Despite its growing popularity and prevalence, Complementary and Integrative Medicine (CIM) continues to be assailed by critics as costly, ineffective, and potentially harmful. Within this issue of Otolaryngologic Clinics of North America , we explore why many patients continue to embrace CIM despite these attacks. In order to provide a framework for evaluating CIM practices, we discuss the benefits and shortcomings of standard medical practices in treating common problems faced by our otolaryngology patients. We then explore the evidence behind CIM practices used to treat these disorders and indicate where CIM can prove beneficial or harmful to our patients.

Practitioners referencing this volume will benefit from an approach that acknowledges the gap in adherence between prescribed standard therapies and patient behaviors. By definition, CIM can help bridge this adherence gap by engaging patients in therapies that are patient centered and participatory. Each of the authors in this volume use CIM as a partner to rather than a substitute for standard medical practices. Similarly, the authors routinely partner with CIM practitioners who have demonstrated best practices in their communities. Although some studies cite a dissatisfaction with mainstream medicine to be a significant factor in CIM use, we have found that most patients willingly blend conventional and CIM in order to optimize their health.

CIM has continued to thrive in an era where patients increasingly seek care that is evidence-based. As mindful stewards of CIM, we must continue to judge its benefits by the Bradford-Hill criteria of

• 1.
  

  Biological plausibility

  
  
• 2.
  

  Association strength, consistency, temporality, and dose response

  
  
• 3.
  

  Reversibility

Whenever possible, our authors have applied these criteria to proposed CIM practices. Although scientific evidence supports many CIM therapies, there are still many that lack evidence despite their widespread use. More research is needed to support these CIM practices and determine safety, effectiveness, and proper dosing.

Medical practices that benefit patients must ipso facto possess the capacity to harm patients. Although often perceived as “natural” and “safe,” CIM products may be contaminated, may interfere with other medical products or practices, and may actually prove harmful to our patients. We advocate the use of specific CIM therapies precisely because they affect the human condition, not because they are harmless placebos. CIM providers vary in their abilities and training. Many CIM practices across the globe have become increasingly regulated in order to insure patient safety. For example, the dietary supplement industry within the United States has become subject to Good Manufacturing Practices despite existing outside the purview of the FDA prescription medicine approvals process. Thoughtful and conscientious enforcement of patient care priorities rather than draconian regulations should continue to strengthen the safety record of CIM practices.

CIM practices will continue to flourish even in the new era of 4P Medicine. Coined by Leroy Hood, MD, PhD, cofounder of the Institute for Systems Biology, 4P Medicine is medical care that is Predictive, Personalized, Preventive, and Participatory. Dr Hood maintains that such care must use “new computational and mathematical tools to analyze the enormous amounts of molecular, cellular, phenotypic, and medical data that now can be generated for each individual” ( https://www.systemsbiology.org/hood-group ). Rather than creating a virtual cloud of billions of data points about a person in order to maintain their health or treat their disease, CIM will continue to fill the adherence gap between these therapies and patient behavior. Hopefully, patients will be able to use greater knowledge about their personal health to partner with their physicians in designing care strategies blending standard medical practices with CIM to maintain their well-being.