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Weekly Edition 057: Saturday 30th March 2002

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An Anthropological View
by Kirk W Huffman

Thinking About Kava - Part Four

Last Saturday I went for lunch with friends over to C'an Sort near San Joan, the best place (at least on Saturdays) on Eivissa/Ibiza for absolutely superb vegetarian/organic food (and Carol's chocolate brownies, over which wars could be fought). Saturday lunches there are sort of a gathering of the 'alternative elite' of the island - a multi-cultural and multi-linguistic meeting in which there are so many people to talk to about so many things that sometimes there can often be little time to eat. Bel Fogelberg was there. Bel, originally from Australia, is the last person on the island to weave a particular type of traditional eivissenc thick blue-black cloth necessary for certain types of women's' costumes. She learned the process over 30 years ago, when there were still weavers of this cloth on the island. Now these weavers are dead and the traditional island black-haired sheep that provides the wool almost non-existent. Ibicenco women who need this cloth now place orders with Bel. But when the last black-haired sheep is gone from the island, what will happen then? I had seen Bel a couple of weeks ago at a dinner and she had said that she had been suffering from a painful stiff neck for quite some time. I suggested she try taking kava tablets. Medicinal kava extract, from the South Pacific kava plant, piper methysticum, along with its other wonderful properties, can be a very effective natural pain-killer and is particularly useful for stiffness and aches along the neck and spine as it works through the central nervous system along the spine. I told her that because of recent events neither kava tablets nor medicinal extract were available since January on Eivissa (strange, in an island where just about anything else is available - one colleague has joked that recent European attempts to ban kava are probably just about the best way to eventually guarantee that it sells well on the island!). Bel said she would order it from a mail service in Guernsey/Jersey that supplies a large segment of the English-speaking population of the island with quality vitamin/mineral and herbal supplements at prices much lower than anything on the island. But when I saw Bel at C'an Sort she told me even these suppliers had told her they no longer provided kava tablets, even though they were advertised in their catalogue.

This is just another example of the spreading cancer of 'a ban that does not yet officially exist' but in fact prohibits people who would benefit from taking extracts of this amazing plant from doing so. It seems the problem does not lie in the Pacific, where the kava plant grows, but in Europe - and now the US. According to (often rather lurid) press reports in Europe and the US, some medical professionals have hinted there may possibly be a connection between the taking of medicinal kava extract to relieve anxiety and stress and liver damage. Nothing like this is known in the traditional kava-drinking cultures of the Pacific, so if there is some such connection, then it seems possible that it may not be anything to do with the traditional drink from the plant at all but more to do with the medicinal extraction/production process for kava tablets and extracts in 'the modern world'. This would not be the first time that a perfectly good and useful natural product has been damned by 'modernization' - and it won't be the last, either. The European and US press-reading public must already be convinced that kava is 'no good', particularly with such headlines as 'Out for Kava-Kava' (in Germany, 19th November 2001) and even recent Pacific (particularly Fijian) press reports - copying the European ones - relating news on '30 cases of hepatitis in Germany and Switzerland', '24 cases of serious liver disorder in Germany and Switzerland', etc, etc, etc. The latter certainly puzzled people in Fiji (reaction would be similar in England if the Daily Mirror came out with a 'Tea found to be responsible for Senile Dementia' headline), but many of the articles said the news was based upon medical reports. All of this rather reminds one of the hysterical anti-kava press campaign in Australia in 1986-7 which had lurid headlines such as  ĹKava takes hold on Aborigines'; 'Kava a Danger to Aborigines says Senator'; 'A New Sinister Scourge'; 'Kava: New Poison for Aborigines'; 'Darkness descends on Milingimbi...and kava flows'; 'Inquiry into Kava'; 'Kava Crisis'; 'Aborigines seek ban on 'killer' kava' and so on.

