The Need for Studying the Problem of Coca-Leaf Chewing

Abstract

The following article has been written by Professor Dr. Carlos Monge M., one of the outstanding authorities on the problem of the coca-leaf chewing, founder of the Instituto Nacional de Biología Andina for the study of the Andean man. Pr. Monge states hir position and refutes what he considers to have been misrepresentations of it; he concludes that the problem of coca-leaf chewing has not yet been fully investigated from a sientific, economic and social point of view.

Details

Author: Carlos Monge M.
Pages: 13 to 15
Creation Date: 1952/01/01

The Need for Studying the Problem of Coca-Leaf Chewing

Pr. Dr. Carlos Monge M.

The following article has been written by Professor Dr. Carlos Monge M., one of the outstanding authorities on the problem of the coca-leaf chewing, founder of the Instituto Nacional de Biología Andina for the study of the Andean man. Pr. Monge states hir position and refutes what he considers to have been misrepresentations of it; he concludes that the problem of coca-leaf chewing has not yet been fully investigated from a sientific, economic and social point of view.

I wish to thank the Division of Narcotics Drugs of the United Nations Secretariat for having kindly asked me to put forward my ideas on the problem of coca-leaf chewing. Those ideas have often been distorted, particularly in Peruvian publications, and such distortions may have played a role in forming the opinion of the experts. I should like to remind them respectfully that they ought to turn to the original documents which have been written by me and not to articles or studies in which the truth has been twisted. To give a concrete example, let me observe that in a recent issue of the Bulletin on Narcotics(vol. IV, no. 2, April-June 1952) which was placed before the Commission on Narcotic Drugs, there is an article entitled "The Problem of the Chewing of the Coca Leaf in Peru" containing the following sentence (page 31 of the English edition): "It is affirmed that the inhabitant of the Andes is a distinct being, physically and chemically; that he forms a whole with the environment in which he lives and to which he is perfectly adapted; that he constitutes a climatic and physiological variety of the human race, etc., and that while other races do not need coca, to the Andean it is indispensable." The bibliographical reference for this citation is the following: "C. Monge: E1 problema de la coca en el Peru, Anales de la Facultad de Medicina, T. XXIX, p. 311, 1946". It is sufficient for me to say that the last assertion (italicized above) which is attributed to me, is absolutely false. It is nowhere to be found in the article just referred to, nor is it to be found in any publication of the author of these lines. As this remark has been attributed to me on several occasions in various articles either by the same author, or by others sharing his outlook, one understands how such fanciful opinions on the problem of coca-leaf chewing have helped to mislead the judgment of those interested in the subject. I do not believe this attitude is malicious, but rather irresponsible, as is characteristic of popular literature on scientific matters.

It is true that, in Peru, there have always been two standpoints from which, the effect produced on the human organism by the consumption of coca leaves has been judged. For Hipolito Unanue, the founder of medical studies in Peru at the end of the eighteenth century, coca was the sacred plant of the Incas, whose consumption at high altitudes was beneficial. For many Peruvian investigators, including Luis Saenz whose reputation as a physician is well known, the coca leaf causes grave disorders, both physical and psychical. I have always taken great pains when giving my opinion, on a certain question to respect adverse opinion and to rely only on original documents. Nor have I ever doubted the honesty of serious investigators of this complex problem, and I still believe that every opinion deserves respect if it is based on a sincere attempt to weigh the facts. And here I am referring not only to Peruvian authors, but also to foreigners and, especially, to those experts of the United Nations who came in an official capacity to Peru to investigate the question. I certainly do not mean to say that I am in agreement with the conclusions arrived at by others, but rather that I maintain my right to reach independent conclusions on the basis of the facts that have been established and on others which I have uncovered or that have been brought to light by reputable scientists of unquestionable integrity. If my opinion which is derived from a study of the above-mentioned facts differs from that of others, it is simply a difference of interpretation, of selecting a criterion, and of deciding upon what is true.

