Remembering Rahmi Oruç Guvenç, PhD

By Erik Goldman

Guvenc 1Dr. Rahmi Oruc Guvenc, demonstrating ancient Turkish healing music at NYU, Sept. 1995The fields of music and healing lost a true luminary last month, with the passing of Turkish music therapist and researcher, Dr. Rahmi Oruç Guvenç.

His death on July 4 from heart failure was reported in the Daily Sabah, a Turkish newspaper. He is survived by his wife and close collaborator, Azize Andrea Guvenç, and his two daughters.

Dr. Guvenç (pronounced “Goovanch”) was born in 1948, in Tavsanli, a small town in western Turkey. He showed an interest in music at an early age, and took up a serious study of Turkish stringed instruments like the Ud, Rebab, Tanbur, as well as the Ney flute, while also studying philosophy at the Istanbul University.

He earned a doctorate in clinical psychology from Cerrahpasa Medical University, with research focused on the healing effects of music, particularly as understood and practiced by the ancient peoples of Turkey and Central Asia.

Turkish classical and religious music, like much Near Eastern music, is based on a system of modes called makams--microtonal scales and specific rules on how to use each tone in creating melodies. These traditions, some of which stretch back thousands of years, also contain many rhythm patterns rarely heard in Western music.

Music & Medicine

Dr. Guvenç’s research showed that musicians and healers once possessed precise knowledge of how musical vibrations, rhythms, and movements affected the human psyche and soma. They were able to utilize this knowledge to facilitate healing. He held that up until the 18th century, there were hospitals and clinics in Ottoman Turkey based entirely on music and movement therapy.

Dr. Guvenç’s life’s work was about rediscovering these practices and making them accessible to modern people. In 1975, he founded TUMATA, an acronym for Türk Müsikisini Araştırma ve Tanıtma Grubu (Group for the Research and Promotion of Turkish Music), which developed the theory and cultivated the practice of these ancient musical healing modalities.

Over the years TUMATA produced many recordings, two of which—Ocean of Remembrance (1995) and Rivers of One (1997) --were released internationally.

In addition to his scientific and performance work, Guvenç was also recognized as a Sufi sheikh, or leader, well-versed in Islamic music and chant, who regularly facilitated sessions in sema—the practice of turning or “whirling,” made famous by the poet Rumi, and the Mevlevi dervishes.

I had the privilege of meeting Oruç Guvenç and members of TUMATA in 1995, during one of their rare visits to the US.

At the time I was a reporter for International Medical News Group, and I’d convinced my editor to let me cover a seminar on Eastern Music Therapy, sponsored by NYU’s Nordoff-Robbins Music Therapy Clinic.

Equal parts lecture, concert, ritual and group participation exercises, the day provided a fascinating entry into a world where the connection between healing and harmony was not just a concept, but a tangible reality to be experienced.

Unexpected & Unforgettable Excursion

For me the day took an even more interesting spin after the formal sessions, when in conversation, I mentioned to Dr. Guvenç that I was a writer for a physician’s publication.

“Oh, I know a medical doctor---a heart surgeon—who’s really interested in these sorts of things,” he said, referring to music, healing, and contemplative practice. “Maybe you would like to meet him someday?” he asked.

“Surely, I would,” I replied.

“Maybe you would like to meet him tonight?” he offered.

Guvenc 2An hour later, I’m the back of a car with a bunch of gleeful Sufi musicians—and their instruments--headed off to some unknown destination in New Jersey, to meet a doctor whose name I had not even been given.

He turned out to be Mehmet Oz, who was not yet the household name he would soon become, but was already exploring the potential of things like biofeedback, Reiki, and music, in the care of people with advanced heart disease.

Dr. Oz and his wife, Lisa, had prepared a huge feast to honor Dr. Guvenç, and graciously opened their home for what proved to be a truly memorable evening of food, music, and intercultural exchange. I am grateful to have been included.

Much has changed in the world since 1995. It’s hard to imagine today even being able to get the visas to bring a group of Sufi-inspired music therapists to a major American university. Throughout the decades and their turmoil, Rahmi Oruç Guvenç, remained committed to nurturing peace and healing through the science of melody and rhythm.

