It has been nearly a month since I penned the previous article in this seemingly endless series about Kava, the rather wondrous plant from the South Pacific, the extract from whose roots, in medicinal form, have become increasingly popular in Europe and the US over the last decade as a natural antidote to combat stress, anxiety and tension. Readers will have to refer back to the previous five articles on kava in this newsletter, and will note that there recently seems to be almost a worldwide 'ban' (except in the South Pacific) on sales of medicinal extract and tablets of kava in Europe, the US, Canada and Australia. We have gone into the pros and cons of this in the past articles and the reasons why we think this 'ban' is wrong and mistaken. The evidence but forward by German medical authorities indicating a possible connection between medicinal kava intake and liver damage does not seem to be conclusive nor of good quality (although, of course, the medical authorities have done the correct thing by bringing any suspected health threat to notice), and yet other countries have taken these warnings at face value with almost no enquiry and have recommended the withdrawal of medicinal kava and tablets from pharmacy shelves. This 'problem' really came to public notice in Germany from the end of last year and newspaper reports fanned the flames of a 'kava panic' in Germany where kava medicinal extract and tablets sales have been massive over the last decade or more, and particularly from the late 1990s. Newspaper reports spreading out from Germany around the world have, in effect, had the unfortunate result of destroying the important kava export market from the South Pacific, causing puzzlement, anger and hardship in certain Pacific Island nations. Everyone in the pacific now believes that kava extracts are completely banned throughout Europe. But this is not the case. Although, as we pointed out, kava extract was officially banned in France from mid-January, the only country in Europe now where it is easily, openly and officially available from pharmacies as before is Germany, the country which seemed to have begun the whole furore in the first place. I confirmed this again by phoning contacts in Germany on April the 29^th and was told the pharmacies were selling kava tablets as before, although sales were lower than before the press furore, and that the relevant German government ministry (the Bf Arm, the Federal Institute of Drugs and Medicinal Devices, in Bonn) had not made any announcement, in spite of what the world seems to think.

So why all the problems? Why can't people elsewhere in Europe get kava tablets if they want to and what has led to this situation where most people assume there is a 'ban' when there isn't (except in France). It has an awful lot do with the way the press has dealt with this affair over the last six months and is almost an accident of timing combined with other rather dubious trends happening in the medical and pharmaceutical world of Europe and the US at the moment.

In August 2001, at the height of a major medical scandal, the German government forced the withdrawal from use of the cholesterol-reducing drug Lipobay (called Baycol in the US) produced by the Bayer Company. This particular drug (nothing whatsoever to do with kava) had been widely promoted and sold and was then found to have major side effects which it seems had possibly been known for some time. By mid - January 2002 even the Bayer company was forced to admit that the drug had been responsible for an estimated 100 deaths worldwide (from renal failure, etc), and it seems that over 1000 patients taking it may have been potentially crippled. In the middle of 2001, though, the scandal was at its height in Germany, and journalists dug out rather horrifying information regarding certain activities of the Bayer Company and certain German doctors in regard to this medicine. At one time it looked as if the resulting furor and potential court cases, some said, might bankrupt the company. German press reports indicated that the Bayer company was alleged to have 'sweetened' (some said 'bribed') certain doctors in Germany to persuade them to prescribe the anti-cholesterol drug: the return for prescription was said to be a luxury trip on the Orient Express. This was said to be happening from spring of 1999. Doctors were to use copies of the prescription forms to show to Bayer that they had put patients on to the drug, and with every 25 patients the prescribing doctor was promised one of these trips. When this 'arrangement' came out in the press, Bayer countered by saying the luxury trips were only an "information event for southern German doctors". Of course there was a press frenzy, and rightly so. Information about possibly slightly dubious arrangements between certain pharmaceutical/drug companies and certain sections of the medical profession (not just within Germany but almost worldwide) has been seeping out for years, and this was just confirmation to certain journalists of what some saw as a wider phenomenon. This led the ex-President of the Berlin Medical Practitioners' Board to state that often doctors' training costs or their medical journals were frequently paid for by elements of the pharmaceutical industry. Whether he said this in their defence, to show that such links were normal practice, I am not sure. Almost the last straw for the Bayer company came in the middle of 2001 when it was discovered that a medical study done for the German Health Ministry, dated 15^th June 2001 and indicating serious side-effects with the Lipobay drug, was held on to by Bayer and only passed on by the company to the relevant government ministry at the beginning of August 2001, after government withdrawal of the drug.