A short aside here is merited. Australian Aborigines were neither traditional kava growers nor drinkers. Kava drinking was first introduced to certain aboriginal groups in Australia's Northern Territory in the early 1980s by Fijian Methodist missionaries there who saw it as a safe alternative to alcohol. As with the American Indians, alcohol has been a veritable scourge for Australian aboriginal - neither population group possess the stomach enzyme necessary for alcohol processing, so they literally poison themselves with it (approximately 50% of Japanese lack this enzyme as well and...approximately 4% of European women). For those lacking this essential enzyme, alcohol can literally kill, and the slightest amount of alcohol in the system can initiate liver dysfunction and raise liver enzymes in liver function tests. Medical tests carried out by the Menzies School of Health Research (Darwin) on chronic heavy-kava drinking aboriginal in Arnhem Land over an 8 month period in 1987-8 did indicate a slight increase in biochemical indicators of liver dysfunction, but these returned to normal amongst those who ceased drinking and the report here states 'there is no evidence of any chronic effects of kava use on health' after cessation of drinking. Most of the aboriginal involved in the tests were rather severely undernourished (not as a result of the kava drinking, it unfortunately seems to be a part of life for aboriginal in that particular area), which of course may have produced an effect on the results, and a certain amount of alcohol intake cannot be discounted (although there was supposed to be none). I should here point out that consuming large amounts of coffee could produce liver problems amongst susceptible individuals back here in 'our' side of the world! Kava drinking amongst certain aboriginal communities certainly eradicated alcohol-induced fighting and violence - one cannot even feel angry when drinking kava. Kava and anger are completely incompatible. The frenzy of the Australian press campaign was stunning in the extreme. Aboriginal groups can consume vast quantities of alcohol and its effect is devastating. Alcohol sales to aboriginal in certain outback areas of Australia can be of a regular sizeable amount. Small wonder that some Australians suspected a certain amount of instigation in the anti-kava press campaigns by 'elements of the alcohol industry'.

The present series of press reports is certainly milder than the Australian one of 1986-7, but rather flawed in a different way. Various figures of reported cases of medicinal kava extract associated with liver damage in Europe vary from article to article: 24 cases, 30 cases, 60 cases (US), and so on. So one sort of gets the impression that it's a 'tip of the iceberg' type of problem. There is usually the mention of one associated death from liver failure, and several liver transplants. No wonder some people (journalists included) jumped for their writing pens (or computers, nowadays, I guess). It seems very few have actually bothered to really dig around to get to the bottom of all this. I have. Things fall into perspective.

If one digs back through all the material one keeps coming up against the same two or three short medical reports, all recent, all brief, and all saying that there is as yet no proven connection between the medicinal kava intake and the liver problems. It seems there may possibly be one known case in Germany/Switzerland and one known case in the U.S where kava seems to be the only causal factor. The other cases seem quite possibly to be of individuals who may already have had a damaged liver from other causes but who had taken medicinal kava tablets to relax sometime along the way (and maybe extremely heavy doses at that). As the kava intake was the 'unknown factor', it is the one that tends to be pinpointed. This is only correct procedure, though, as medical doctors must be aware of every possibility and they did the correct thing by noting it.

However, sometimes things can get a bit out of hand and reach the heights of insanity. A classic example is an article in the New York Times of 3rd January 1997, "FDA Warns That Herb Drinks May Cause Health Problems: Dozens of Partygoers Fall Ill in California". The report deals with sudden illnesses of 50 teenage and early 20s (42 were hospitalized) New Year's Eve revellers in one concert hall who had taken vials of a herbal liquid product known variously as Lemon fX Drop, Orange fX Rush and Cherry fX Bomb. The vials had labels saying only one vial was to be taken every four hours and that it was not to be combined with alcohol or with illegal or over-the-counter drugs. One of the many ingredients in the vial was kava. When the police were called in they confiscated 10,000 tablets (must have been some party!) and were stoned by the partygoers. Lieutenant John Weaver of the Los Angeles Police Department said (and I quote from the report)"people who ingested the substance probably fell victim to one of its legal and natural ingredients, kava..." Well, surprise, surprise, as he then goes on to say that some of the revellers had taken as many as six vials over a short period of time and some had combined it with Ecstasy, LSD and GBH (a legal intoxicant known as Liquid X). That may sound like a rather normal night in Ibiza during the summer (from what I hear, residents don't go much to the nightclubs as they are really for the tourists) but nobody here would be stupid enough to blame any such upsets on kava!