May his memory be a blessing and may he rest in peace.

Amazon - Whole Foods Merger Highlights Healthy Lifestyle Surge

By Erik Goldman, Editor in Chief

Amazon GorillaHealthy living is big business. Very big business.

Which is why the proverbial 800 lb gorilla just reached for the biggest ripest bunch of organic bananas on the tree.

Amazon's surprise move to acquire the Whole Foods grocery chain for well over $13 billion set the business and financial world aflutter last Friday, with predictions and speculations as to the motives and the potential impact of the merger.

Analysts quickly pointed out that the acquisition will instantly transform the online retail giant into a brick-and-mortar behemoth--one that threatens the viability of all other grocery chains including biggies like Walmart and Kroger.

In an insightful piece on the CNBC website, Marcus Lemonis astutely points out that the Amazon - Whole Foods merger will shake the entire business landscape. That's because Amazon is rewriting the basic business playbook. It seems to have intention of becoming profitable. Though many of its business units operate profitably, the company has never turned a net profit and--at least for the foreseeable future--shows no sign of trying to do so.

Growth Over Profit

While most big corporations focus on generating shareholder dividends, and sequestering cash that must be tax-sheltered overseas, Lemonis points out that Amazon's core strategy is focused on growing its size and its reach, rather than pumping up its profit margin.

Simply put, Amazon dominates markets by offering convenience and driving retail prices down. Wall Street's fortune-tellers predict that Whole Foods customers will likely see price reductions in the store aisles once the merger is transacted. In the process, Amazon will put downward price pressure on everyone from from artisanal yogurt producers to herbal medicine makers.

Rather than accumulating cash and issuing dividends, Amazon recirculates its revenue into new conquests---like producing its own original binge-worthy TV serials or marketing its own line of home electronics.

Amazon makes it more and more difficult for its competitors to stay in the game. It's hard compete when you're under pressure to show your shareholders a profit but your main competitor does not.

What's often overlooked in all the financial prognosticating is the fact that this grand drama is being played out in the arena of healthful living.

From Granola to Payola

Given how big the Whole Foods stores have become, its easy to forget that the chain emerged from the once-marginalized "health food" movement. Whole Foods began nearly 40 years ago as a single independent store in Austin, TX, and grew by aggregating (or overtaking) other indie shops.

The products and the values people seek in Whole Foods---organic, fair-trade, allergen-free, grass-fed, locally-grown, non-GMO, drug-free---were once ridiculed or dismissed outrightly by mainstream American culture. Some of them still are.

And yet the "crunchy granola" movement that began with hippies, back-to-the-landers, and advocates of clean living from a variety of religious denominations, has grown to become one of the biggest and most dynamic forces in the US economy.

That's cause for both celebration and concern.

On the one hand, its a very positive sign that so many people are seeking healthy alternatives to highly-processed, toxin-laden conventional foods (whether or not everything in a Whole Foods store is truly an alternative is another question). And down-pressure on premium-price produce could make healthful living more accessible to millions of cash-strapped Americans who currently avoid stores like Whole Foods. Who wouldn't welcome that?

On the other, the rapid commodification of healthy foods and related products could make it all but impossible for smaller manufacturers-- the nurturers of innovation and guardians of the movement's core values--to stay in business. That's a serious potential risk.

The Whole Foods acquisition is not Amazon's only recent foray into holistic living. In March, the company launched its own dietary supplement line.  The Elements brand boasts a quasi-pharma look and feel, and an appeal based on purity, traceabilit, and transparency similar to the core values promoted by practitioner-only nutraceutical brands.

Thing is, Amazon's in-house products sell direct-to-consumer at less than half the price of most practitioner-only products in the same categories. As it has done in practically every other industry, Amazon's offerings will make it harder for practitioner-only nutraceutical companies to justify their higher prices.

It remains to be seen how Amazon's influence affects the healthy living and holistic mediicine movement. But anything that big certainly should not be ignored. One thing is certain: the economy's biggest gorillas are certainly not ignoring us!










In Memoriam: Fredi Kronenberg, PhD

By Erik Goldman

KronenbergHolistic Primary Care honors the memory, and celebrates the life and work of Fredi Kronenberg, PhD, a pioneer in the field of botanical medicine and women's health, who died on April 20.

