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Hello everybody. This is Marshall Poe on the editor of the New Books Network. And I'd like to tell you that we have a new and improved website. It has two new features that we think you'll love. One of them is a vastly improved search engine, so that when you type in keywords, you'll get a bunch of episodes really quick. The other is the ability to create a listener account. And in that listener account, you can save episodes for later listening. So you can create a kind of listening list. We think these features are neat, and we think you'll enjoy them. Please visit the site today. Hi, I'm Dr. Robert Pearl, former CEO of the Permanente Medical Group, Kaiser Permanente, a Stanford Medical and Business School Professor, a Forbes contributor and bestselling author of the book Mistreated, while we think we're getting good healthcare and why we're usually wrong. And I am Jeremy Kor, host of the New Books and Medicine podcast. American healthcare is broken. Across the United States, there are over 200,000 patient deaths from medical error every year, growing physician burnout, outdated technology, and inconvenient and delayed care for patients. And on top of all of this, skyrocketing drug prices and increasingly unaffordable out-of-pocket patient expenses. For decades, our nation's political and medical leaders have talked about fixing the American healthcare system, and yet the problems are now greater than in the past. Every other industry that is inefficient and ineffective has experienced disruption. Healthcare will be no different. The question is whether the solutions will come from inside the healthcare system or be imposed on it. We'd like to invite you to listen to our new podcast, Fixing Healthcare with Dr. Robert Pearl and Jeremy Kor. Each episode will feature one of the top leaders and innovative thinkers in healthcare today. This show's format is simple. The guests will present their roadmap for fixing American healthcare's biggest problems. And from there, Jeremy and I will scrutinize the plan and help listeners separate fixes that are the potential to succeed from simply the hype. Our goal is that everyone from healthcare consumers to political and medical leaders will find value in the discussions on our show. You may not agree with the different solutions offered, but you will never again conclude that nothing can be done. We hope you will join us. Please subscribe via iTunes or your favorite podcast software. For more information, visit our website at www.fixinghealthcarepodcast.com. Hello, my name is Dr. Francesco Isolani. I'm a medical doctor, a trauma anesthesiologist, and a student of the history of alcohol, drugs, and intoxicants. This is my first interview for the new books network, and I'm talking to Professor Lisa Gazan. Dr. Gazan is a professor of anthropology at the University of West Georgia. Title of her book is Drug Effects, Shot in a Biocultural and Socioeconomic Perspective. It's part of the advances in critical medical anthropology series. How do you pronounce cut or shot or what is the... How did you learn to pronounce it? I pronounce it caught. The British do pronounce it cat. Cat, okay. So the full title of the book is Drug Effects, Shot in Biocultural and Socioeconomic Perspective. And I enjoyed the book, and I found it... You're very smart, and you know a lot about the subject you're talking about. And it's a very wide-ranging subject, because part of the reason I enjoyed the book is because you covered the pharmacology, and the economics, and the medical, and just lots of different perspectives. But how would you describe the book to somebody who hasn't read it? Describe the book to somebody. I would say it's looking at caught as a drug from a multiple perspectives, looking at it from a cultural perspective, which is really my discipline in cultural anthropology, as well as looking at it from a pharmacological perspective, which actually in a holistic anthropological context makes a lot of sense. As anthropologists, we consider ourselves holistic, which means that there's a lot of different perspectives that matter in order to understand something. So I try to understand the history of it, and look at the pharmacological debates, because ultimately, and is a medical question and volunteer, it's not just a social question, it's not just a cultural question or economic or anything, but there's also, at heart of the question, is what is this doing to people's bodies? And I think medical anthropology does a really good job of bringing in the actual, the medical side, two questions of what is the overall effect of any kind of illness or disease and society. We have to really look at everything together for it to make sense in a holistic way. So anyway, so if you want me to keep going on that, then what I do is try to understand it again, historically, economically, because COT plays an important role in society economically. So the people in Madagascar themselves, they kind of helped me frame my question, actually. When I went to Madagascar, I wasn't planning on looking at COT. I was planning on looking at questions of forest use and land cover change. And so I went into a particular area to study land cover change, and I realized that the biggest change that was happening was related to the production of COTs. - So I'm sorry, what's forest use? - Forest, forest use and land cover change. - Yeah, like deforestation, right? Deforestation issues and land cover change. - Uh-huh, okay. - Yeah, so, and then when I became interested in understanding COT and its role in deforestation and forest use, I realized that I was opening up much larger can of worms, and that I had to really look at it from this larger medical perspective. - It was, that was one of the things that, like I said, I just really appreciated, it's often times you see the subject of drugs or medicines or intoxicants approach that from a very sort of