The US does certainly have a rather schizophrenic attitude to certain substances, and these attitudes go in and out of fashion. By 1998 kava was the new 'in thing' in New York, and whilst I was then a Visiting Fellow at the Metropolitan Museum of Art there, I noted its progress. I knew it was really 'in' when I saw the colourful front page of the US 'Sun' magazine for 4th August 1998: "Bible Cures Revealed! Doctors' new guide to Healing Herbs in Sacred Scriptures" and just underneath this headline: "Kava Kava: Daily dose at night relieves anxiety". Believe it or not! But I still haven't found the part in the Bible that mentions kava. What had swung US medical opinion behind kava were the results of an extensive and extremely detailed 1997 experimental study on kava using 101 patients suffering from anxiety and tension. The work was carried out over a 25 week period by German scientists and the positive results (nothing new, of course, to regular Pacific kava drinkers) hit the American medical profession with an almost audible noise. At last something really good and harmless has been found! I should here point out that liver enzymes were regularly checked during the experiments and nothing untoward was found. News circulated of certain Californian doctors taking some of their patients off of Prozac and putting them on to kava tablets, with commendable results. I remember an academic colleague at the Metropolitan Museum laughingly telling me (in regard to the previous statement) "The kava producers better be a little bit careful, if it becomes too successful it will start bothering the big companies and you begin to see indications that the police suddenly start to take an untoward interest in it!"

Strangely enough, they did (although I am sure this had nothing to do with the 'big' companies selling other medicines), resulting in the famous Californian 'kava trials' of September 2000. There is a rather large Tongan South Pacific community living in San Mateo county in California and, as in Tonga, the men will often have a lengthy kava-drinking session in the church grounds after the church service. One Tongan was arrested by the police for seeming 'drunken driving' but as the police found no alcohol in him the local public defender got it changed to 'driving under the influence of drugs'. The police lay in wait outside the Tongan church in San Mateo county and arrested another Tongan. A trial date was set and the DA (District Attorney) wanted to prosecute for use 'of an hallucinogenic substance'. By this time I was a Visiting Fellow at the Australian Museum in Sydney, but an old school friend in California put me in touch with the defence lawyer before the trial. Anyone who knows about kava knows that it is not a hallucinogen (but the prosecution didn't know that, it seems they knew almost nothing). Kava is neither a hallucinogen nor a stupefacient, although it is a (mild, non-addictive) narcotic, soporific, analgesic, diuretic, muscle relaxant, a 'mood leveller', and much, much more. This trial was critical, as if kava had been shown to be a hallucinogen, then it could be legally banned. Unfortunately, I do not have my complete 'kava trials' file here at hand, but I seem to remember that a total of 11 Tongans eventually went on trial and that 10 were declared 'innocent' and one was declared 'guilty'. But 'guilty' of what, no one seemed to know. 'Guilty of being Tongan', one colleague laughingly told me. Nothing more was heard after that, and 'hallucinogenic kava' faded from the press.

Back to the 'Europe-kava-liver' problem. Many of the actual cases seem to involve individuals with possibly already-existing liver damage who were then taking kava tablets (sometimes 2-5 times the recommended doses) sometimes at the same time as alcohol and in some cases 'other substances' possibly as well. The sad but famous case of the one German 'death from kava-induced liver failure' turns out to be an 81-year-old woman with a long history of alcohol abuse problems. These examples are taken from what sort of numbers range? If only a few thousand people were taking these kava medicines then maybe things were not as they should be if there was any possibility that kava was involved. I decided to find out. On 14th January I spoke with one of the representatives of a small German pharmaceutical company (employing 300 people) that produces and sells three kava extract medicinal products. I was amazed at the size of the sales market! The company has been producing medicinal kava extract for over 30 years. During the period 1990 to October 2001 they had sold 40 million daily doses of their major kava product and 23 million daily doses of their other two kava brands - with no reports whatsoever of serious adverse side effects. I was stunned, and said so. I was then told that the biggest share of the market in kava extract sales in Germany was held by another small company, which had sold 100 million daily doses over the same period!

So with sales of that magnitude (and that is only two small companies amongst a larger number) and if one believed the press reports then just about everyone in Germany and almost the whole of Europe should now be suffering liver problems. This is obviously not the case, so there are other factors that are involved in these 'kava bans'. We will look at these next week. If at times you have laughed or scratched your head or have become angry at certain points in this article, wait until next week, this is nothing!

Kirk W Huffman

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