A Stanford-trained physiologist with a deep love and reverence for the natural world, Dr. Kronenberg found her professional niche in the world of herbal medicine research. Following her post-doctoral research on the physiology of menopause, she became one of the world's experts on the use of herbs to attenuate menopausal symptoms as well as the application of botanical medicines for many other women's health concerns.

Kronenberg was among the exuberant vanguard of researchers and clinicians that spearheaded the integrative medicine movement in the early 1990s. She was the founding director of the Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine, one of the first centers established under the NIH's National Center for Complementary and Alternative Medicine (NCCAM).

Among her many other achievements at Columbia, Kronenberg launched the seminal "Botanical Medicine in Modern Clinical Practice" conference series that ran from 1996-2005. The rosters for these meetings read like a Who's Who of holistic and integrative medicine, and they educated practically an entire generation of physicians, nurses and other health professionals on the use of herbs to prevent and treat a wide range of conditions.

She was also affiliated with the University of Arizona' s Center for Integrative Medicine, and collaborated closely with Dr. Andy Weil and his team on the "Nutrition & Health: State of the Science" conferences.

She also did much ground-breaking research, most notably her studies of Black Cohosh as a remedy for menopausal symptoms, and the role of phytoestrogens in women's health. She maintained a strong interest in traditional Chinese herbal medicine, and did much to build bridges between the Asian and Euro/American herbal traditions.

After Columbia's Rosenthal center shuttered its doors in 2007, Kronenberg continued her work at the Clayman Institute for Gender Research at Stanford.

Kronenberg was a founding editor of the Journal of Alternative & Complementary Medicine, and served as a contributor or board member for several other journals in the field. She was also a beloved member of the American Botanical Council, the nation's leading herbal advocacy organization.

ABC founder/director Mark Blumenthal notes that, "Fredi had been a long-standing and active member of the Board of Trustees of the American Botanical Council for 18 years, since 1999 until her death. During this entire time she was an outspoken and positive influence on the direction and role of ABC. She introduced ABC to many prominent leaders in the CAM community, many of whom have participated in ABC’s nonprofit research and educational mission, publications, and programs."

ABC published an in-depth spotlight on Kronenberg in 2010.

As unpretentious as she was brilliant, Kronenberg never sought the camera or the spotlight. But she was a true leader, and anyone who's been involved in holistic, functional or integrative medicine over the last 30 years has been touched by her work---whether they realize it or not.

Kronenberg was a visionary who led with a quiet grace and a twinkle in her eye. She inspired others with her genuine spirit of inquiry.

In a touching note on, Roy Upton, president of the American Herbal Pharmacopeia, recalled that Kronenberg, "Possessed the straight forward honesty of a New Yorker tempered with an incredible abundance of kindness, playfulness, and love. The last time we were together, she, I, and a mutual friend were skipping arm and arm down the corridor of a phytochemistry conference. Something you just do not see PhDs do (smile), especially in sight of other PhDs (big smile). I was blessed to have known her."

Fredi died in her home, after a long struggle with lung cancer. May her memory and her legacy be a blessing for all who knew her, and for all involved in the noble mission of improving health and wellbeing.





Cancer Care Fundamentals for Frontline Clinicians

By Kristen Schepker, Assistant Editor

Today's rapidly growing population of cancer survivors obliges all frontline clinicians to develop a better understanding of this complex disease, and to learn how to support patients both during and after chemotherapy, radiation and other forms of treatment.nalini chilkov

Improvements in early detection and better therapies have contributed to a continued increase in the number of patients experiencing life after cancer. Many now live for decades following an initial cancer diagnosis, and the American Cancer Society projects that the number of cancer survivors will increase from 14.5 million in 2014 to 19 million by 2024 (Am Soc Clin Oncol. J Oncol Prac. 2015; 11(2): 79-113).

That's certainly a positive trend, but the ensuing journey through survivorship is not an easy one, says Nalini Chilkov, LAc, OMD, the founder of the American Institute of Integrative Oncology Research and Education. Eliminating tumors is one thing. Becoming healthy is quite another, explained Dr. Chilkov at the recent Clinical and Scientific Insights (CASI) conference in San Francisco. 