monolithic, very narrow and culturally bound way. And, you know, framed in terms of good or bad or legal or illegal, but one of the things that I found really interesting about the book is I come to things from the pharmacology side, but I also have an interest in harm reduction and you think of, you know, when you approach things from that perspective, really with COT, there's not a lot of harm to reduce. One of the things that really struck me about it was how it can be framed as a schedule one drug or it can be framed in a certain way, but especially within the way it's used in traditional societies, it's exceptionally safe and in many ways sort of positive in the sense that it's used in a social and social context. So maybe you could talk a little bit about that because I was so interested in how you brought out, you talked about the many use of it in the use in Kenya and then Madagascar, you break it down into the different, that's a lot, but maybe you could start. - Sure, let me first say that, okay, so I talked about looking at it from a pharmacological and cultural perspective, there's also a larger perspective of looking at it in terms of a global political economy and the war on drugs, and this does tie in with your question because I think this is part of the reason why there's such alarm over the drug is because of these larger political and economic questions that come into play. Cott is associated with terrorism and piracy and Somalia, and so even a drug that has actually pharmacologically and very mild effects, it's a really bad name. And I think it's important to look at it from that perspective, it's another perspective, another reason why people tend to be against Cott and why Cott gets a bad name is because it's associated with laziness and lack of economic development. People, there's a sort of causality that people tend to get a little bit mixed up and assuming that people chewing Cott is the cause of poverty as opposed to a symptom of it. And in fact, I do have a passage from the book that I can read to you that brings out some of that analysis that I do of Cott and laziness. - Yeah, that'd be great. - Okay, but it's interesting, first of all, pharmacologically Cott is a stimulus, it's a mild infedimine, so to say that it makes people lazy is a little bit ironic. - Yes. - Okay, so on page 54, I'll read it from some excerpts. One social problem that Cott is identified with in many cultural contexts globally is so-called laziness or an unwillingness to work productively. Even if they are not generally regarded as a public menace, young men pretend to be the chores globally, the people who chew a lot of Cott tend to be young men. They're seen particularly by the middle class and professionals as lazy and as barriers to economic development. They gain their reputation not only because they chew Cott in public while other people are working while they're stirring the day, but also because they are content to work informally or not to work at all rather than taking on a steady job. In a survey we did with 147 urban respondents, we found that contrary to common stereotypes, common citizens of the city of Diego Sores, where the city is located, where the study is located, do not tend to find that Cott makes people lazy. Only 7% responded that it makes people lazy, 77% said that it does not. Despite these accusations of laziness, what seems clear from the outside and what the common people implicitly recognize is that not only are there not enough jobs for the available manual layer market, there are not enough professional jobs available to make staying in school seem worthwhile. So there were people say all these kids that start showing Cott they drop out of school, without taking into consideration the larger context of a complete lack of jobs. A couple of things I have to know you. One thing is when you read that, it has echoes of if you substituted cannabis or marijuana and the way that it was used, especially in the early days of the 30s and 40s, but against Mexicans and African Americans, and still to this day, I think that's a common perception and it's interesting that just interesting, I don't know what to say. Yeah, I think it really does tie in with larger agendas. So in other words, drug perceptions of drug legality and illegality are about so much more than health and pharmacological properties. And we do see that in terms of, especially like you're saying, cannabis is probably a big example. Then if you look at drugs like alcohol, which is extremely addicting and very legal, you just realize that looking at drug interdiction and drug management of drugs from a public health level is just saturated with global politics and cultural perceptions of harm rather than any kind of pharmacological absolutes. So one of the things, maybe you could talk about, because Madagascar is exceptionally poor. I don't know. There's recently like a coup, or an overthrow of the government within the last three years, or something. Was there some political? In 2002, there was a takeover. Yeah, there was a takeover of the presidency. And so... So you were there post that period? Is this research? I started this particular research in 2004, but I've been doing research in Madagascar, actually my first visit there was in 1990. Okay. And I did my dissertation research there and wrote an earlier book on, particularly on protected area issues. In the north there, and then I developed this research project. So I've been going to Madagascar on and off since the early 90s, but this particular project started in 2004. Yeah, so that made that major political issue was sort of just behind them. It was definitely in people's memory, but it was just behind when I started this study. Okay. How poor is it? It's one of the poorest countries on earth, like in terms of GDP, or in terms of per capita income, right? Yes, it is, absolutely. It's extremely poor. And that's another one of the arguments I make that the whole