human Services, and Education for fiscal year 1992, dated November 26, 1991.” govinfo.gov
3. National Institutes of Health. “NIH Almanac: National Center for Complementary and Integrative Health (NCCIH), important events and directors (last reviewed January 21, 2025).” nih.gov
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