Life after cancer is often rife with long-term physical effects of treatment, as well as psychological challenges like fears of recurrence. The path can be even rockier for children with cancer, who may be at an increased risk of developing subsequent cancers and who often endure treatment-related side effects for many years after treatment has been completed.

Primary care practitioners--especially those with a holistic orientation--can play a vital role in pushing the model of long-term cancer care beyond simply "absence of the disease" and toward optimizing  health and wellbeing, says Dr. Chilkov,  author of the book 32 Ways To OutSmart Cancer: Create a Body in which Cancer Cannot Thrive.

But, as the authors of a 2014 study found, there is a glaring education gap. Awareness of the late and long-term effects of chemotherapy is limited among primary care physicians (Nekhlyudov, L. et al. J Oncol Pract. 2014; 10(2): e29-e36).  "Education for all providers caring for the growing population of cancer survivors is needed," the researchers concluded, an observation that Chilkov reiterated throughout her CASI lecture.

The "Hallmarks of Cancer"

A central piece of that education, she proposed, is to understand the unique differences between cancer cells and "normal" healthy cells.

For guidance on this subject, Chilkov pointed to a landmark paper, "The Hallmarks of Cancer," published by Douglas Hanahan and Robert Weinberg in January 2000 in the journal Cell. Hanahan and Weinberg assert that the many complexities of cancer biology can be traced to a small number of specific qualities that distinguish tumor cells from healthy cells (Hanahan, D. & Weinberg, R. Cell. 2000; 100(1): 57–70).

hallmarks of cancerThey propose that most, if not all, types of human cancer share six key molecular, biochemical, and cellular traits:

1.) They stimulate their own growth ("self-sufficiency in growth signals");

2.) They're resistant to inhibitory signals normally intended to block cell proliferation ("insensitivity to growth-inhibitory (antigrowth) signals");

3.) They resist programmed cell death ("evasion of programmed cell death (apoptosis)");

4.) They have an unlimited ability for multiplication ("limitless replicative potential");

5.) They can grow new blood vessels ("sustained angiogenesis"); and

6.) They can both invade nearby tissues and also spread out to distant sites ("tissue invasion and metastasis").

These six core biological capabilities, the authors argue, "constitute an organizing principle for rationalizing the complexities of neoplastic disease."

In a 2011 update to their original publication entitled, "Hallmarks of Cancer: The Next Generation," Hanahan and Weinberg added new principles to their original list of cancer cell traits. The first, termed the "reprogramming of energy metabolism," highlights the ability of cancer cells to modify, or reprogram, cellular metabolism in order to most effectively support neoplastic proliferation.

The second, "evading immune destruction," defines cancer cells' capacity to evade immunological destruction, in particular by T and B lymphocytes, macrophages, and natural killer cells (Hanahan, D. & Weinberg, R. Cell. 2011; 144(5): 646-674).

Underlying these hallmarks, Hanahan and Weinberg explain, are two additional important characteristics: "genome instability," which generates the genetic diversity responsible for acquisition of these other hallmark traits, and "inflammation," which drives several of the other hallmark functions.

The Tumor Microenvironment

It turns out that many tumors are really good at recruiting normal cells to do their bidding. Hanahan and Weinberg note that cancers "...contain a repertoire of recruited, ostensibly normal cells that contribute to the acquisition of hallmark traits by creating the 'tumor microenvironment.'"tumor microenvironment The biology of tumors can no longer be understood simply by enumerating the traits of the cancer cells but instead must encompass the contributions of the tumor microenvironment.

Dr. Chilcov explained that tumor cells and the surrounding connective tissue cells form "a sticky mat covering the surface of the tumor cells." Beneath this mat, tumor cells can "hide" from immune cells that would normally become activated and attack the offending cancer cells. In effect, its cellular camouflage.

According to researchers Diwakar Pattabiraman and Robert Weinberg, emerging tumors recruit a wide range of cellular components that can be classified into three main groups: 1) Cells of haematopoietic origin like T cells, B cells, and natural killer cells; 2) Cells of mesenchymal origin such as fibroblasts, myofibroblasts, mesenchymal stem cells, adipocytes and endothelial cells; and 3) Non-cellular components including proteins, glycoproteins and proteoglycans that make up the extracellular matrix (ECM).