story of pot is really interesting for both the medical reasons and then talking about drugs. But it's also really interesting, as a case study, of how some of the poorest people in the world today adapts to conditions of poverty. Because the pot economy is really an entirely local economy. It's grown locally, sold locally. Do you think that's what saved it? Do you think that's what's prevent, you know, the fact that freshness and that it's not? So I just wonder that, you know, because any time that there's money in it, you would expect that the powers that be or whatever, you know, if you look at opium or you look at the way that, and that cat is sort of interesting because it does persist. Is the local part of it part of it? Yeah, I really think it is. Also because, yeah, because cuts active properties break down so quickly, within 24 to 48 hours, it breaks down into what's considered a scheduled one drug, which is the most serious right up there with heroin, to a schedule three drug, which is actually not even controlled internationally. The schedule one drug is, but it breaks down, and it doesn't synthesize well in a laboratory. So there's really not much of a market for it in Western countries. There probably never will be. And I think that definitely protects it, as it's very much related to certain kinds of social contexts. It has very local interests, and the logistics of moving it around are very difficult to. It doesn't mean that it doesn't exist in the United States and Canada and other places, but a lot of time it's used is within Somali immigrant communities. Okay, and then also, in my experience also, Ethiopians and also, you know, it's different the United States from in England, because in England I think it's legal, and I know that there's actually they'll fly jets full of it, or they'll not jets full of it, but they will fly it so that it can be consumed fresh, right? That's right, that's right. Yeah, they fly it mostly comes from, it's mostly grown in Kenya and Ethiopia. And in fact, the development of Ethiopian airlines came about in about 1950s, specifically with what one of the impetus was to fly caught, actually to Yemen at that point in time. But yeah, today there is there's a lot of air traffic going between the Horn of Africa, and in England, and it is legal there, they're having some discussions about it, there's a lot of people talking about wanting to make it illegal, but at this point it is still legal. So that's interesting, you know, that people still have the positive associations with it, because I don't think it would be, it wouldn't be somebody who's just taking it up to Novo, who's going to go to the trouble of getting it in a place like England, where you could just either buy something illicitly, like speed or some, you know, if you're looking for that kind of effect. Yeah, there's other drugs that do it just as well. Right, I thought it was interesting, you know, do you know about the prevalence of amphetamine and psychostimulants being used as psychiatric medications? And do you find that kind of entrep, if you thought about that in relation to the way that cot can be used sometimes, I'm sure people do use it in addition to the social thing, they might use it like you said to work or to study. Absolutely. You're talking about like in saying in Ritalin, where stimulants are used in drugs like Ritalin? Yeah, yeah, or Adderall, which is a-- Adderall, yeah. Which is racemic amphetamine and it's given, you know, for-- it's given in low doses for, you know, attention deficit hyperactivity disorder. And it's very commonly used to help people study or to help people focus in school. So, did you-- I do think that's really interesting, how drugs are placed so many different roles. There's religious roles, there's social roles related to cultural identity, but there is this kind of self-medication that goes on. Either medication, not necessarily just self-medication through prescriptive psychiatric drugs, but yeah, people do use cots as a way of Medicaid themselves for certain things. Either to work or like you said to study ironically, and amphetamine produces some concentration as well. In fact, when people chew cot in Madagascar, that's one of the words they use to describe the effect that they get from it and what they like about it, is it allowed them to concentrate. So, even when they're chewing it entirely socially with their friends, they like the feeling of concentration they get even in that social space. - Yeah, you know, that is partly a function of the plant to have that somewhat-- you know, the concentration can be accompanied by euphoria. The danger with amphetamines is that, you know, one little pill, if somebody develops tolerance to it, then taking two or three little pills is really not that hard. Whereas the thing about cot is that you have a built-in safety mechanism in that it's work, isn't it? Like, I mean, it's like a process that's of ingesting the drug or the pharmacologically active components over time. How long does it take to chew it? - Right, exactly. It takes a while to chew it and the pharmacological reviews that I have done have talked about the danger of cot as a chew plant as being severely reduced by the fact that it is ingested by chewing it and the effect takes a while to take place. You can't really overdose on cots, so to speak. And so, along the pharmacological reviews, especially the ones that are more sensitive to social context in which it's taken, that are paying attention to the route of administration, really recognize that this isn't the kind of drug that you can overdose on, that there are built-in checks and balances on its effects. - Which is remarkable and is often the case when you, you know, like one of the things since I'm reading on drugs in alcohol, you come up against, it's kind of a recurring theme that if you look at the medicine side of it, for example, there's the belief that a pure compound that stimulates