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.
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.
Almost $3 billion is spent annually on homeopathic medicine, for example, but there is no hard evidence to show that it is effective. The treatment, which is based on the theory that "like cures like," offers patients highly diluted solutions of natural substances that create similar symptoms. (An insomniac, for example, would be given a solution with a small amount of caffeine.) A number of homeopathy's key concepts "are not consistent with the current understanding of science, particularly chemistry and physics," the complementary medicine center notes on its website.
"I think people using alternative medicines are wasting their money and are being fooled into thinking they are getting something that is beneficial for them," says Dr. Jerome Kassirer, distinguished professor at Tufts University School of Medicine and former editor in chief of the New England Journal of Medicine.
Then there's the issue of safety. Herbs and supplements used by alternative health practitioners are not approved by the Food and Drug Administration because they are considered food, not pharmaceuticals. Thus, their purity is not guaranteed. The FDA has identified concerns with some dietary supplements that have been adulterated with drugs, mislabeled or may contain harmful substances including kava, ephedra and comfrey. A listing of alerts is on its website at http://www.fda.gov/Food/DietarySupplements/Alerts/default.htm.
Some supplements -- such as St. John's Wort and ginko biloba -- also are known to interfere with conventional drugs, but many supplement users do not discuss the supplements they take with their doctors.
Gaudet says that medical students at Duke -- who are required as part of training to spend some time "loitering" in health food stores -- find that most consumers get information on how to use supplements from the health food store clerks. And a 2007 study by the complementary center and AARP looking at medical practices of people aged 50 and older found that 63% have used some form of alternative medicine but less than one-third told their doctor.
"There are some of these alternative medicine potions that can be harmful," Kassirer says. "And I think people treat themselves when they should be seeing a doctor, and that can result in a delay in necessary treatment."
Alternative medicine practitioners counter that most of the therapies, even if not effective, are not likely to harm. "I think many herbal remedies are quite gentle compared to strong drugs. . . . They aren't necessarily all safe, but by and large they have gentle effects," Briggs says.
Nor are all the issues unique to complementary medicine, Gaudet says, offering as an example: In many areas of traditional medicine, such as surgery, rigorous trials are rarely completed.
It's also unreasonable to argue that alternative therapies must be studied as thoroughly as a lot of mainstream medical practices, Guarneri says. The research should be as strong as a therapy's potential for risks.
Certainly, a new chemotherapy treatment should be rigorously tested, she says. But "I don't need a 2-million-person double-blind, randomized trial to tell someone to eat blueberries because they are low in sugar and high in antioxidants."