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Neurology Today:
doi: 10.1097/01.NT.0000361425.16754.ca
In the Field

David Simon, MD: On Integrating Conventional Neurology and Complementary Medicine

STUMP, ELIZABETH

Free Access

For conventional clinicians, the words “alternative medicine” may seem discordant with practices that are evidence-based. This is why it is important to distinguish alternative medicine from a mind-body medical approach, said neurologist David Simon, MD, medical director and co-founder of the Chopra Center for Wellbeing in Carlsbad, CA, which has been a focal point for holistic medicine since its establishment in 1996.

When queried by Neurology Today about his mind-body approach to treating neurologic disorders, Dr. Simon explains that what he advocates — stress management, nutritional counseling, healthy sleep-wake cycles, yoga and meditation — should be considered complementary to conventional treatment and regarded as part of a holistic approach — addressing physical, psychological, emotional, and lifestyle components of health and illness.

“Cognitive events impact physiological functions, which over time can influence health,” he said.

Dr. Simon first became interested in holistic medicine during his undergraduate studies in anthropology. After earning his medical degree in 1977 from the University of Chicago and finishing his neurology residency in 1983 at the University of Colorado, he completed fellowships at the University of Colorado in neuromuscular disorders and epilepsy.

From 1985 to 1994 he was the medical director of the Neurological Rehabilitation Unit and medical director of the Clinical Neurophysiology Laboratory at the Sharp Cabrillo Hospital in San Diego, and from 1992 to 1994 he was the chief of staff at the same hospital. It was during this time that he began his collaboration with endocrinologist, Deepak Chopra, MD, to develop stress management programs for patients. Today, Dr. Simon also serves as a voluntary assistant clinical professor in the department of neurosciences at the University of California-San Diego School of Medicine.

The most common neurologic complaints he sees at the Chopra Center are multiple sclerosis and chronic pain. These patients “seek and appear to benefit most from a ‘holistic’ neurological approach,” he said. They are also most open to “making the lifestyle changes required to improve their health and well-being. Although patients with Parkinson disease, dementia, brain tumors, and epilepsy frequently seek holistic methods, I don't find the mind-body approaches as relevant in these conditions,” he added.

At the Chopra Center, Dr. Simon leads programs in mind-body medicine, emotional healing, and spirituality. The prolific wellness book author also demonstrates integrated mind-body medical programs to medical institutions and health centers around the globe. His books include Free to Love, Free to Heal (Chopra Center Press); The Ten Commitments; Vital Energy; Wisdom of Healing (HCI); and Return to Wholeness (Wiley).

Figure. DR. DAVID SI...
Figure. DR. DAVID SI...
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For Neurology Today, Dr. Simon described how neurologic patients can benefit from holistic care and his methods for integrating complementary and conventional modern medicine.

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WHAT ASPECTS OF COMPLEMENTARY MEDICINE DO YOU USE IN YOUR PRACTICE?

Many of my patients participate in a six-day program that includes practicing stress management approaches, developing healthy sleep-wake cycles, learning effective communication skills to reduce emotional distress, and undergoing nutritional counseling. They also receive daily therapeutic body treatments like massage, and instruction in yoga and meditation. I utilize principles and practices that integrate holistic healing practices, usually drawn from the East, with conventional Western medicine.

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HOW DO YOU DETERMINE WHICH ASPECTS ARE EFFECTIVE?

I closely follow the medical literature on psychoneuroimmunology, psychosomatic medicine, and nutrition and draw upon scientific evidence to guide my recommendations to patients. As I believe is true for any clinician in the field, it's sometimes difficult to know which aspects of a therapeutic regime are responsible for improvements. In this regard, I listen to my patients, who often point to their lifestyle changes as an important and at times major factor contributing to their enhanced quality of life.

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COULD YOU CITE AN EXAMPLE FROM YOUR WORK IN HOW YOU MIGHT OFFER A DIFFERENT APPROACH TO TREATING OR PREVENTING MIGRAINES?

My sense of best medical practices is for a doctor to use the tools that are the most effective and that have the least likelihood of side effects. If a pharmaceutical agent is best able to meet the needs of a patient, I prescribe it. If a behavioral approach offers the best benefit/risk profile, I recommend it.

For example, the current medical model of migraine headaches focuses on spreading thalamic-cortical depression and its accompanying neurochemical and neurovascular changes. We have numerous pharmacological options to influence one or more component of the pain-invoking cascade.

In addition to the appropriately (sparing) use of medication, I find that patients with migraines benefit from behavioral approaches that appear to raise their threshold for the triggering of a migraine attack. These include learning stress management skills and mindfulness meditation techniques; eating a balanced diet, rich in antioxidants, with a reduced intake of refined carbohydrates, caffeine, and alcohol; incorporating a regular exercise program that includes yoga, cardiovascular exercise, and strength training; developing a restful sleeping routine; addressing core relationship stresses, and learning the skills to effectively communicate unmet emotional needs.

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HOW DOES YOUR TREATMENT OF A PERSON WITH MS, FOR EXAMPLE, DIFFER FROM A TYPICAL NEUROLOGIST?

