The Pharmaceutical Journal, 5th April 2003
When I offered to write an article on kava kava, I was asked to declare any commercial interest. So let me begin by explaining. I do not work for or with any manufacturer, distributor or retailer of kava kava. Before the government announced a ban I knew nothing about it. I have never drunk it nor taken it as a medicine or food supplement. I have absolutely no personal interest in it at all. So why then am I against the ban? Because I believe in freedom. Kava Kava is the national drink of Fiji and Tonga. It is a stress reliever for many in this and other countries, a drink and a medicine to them. I operate on the belief that wherever possible people should be free to make and offer what services they like, and wherever possible people should be free to decide if they want to buy them. Why is the government keen to ban it? They say they are because they claim kava kava could, in certain circumstances, cause liver damage in people taking it. That is possible. We know that nuts can make some people violently or even dangerously ill. Despite this, we do not ban all nuts. We do ask processed food manufacturers to put a clear label on products saying they may or do contain nuts. We let people with nut allergies make up their own minds. Why can't we label kava kava to warn consumers not to take it for long periods without consulting a doctor and that liver toxicity is a possible side-effect? The government says they cannot take this risk, because people do not know in advance they have this reaction. But nor do people with a nut allergy know, until they eat enough nuts to find out. The same government puts out forceful advice that smoking can cause death from cancer and bronchial diseases. Most doctors tell their patients to give up smoking entirely, as they worry about the consequences. Following the logic of their kava kava ban, they would now ban cigarettes completely. There is overwhelming medical evidence about links between smoking and ill health but only very tenuous evidence between kava kava and liver disease. The medical case presented to us comprised 77 patients over more than a decade amongst a combined population of five hundred million. One case above all was stressed, as it was that of a 14 year old girl. In many of the other cases drinking and other medications were also involved, making causation of liver disorder difficult to establish precisely. It was the weakest case for banning something I have ever heard. I want the government to think again. There are cases in recent history of chemical pharmaceutical companies making mistakes and selling products that can be harmful to patients. Most medicines and natural substances can be harmful if taken to excess. Different people do react differently. That is no reason to give up on trying new pharmaceutical products. Nor is it good reason to abandon well tried herbal and vitamin remedies that people believe in. More than half the battle in feeling good or getting well is belief, whatever the scientists may say about the theoretical "efficacy". It is a strange idea of modern science that everything has to be measured and documented. Only the statistic is significant. Scientific doctors argue that there is no theoretical reason why kava kava should relieve stress, so therefore it cannot. They might even argue that a series of clinical trials has not documented medical efficacy. But what is a clinical trial? It is asking people to take a stress reliever, and then asking them if they are less stressed. There are few objective ways of measuring stress. In the end it comes down to a personal judgement. All medical trials of any remedy show variable results depending on the mood and nature of the illness of any patient. A successful clinical trial is a balance of success over failure. Most medicines can induce side-effects. Clinical trials purport to assess where the ultimate benefit outweighs the possible adverse effects. Quantitative analysis is applied, but in the end the resulting judgement contains a large subjective element. Eighteenth century physicians were being scientific when they purged patients of blood at the height of a fever. As we now know science can change. Few would argue for that treatment now. The battle between the Paracelsians and the herbalists in the sixteenth and seventeenth centuries saw the boot on the other foot. The herbalists were the establishment, trying to prevent the emerging chemical doctors from plying their trade. Today, the chemical doctors are more in the ascendant, working closely with the drug companies. Together they have achieved many successes. They should not become so exclusive as to deny the value of more traditional approaches. My advice to the government is to cool down, take a deep breath, and realise they have made a mistake. There is no need to ban kava kava. Whatever problems there may be can be taken care of by labelling and advertising, just as surely as the side effects of chemical drugs are handled. This government has no intention of banning cigarettes so it should not be banning kava kava. The other day I went for a medical check-up. My doctor asked me if I smoked. I said "No". He asked me if I drank spirits. I said "No". "Never mind", he said cheerily, "the stress will get you". If he really thought that, maybe he should have prescribed kava kava! He certainly did not ask me how many glasses of kava kava I was downing a day. He certainly did not see it as a great threat to the health of the nation.