This affair 'went international', with the use in the US of the same drug, there called Baycol. It seems the potential court cases in the US are still piling up. At the same time, however, in the US, another series of medical-associated scandals were reaching their climax. For a number of years it had been suspected that certain drug firms might have been trying to assert undue influence on certain medical journals to get positive reports about their new drugs published or to get adverse studies dropped from publication. This came to a head in the US in early September 2001 when representatives of a dozen of the world's most prestigious medical journals announced the adoption of strict uniform requirements to prevent drug firms that fund studies from manipulating the results or burying the publication of studies that are unfavourable. This move was to stop the growing influence exerted by drug firms over research findings, and was the result of several major related scandals of this type over the last decade. Knowledgeable journalists in Europe and the US moved in on this series of affairs, producing articles with headlines such as 'Drug scientists put profits before lives'. For those with knowledge of some of the seamier aspects of this drug/medical world, this was nothing new, but it was rather new for most of the reading public. There have always been suspicions that certain companies might use rather wily tactics to not just get their new medicines/drugs approved, but also might use other wily tactics to get certain doctors or government ministries to promote them. This was put very well by Australian grief counsellor, Mal McKissok, in an article in the 'Sydney Morning Herald' on the 4^th March 2002:" I think there's a conflict of interest when drug companies are sponsoring research and governments are responding to it". Well, there is not just a potential conflict of interest but a potential situation of danger for the public!

Readers should therefore view the press furore last year about kava with all the above in mind: the Bayer company scandal was winding down as was that related to publication of medical results, but the public and journalists were still 'primed', so to speak. And it is at just that precise time that a mention about Kava and possible connection with liver damage came to public notice. The media juggernaut, sensing another major news item, shifted into high gear. Medical authorities, terrified of the (health and) financial ramifications of the Lipobay/Bayer company affair, almost immediately started issuing cautionary warnings and the whole thing began to spiral almost out of control with hardly anyone really bothering to look in depth at the basis of the claims. Kava was damned in the public eye before it even had a chance to speak up for itself. Although an acetone-based kava extract ('Laitan') had been pulled off the market in Switzerland as early as October 2000, there was no associated media build-up as the incident was minor, unproved, a precaution, and the media were interested in other things at the time. It was really only from September 2001, as the other above-mentioned scandals started winding down, when a few minor medical reports about kava came to the notice of the German press, that the media there really began to move into action. No one was really there to protect kava at her time of need from the increasing barrage of insults. In January 2002, when my wife and I were in Germany and I was speaking to pharmaceutical people all over Germany by phone to try and get to the bottom of all this, no-one I spoke to thought that the 24 cases of liver damage mentioned by the German Bf ArM in their circular letter of 8^th November 2001 had anything really to do with kava extract, it just so happened that kava extract intake was one of the ingredients shared by these 24 individuals. There were, of course, thousands of other cases of liver damage within Germany over the same time period, but kava was not blamed for these. The most serious cases were one death (politely called 'Exitus' in some of the reports) from liver failure, and four, possibly five, liver transplants. When one actually looks at the German list, it looks 'set in concrete' and all set and sealed. But it is not. The sad but famous 'Exitus' case, if one follows up to find out who it actually was (there is, of course, no information in the list), turns out to have been that of an 81 year-old woman with a long history of alcohol abuse and possible other substances (I got this information over the phone) who had also been taking 120mg/day of an ethanol-based kava extract over a 9-month period. Half of the 24 listed cases were people over 60.Long-term alcohol use was thought to be common denominator in many of the cases. This rather ties in with a general Ibicenco belief that all Germans really seem to do is work, get drunk, and sleep.

This rather reminds me of a rather interesting 'joke' from Vanuatu, in the Southwest Pacific, the homeland of the real kava. There, death is not really looked upon, as something natural unless one is extremely old and one passes away in a style that is obviously natural. Most other deaths - of individuals not of a proper age to die naturally - is attributed to sorcery, poisoning, or other such causes: i.e., someone else is involved. One old Vanuatu friend told me years ago the following example: 'Well, what if you are 100 years old, blind, deaf and crippled and walking with the help of two sticks below a 100-foot high cliff during an earthquake and a cyclone and a rock falls on you and kills you? Is that a natural death or did someone make the rock fall?' There was a certain amount of traditional Vanuatu poetic license (there called 'putting sixpence on top') in that quote, but it does, I believe, have relevance for these above suspected kava-associated liver damage cases in Germany. Kava seems to have been chosen as 'the rock'! And why would this be? More next week.