Assuming the diagnosis is correct, I employ appropriate disease-modifying agents as any neurologists would. Since many of my patients report that their MS symptoms worsen when they're facing increased stress, I also focus on helping them follow a lifestyle that supports greater overall emotional and physical balance. Given the 1,000+ studies documenting the role of stress on immunity, I place as much importance on helping people manage their lives as I do on managing their disease.

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HOW DO YOU EXPLAIN (IN WESTERN TERMS) THE MECHANISM BEHIND HOLISTIC REMEDIES?

Research in the field of psychoneuroimmunology has established the link between mental and emotional states and immunological function. I also believe that a person's expectations can influence their response to a diagnosis. Although most physicians are aware of the placebo effect (and often disparage it), I find that many doctors are unaware of the “nocebo” effect — the evidence that negative expectations have a potentially harmful influence on a patient's outcome. Teaching patients lifestyle skills to positively manage their health may lessen the symptoms of their illness.

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HOW DO YOU INTEGRATE THE EASTERN INFLUENCES WITH THE WESTERN MODEL OF MEDICINE? DO THEY EVER CONFLICT, AND IF SO, HOW DO YOU HANDLE THAT?

There are important but manageable differences between the conventional medical model and the holistic healing traditions commonly associated with the East. The biomedical model views human beings as molecular machines, and therefore illness is usually treated through an effort to modify biochemistry. GERD, for example, results not from work stress, but from hydrochloric acid molecules leaking into the esophagus. High blood pressure is caused by excessive amounts of circulating angiotensin molecules, not anxiety over a pending house foreclosure. Depression is explainable by a lack of serotonin, not whether a person's relationships are nurturing.

Conventional medicine focuses on the mechanisms of disease, and through this approach, we have made unprecedented advances in the relief of suffering and the extension of life.

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SO HOW WOULD A HOLISTIC APPROACH BE DIFFERENT?

A holistic approach looks at how a person's interpretations and choices may influence the course of the illness. For a patient suffering from depression, a biochemical physician would likely prescribe a course of a selective serotonin reuptake inhibitor and, perhaps, psychotherapy. A holistic approach would seek to understand the root imbalances contributing to the depression, taking into consideration and providing guidance into a patient's lifestyle, activities, diet, recent stressful events, beliefs, relationships, and patterns of response. The goal is to show a person that they have choices of how to interpret their life challenges. A treatment plan would take these behaviors and prescribed medication into account in an effort to explore what it would take to “activate” that person's brain to begin producing mood-elevating neurochemicals.

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HOW DO YOU FOLLOW EVIDENCE-BASED MEDICINE GIVEN THAT SOME OF THE COMPLEMENTARY THERAPIES DON'T HAVE THE SOLID EVIDENCE BASE/CLASSES OF EVIDENCE USED BY THE AAN AND OTHER MEDICAL SOCIETIES?

The scientific literature contains abundant clues about the role of the mind and emotions on health and illness. For example, a recent study of interest in Psychosomatic Medicine in 2009 looked at patients admitted with autoimmune diseases (including 17 with MS, 10 with myasthenia gravis, and two with dermatomyositis) The researchers found a statistically significant correlation between cumulative childhood stress and autoimmune disease decades later.

It has been my experience that many people with chronic illness carry a plethora of self-defeating beliefs born of early emotional trauma. If a physician can provide the safety for them to discuss their early family experiences and their current emotional challenges, a connection between buried emotional pain and many physical symptoms will be revealed. Listening compassionately to patients and encouraging them to make healthier choices is the first step in harnessing the power of emotions for healing.

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WHAT CAN NEUROLOGISTS TAKE AWAY FROM READING YOUR NEW BOOK, FREE TO LOVE, FREE TO HEAL?

In my experience, many patients struggling with chronic neurological illness carry an underlying story about the meaning of their disease — a story about how their life circumstances may have contributed to the illness and how they believe their choices might influence its course. I find that people suffering with a wide range of conditions, including chronic headache, chronic pain, and autoimmune diseases, often have an internal narrative that they rarely reveal to their doctors. A physician's willingness to take the time to explore the hidden story can lead to insights that improve the patient/doctor relationship, enhance a patient's quality of life, and in some cases, contribute to genuine healing.

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HOW DO YOU RESPOND TO NEUROLOGISTS ARE WHO ARE HESITANT TO INCORPORATE ALTERNATIVE MEDICINE OR COMPLEMENTARY THERAPIES?

I'm sure that like me, many neurologists encounter patients who don't respond to conventional treatments despite the physician's best efforts. When a neurologist is working with a patient who hasn't responded to standard medical approaches and they suspect there is an emotional or psychosomatic component to their problem, I suggest something as simple as teaching a mindfulness meditation technique.

Although I commonly hear doctors say that patients aren't open to complementary therapies, I have found that if a doctor says, “I'd like you to try this because I think it might be helpful,” most patients will try anything that might possibly relieve their distress. I'm well aware that the plural of anecdote isn't data, but this is a way for a neurologist to put his or her toe into the water.

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REFERENCE

• Dube SR, Fairweather D, et al. Cumulative childhood stress and autoimmune disease in adults. Psychosom Med 2009;71:243–50.

©2009 American Academy of Neurology

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