a single receptor is better than a plant because we're looking for one thing. But the plant has many things in a long tradition of use in a safe context. It's like you said, I mean, it's just you can't physically overdose on it. - Right, and when it's true in different social contexts, people recognize the progression of the drug effect in different ways of thinking about the different stages of it. So there's the time when you're sort of waiting for it to take effect and then there's the time when it's the most strongly affecting them and yemenate, they have a word for this, the period of time when you're really feeling this, the speed effects of the amphetamine and conversations are going and everything's very animated. And then they recognize this, the same period of quietness afterwards, where people are more introspective and more thinking to themselves. So they recognize this as sort of going from up to a down as per the cycle of amphetamine. Is that common from amphetamines across the board? - There's always, yeah, I think that it would depend on the dosage, but I think that anytime you can't have a perpetual state of stimulation, eventually they're having to be a return to homeostasis. Depending on how far, you know, the extreme example would be a meth person who would snort or smoke or inject like a large dose of meth that would keep them awake for days. They would subsequently be almost comatose. We're very tired because the body will eventually catch up. But, you know, again, with a plant, it's harder to get, I guess I can't say with a plant because there are plants like scapolamine or, you know, the dissociative belladonna alkaloids and things like that, that would be extremely toxic. But it's obvious that caught is not that way. And yeah, you know, it seemed like, you know, part of the thing that I found interesting is, I guess partly because it's chewed in places where it's hot. You tend to stay up at night because in the daytime, I would imagine it's hot. So is there more time, you know, so how it's chewed like at night and it's or the chewing sessions typically, I know like in the Ethiopian context, the chewing sessions are typically social things where it'll go into the night and then and then maybe they'll even though they're tired, they're still stimulated. There's still some stimulation. So that's where people will either, you know, drink or what other ways do they deal with that? Or is that the way it's used there in Madagascar? Or is it more of like a daytime in the market hanging out? Well, this is a way, okay, so in just to contrast this a little bit with, with places like Ethiopia and Yemen where it's been chewed literally for centuries and is oftentimes incorporated into religious ceremonies, as well as social very specifically highly choreographed social settings. In a place like Yemen, you're not supposed to chew it by yourself. It's considered to be sort of a bad thing. And everybody gets, I mean, from what I hear from people who visit Yemen, everybody who goes, you get drawn in, especially if you're a man, you get drawn into caught chewing. In fact, even the president does a lot of, at least at some points does, has done business over caught sessions. And it's a, it's a deeply ingrained part of Yemeni politics. In Madagascar, it was introduced much more recently. It was introduced in the colonial period around the beginning of the 1900s under the French, and the French hired Yemeni dock workers, they were ship workers, and they came over and they were, and they stayed in Madagascar, the city that this is in is called Diego Suarez, and there's a large natural harbor. So some of these Yemenis just stayed in Madagascar. They, they chewed amongst themselves socially. And eventually they started growing kitchen gardens, just a few plants for themselves. It kind of started catching on and gradually over the 20th century, it started, let's it really start catching on amongst the general Malagasy population? So probably, oh, in the 80s, someplace, or even in the early 90s, when more and more common Malagasy people started chewing it. The reputation was that the tradition that the taxi drivers were the first to start chewing it in order to keep themselves awake. Well, a lot of the taxi drivers are young men. And so now, I talk about there being several different main categories of Chur, so you still have the people who are Yemeni identified. They still consider themselves, the word they use is arab. So they, they chew amongst themselves. They, they generally don't consume alcohol while they do it. And the next group of people you have are the people who are well-employed, they may have steady jobs, and they'll chew on weekends or on their days off. And then you have the young men, the Chur who are kind of considered like juvenile delinquents. And it's part, it's a big part of youth culture. Interesting thing with caught is in many places where you find it, especially as a newer custom, where it's been taken out more recently, it is a way of being hit or cool in the young male generation. And it's the same thing in Madagascar. So what they do is they generally, they like to chew it right after lunch. So it is during the day. Because of this whole need for speed and the time factor, you got to get it from the field to the Chur as fast as possible. People will tend to pick the caught in the morning and get it to the city by by around noon or one o'clock. So around noon or one o'clock, the caught trucks start coming in and people, there's a big hullaboo in the streets and people gather around and everybody buys their caught for the afternoon. Sometimes people chew it by themselves. It's not stigmatized to do so. Oftentimes people chew it with groups of friends. And generally by evening, by about, by say, dinner time late afternoon, people are spitting out their wogs of caught. And some people, some people drink alcohol, a lot of people drink alcohol, but not everybody in order to