Leon Wittman tweaked his shoulder in 1994 while attempting to keep his basement from flooding during a thunderstorm by scooping water out of a window well with a bucket.
His left arm began to ache. He realized about a year later that he rarely used it anymore and could no longer comfortably sleep on that side. A physician said the only cure was surgery.
Wittman and his wife Charlene have always shied away from physicians, preferring to "maintain a good attitude, drink lots of water and figure things out on our own," as he puts it. And so he opted instead to try a pain relief supplement that included acetaminophen, alfalfa, cramp bark and valerian root -- which, he says, improved his shoulder within a month. The Shawnee, Kan., man now takes a glucosamine, chondroitin and MSM supplement.
Many Americans like Wittman choose to treat themselves with complementary and alternative medicine in lieu of surgery, pharmaceuticals or other traditional care. Their numbers have been steadily climbing over the last decade. According to a July study from the National Center for Complementary and Alternative Medicine, based on interviews with more than 23,300 adults during the 2007 National Health Interview Survey, almost 40% of adults use some form of complementary and alternative medicine to treat a variety of conditions.
They spent about $33.9 billion on these practices in 2007, accounting for about 11.2% of the public's total out-of-pocket health expenditures. In 1997, the last time such a survey was taken, the figure was $27 billion.
"Whatever this amount of the population is doing is no longer fringe," says Dr. Tracy Gaudet, executive director of Duke Integrative Medicine, part of the Duke University Health System. "We have to figure out what they are looking for that they can't find in conventional medicine."
Medicine outside the mainstream goes by many names -- naturopathy, complementary, alternative and integrative medicine -- partly because its umbrella covers almost any practice or product that is not generally taught in medical school or offered by traditional medical doctors. It encompasses a broad array of practices: crystal gazing, drinking green smoothies, taking fish oil, practicing yoga.
Alternative therapies are used most commonly to treat conditions such as back, joint and arthritis pain, colds and depression. The new study found the most popular therapies to be natural products, deep breathing, meditation, chiropractic and massage.
Self-care, at $22 billion, accounted for the majority of spending, mostly on nonvitamin, nonmineral, natural products. The most popular supplements are fish oil, glucosamine, echinacea and flaxseed. Americans spent $4 billion on yoga, tai chi and qigong classes, and $2.9 billion on homeopathic medicine.
The survey found that visits to practitioners overall have decreased by about 50% since 1997, with the biggest drop seen by providers of energy healing and relaxation techniques. An exception was acupuncture, whose providers saw a threefold increase from 1997 to 2007.
For years, there has been a false assumption that users are anti-establishment and alternative types who choose it over conventional treatments -- but the data suggests otherwise, complementary medicine experts say. Dr. Mimi Guarneri, medical director of Scripps Center for Integrative Medicine in La Jolla, says that these are regular people who want more help staying well.
"The good news about Western medicine is that it responds well in an acute setting -- if they have a heart attack, stroke or are hit by a car," she says. "When you look at other healing traditions, prevention is the first step, treatment is the last step."
But the trend worries many medical experts, although they acknowledge that some alternative therapies seem useful -- acupuncture for treating back pain, for example, and exercise and dietary changes for better regulation of blood sugar.
A 2008 study in the Mayo Clinic Proceedings found, for example, that patients who exercised, ate a low-fat diet and took fish oil and red yeast rice supplements over a three-month period reduced their bad, or LDL, cholesterol by 42%. A group taking the cholesterol medication Zocor saw a 39% LDL reduction.
But many more of the therapies are unproven or untested. Echinacea, ginko biloba and shark cartilage all came up ineffective in recent studies. A June Associated Press article highlighted the fact that after 10 years and $2.5 billion in research, the National Center for Complementary and Alternative Medicine has not found any alternative medicine that works, save patients taking ginger for chemotherapy-induced nausea and limited uses for acupuncture, yoga, massage and relaxation techniques such as meditation.