I may emphasize that there is a third approach to the problem on the basis of which I founded the Instituto Nacional de Biologia Andina for the study of the Andean man, of the diseases of that region and of the use of coca leaf (Supreme By-Law of 1940). The grounds which have led us to adopt this third approach since we began our studies on life at high altitudes are the following:

(A) Symptoms of drug addiction are not found among those who chew coca leaves; this statement is confirmed in the report of the Commission of the United Nations.

(B) No appreciable clinical syndrome appears when coca is no longer taken.

(C) Thousands of conscripted men who join the army each year, drop the coca habit immediately and do not seem to resume their chewing when on leave (there is no legal prohibition in Peru).

(D) In many areas, the women do not chew the coca leaf, and even the habitual chewers themselves abstain during festival days.

(E) The habit is maintained by the Andean man who only comes down occasionally to sea-level, but is easily given up when he settles at a lower altitude; and also sometimes when he leaves his rural occupation to enter domestic service.

(F) There is a direct relationship between altitude and the chewing habit: it is most widespread at 15,000 feet; at the altitude of 7,000-8,000 feet, however, it is seldom encountered; at sea-level it is the exception.

(G) In the hot valleys where coca is produced, coca chewing is also very rare.

In facing these facts, i.e., the harmlessness of coca, the absence of any craving for it, and the ease with which the habit can be dropped, one is drawn naturally to this third approach, that is to investigate the problem scientifically in all its aspects: medical, pharmacological, physiological and economico-social. This has been the policy of the Instituto, which because of its scientific character has had to proceed carefully. Indeed the Peruvian Government has adopted this approach in its study of the problem in view of its controversial character. This was also the standpoint of the present writer, a standpoint which he defined in his article in the Andes de la Facultad de Medicina of 1946, mentioned above, and which he adopted before the United Nations concerned itself with the problem; it is this standpoint which explains the positions that he took subsequently.

Medically speaking, there are still two apparently ireconcilable, clinical points of view: there are those who believe that the coca leaf causes drug addiction and there are those who deny it. One might add a third: that of the members of the United Nations Commission of Enquiry who affirm that coca-leaf chewing is not an addiction, but that it should be treated as such because it is a harmful habit. Finally, the World Health Organization has handed down its opinion (WHO Technical Report, no. 57, 1952) without investigating the practice in situ, that it is an addiction, basing itself on the report of the United Nations Commission which affirms that it is not.

It is very clear that this problem does not lend itself to easy explanations, as someone remarked at the last session of the Commission on Narcotic Drugs, and those delegates who find it difficult to decide between these contradictory opinions should confine themselves to discreet observations. And I believe that the Instituto Nacional de Biologia Andinia was quite right in recommending a scientific study of the problem.

With regard to the physiological study of the Andean man and the deviations of biological reactions to the effect of remedies at high altitude - an extremely important question, requiring very precise experiments - we can emphatically affirm that Andean man is a climato-physiological variety of the human race. A few days after the last meeting of the Commission on Narcotic Drugs, I was invited to an International Congress on Anthropology, organized by the WennerGren Foundation in New York, in order to develop the theme of "Biological Bases of Human Behaviour" on the high plateaux of Peru. This is not the place to review the scientific discoveries of the Peruvian school of medicine. It will suffice to mention that they were of such importance that the United States sent fifty-two specialized research workers by air to take part in the Symposium de Biologia de Altitud, organized by the Instituto Peruano de Biologia Andina (1949) at the request of UNESCO; that the International Council of Scientific Unions (ICSU), named an International Mixed Committee for the study of the physics and biology of altitude, and finally, that a few days ago, the Director of Personnel of the Randolph Field School of Aviation Medicine arrived in Peru to participate in the research of the members of the Instituto Nacional de Biologia Andina and to take part in their investigations. We wish, accordingly, to emphasize that there exists a physiology of altitude, until recently unknown to the experts who have always based their research on the official science dealing with observations made at sea level, that this physiology affects pharmacological reactions at high altitudes, and that, as has been repeatedly pointed out, it is ignorance of this fact that has been responsible for numberless errors.