Each of these components are present at varying proportions in solid tumors of different origins and at different stages of progression (Pattabiraman, D. & Weinberg, R. Nat Rev Drug Disc. 2014; 13(7): 497–512). Together, these elements comprise "a complex habitat involving myriad interactions between cell types and the ECM, each having a role in influencing tumor outcome."

In other words, cancer is not a "thing," it's a system.

This may sound theoretical, but it has direct practical significance, says Dr. Chilkov.

After a patient receives a cancer diagnosis, the first and most pressing medical objective must be to reduce that patient's tumor burden. In order to achieve this goal, it is critical that practitioners develop an awareness of the main components and functions of the tumor microenvironment. "The tumor microenvironment needs to be tended to," she urged, because "it contributes to every aspect of carcinogenesis."

Take inflammation, for example.  It can promote the emergence of various cancer cell traits by supplying "bioactive molecules to the tumor microenvironment, including growth factors that sustain proliferative signaling, survival factors that limit cell death, proangiogenic factors, extracellular matrix-modifying enzymes that facilitate angiogenesis, invasion, and metastasis, and inductive signals that lead to activation of [epithelial-mesenchymal transition] and other hallmark-facilitating programs." Downregulate inflammation, and you make it harder for cancer to get what it needs to grow.

Attention to the tumor microenvironments has already contributed to a shift in the way some oncologists approach the treatment of cancer. Researchers have shown that, "compared to chemotherapy alone, targeting tumor cells as well as key components of the tumor microenvironment significantly improve[s] the clinical outcomes of patients." (Feng, G. et al. Curr Cancer Drug Targ. 2014; 14(1): 30-45).

Starve the Tumor, Nourish the Patient

After reducing tumor burden, Chilkov says, a physician's second goal must then be to "nourish the patient."

The idea here is to "create environment that is inhospitable to the development, growth, proliferation, and spread of tumor cells," she said. This process, she adds, begins during cancer treatment and extends onward through survivorship.

She shared the story of a breast cancer survivor who came to her struggling with severe peripheral neuropathy. In working with her, Chilkov identified a number of underlying factors potentially contributing to the patient's neuropathy including multiple SNPs, high oxidative stress levels, high inflammation, and reverse omega fatty acids. Chilkov and her patient put together a plan that included acupuncture, and dietary guidance around how to "eat the rainbow" and choose anti-inflammatory foods. Within ten weeks, the patient's neuropathy disappeared.

Rather than treating the symptoms, Chilkov said, she focused on "transforming function" to establish the unique and optimal conditions for the patient's recovery and continued health.

Dr. Chilkov is certainly not alone in championing natural therapies as adjuncts to conventional medicine.

In 2006, Keith Block, MD posed the question, "Why Integrative Therapies?" in an editorial that appeared in the journal Integrative Cancer Therapies. In it, Block offers numerous examples of how therapies often defined as "complementary" or "alternative" may contribute to getting cancer patients better, if they are used strategically as part of a comprehensive program to improve the survival, as well as survivorship (Block, K. Integ Cancer Ther. 2006; 5(1): 3-6).

"It matters what you eat," Chilkov told the CASI audience, "because your food is talking to your genes." Some foods can epigenetically influence the expression of certain genes. "Phytochemicals are always multitaskers," she added.

As an Oriental Medical Doctor, Chilkov's approach to cancer care also incorporates targeted Chinese medicine interventions including acupuncture, moxibustion, and traditional Chinese herbal and food therapies.

The ultimate goal, she says, is not just to improve patients' life span but also their health span.

It's the responsibility of the oncology team to minimize tumor burden to the greatest degree possible in each case. But it is the responsibility of primary care practitioners to help individuals carve out their own paths to health and wellbeing. By leveraging what we now know about tumor biology and the factors that promote tumor growth, we can help people envision and actualize healthy life beyond cancer.


Help celebrate our 20th year at TPC Forum at the TWA Hotel April 23 at 6pm
Help celebrate our 20th year at TPC Forum at the TWA Hotel April 23 at 6pm