From the point of view of pharmacology, the splendid work done in the Andean altiplano by AsteSalazar has helped to prove that the problem is more complicated than it had at first seemed, because the quantities of cocaine found in the blood as a result of chewing the coca leaf are really insignificant( 2thousandth of a milligramme). This discovery reveals the existence of unsuspected biochemical (perhaps enzymatic ?) processes, but it cannot lead us to assert that the action of coca-chewing is beneficial or harmful. That is another question in the unexplored field of the biology of altitude. "On this point, one may say that there is a possibility that, at high altitudes, in an extreme state of anorexia, the effect of coca could act as an agent reinforcing humoral reactions, in such a way as to avoid fatigue and to augment an individual's capacity to produce. This then is a working hypothesis which is at present being tested by the members of the Instituto de Biologia Andina." I take pleasure in repeating the final sentences of my 1946 article, which reproduce clearly the basic premise in accordance with which I have long been studying this problem.

The economic and social aspect of this question plays without doubt the principal role both in the habit's development and in its disappearance. In that respect I have had the good fortune as director of the Instituto Indigenista Peruano of concluding an agreement with Cornell University, which aims at developing a programme of cultural development on the Peruvian altiplano. The Peru-Cornell project, which is now in operation after three years of on-the-spot preparatory work directed by Dr. Allan R. Holmberg, Professor of Anthropology at Cornell University is studying coca-leaf chewing from the economic and social point of view. It can thereby be seen that the Government of Peru following a consistent policy, sought to have this problem examined from the sociological aspect.

I may add that an experiment was undertaken at an altitude of 10,000 feet with the assistance of volunteers and when coca was replaced by a system of well balanced meals for over a ten-day period, it was found that it was possible to stop the consumption of coca. Besides, the number, of volunteers was so large that it had to be limited to the groups under study. It must be added, finally, that the inhabitants of the zone where the experiments were carried out are strong, well fed and have a good labour output. These facts, communicated personally to me by Dr. Allan R. Holmberg, indicate plainly the absence of addiction. They also lead to the conclusion that, if the problem is to be comprehensively studied, many experiments are necessary at various altitudes, but especially at high altitudes, to determine the effects of coca on labour output: in short, whether it reduces or increases productivity.

It is evident, if one recalls the discussion on this problem at the last session of the Commission on Narcotic Drugs, that a better method must be found if we want to reach a solution; the effect of coca-leaf chewing must be the object of a careful investigation.

I have traced the broad outline of an economic and social experiment which the Government of Peru has undertaken and in which I had the good fortune to participate, faithful to an impersonal policy free of prejudice, searching for the truth. I must point out that following the adjournment of the question by the Commission on Narcotic Drugs at its 1950 session, a deadlock has been reached, in view of the seemingly irreconcilable opinions of the United Nations Commission on the one hand and of the Peruvian Government on the other. It is necessary to break that deadlock. Mr. Leon Steinig during his visit to Peru in 1951 cleverly laid the foundations for a solution which was then adopted even without discussion by the members of the Peruvian Committee on Coca. That was a triumph, which enhanced the prestige of the Commission on Narcotic Drugs and of the United Nations and enabled it to come to an agreement, which permitted everyone, working together towards a common goal to seek out the truth and to act accordingly. Now if things turn out badly and if the habit is proved to be harmful, no unfortunate measures will be taken such as the prohibition of alcoholic beverages which did so much harm to the morale of a certain people who learned thereby that the law could be flouted. Aristotle once wrote that governments must be wary of imposing measures that their peoples are not able to accept.

In conclusion, this entire problem of coca-leaf chewing must be the object of scientific, economic and social investigation, in order to arrive at an incontestably well-established conclusion pointing the way to future action.