kind of come down from that experience. So yeah, it is a daytime experience for them and very social. OK. For many people anyway. So what about the the land part, which is what you originally went there for, right? Yeah. So how did how did it because again, you know, I'll give you parallels. I'm reading about opium and how it became completely industrialized by the British and I think it was the 1700s or, you know, how it became just commercial, mono culture, dedicated over large swaths of land. And caught is so different. Yes. Yeah, caught is primarily farmed by smallholders. Everywhere it's farmed interestingly enough. And if you look at Yemen as well, you don't tend to find large, huge plantations of caught. I mean, you find some people planting a lot more than others and becoming a lot more wealthy than others than some. So there's some stratification, but really there's a large place for small scale farmers and all of this. And when I found my original questions about the deforestation is to what extent is caught responsible for deforestation. As it turned out, it didn't seem like it caught what is responsible as some people were afraid of. And some people, even people working in the local conservation office were recognized that caught was useful in some areas for stabilizing the soil. In any case, what you realize is with land use change issues, there's a lot more going on than just caught. One of the biggest questions was caught. And this question arose as I interviewed people. I have no idea I was going to be asking about this going into it. For people who were worried that caught planting was going to be taking over traditional food production. So in other words, people were going to be planting caught instead of rice and instead of vegetables. So what I found is that a lot of farmers, particularly in one area, there's two main growing areas, particularly in one area. People were converting their irrigated rice fields into caught plantations, small caught fields, so irrigated caught fields. And the benefit for them was that caught would cost a lot more during the dry season. So anybody who was planting caught in an irrigated field could earn a lot of money from it in the dry season. Most people who were farming caught did not have an irrigated field, and they could only get money from it in the wet seasons, of course, the price was much lower. But there was also a high, people had a high value on growing food crops. So the farmers didn't really want to give up their food crops. So the ideal was to farm to have cots and rice and vegetables, and did not have to give up anything. But of course, there are market constraints and market issues. And as the price of caught went up, it's still caught, and that's what you would do. And you find the same question about caught versus food, the drugs versus food issue. You find that with other drugs and also with caught in other places. And there's a whole book published edited by Ezekiel Gervisa about caught versus food in any theopia. And there's been discussions about that. And Yemen is pretty much the people who've been investigating that find that it's a lot more complex than just saying caught is taking over. A lot of times there's a lot of other market things going on that are discouraging the growing of food crops. Or dramatically encouraging the growth of drug costs, by them being so lucrative. What I found in my guest car was that people in the cities, the policymakers and the people who have just had common opinions about caught farmers, they're like, oh, those farmers, they always want the easy way out, they caught it easier to grow and they get so much money from it. So of course, they're going to switch to that. But when I talked to farmers themselves, the farmers felt like, well, actually, there is a fair amount of weeding that you have to do a successful caught. It's a lot more time consuming than you think. And especially for the people who are farming vegetables, they said, you know, there's a lot of problems with farming vegetables. And that the road system is bad. A lot of times they're probably get destroyed just trying to get into markets. The market had shifted so there wasn't such a demand for vegetables anymore. So the whole question of food versus caught is much more complicated than just saying, oh, caught is so easy to grow and worth so much money. The farmers ultimately wanted to have a diverse portfolio. They wanted to grow vegetables. They wanted to grow rice as well as caught. Is that a function of wanting to grow for their own use and then just have a little bit to sell or they, you know, are they used to being self-sustaining? I guess is part of the question. That's a really good question, particularly with rice. You find that they have a high value on being self-sustaining on rice. Now the farmers hate the idea of ever having to buy rice and they will try to avoid that. The other thing is talking to especially wealthier farmers who have a little bit more capital at their disposition. They've got some more irrigated land. So wealthy farmers are like, you know, it makes sense to grow some vegetables because of because of the markets and that in the dry, in the wet season when the price of caught is low, you know, you want to have some other crops to have out there. So a lot of farmers saw that they wanted to balance it in terms of seasonality and that there was actually good market. There were good market reasons for growing vegetables as well as rice as well as caught. Okay. So when you, when you're looking at this stuff and you run up against a lot of ignorance, like, you know, when you read the descriptions that doctors give for, like, you know, saying that it makes you slow or whatever, not even recognizing that as an amphetamine, it's going to have amphetamine like effects and misinterpreting things. Does that, I don't know, it's interesting because it's so much, you're so much more perceptive than society at large. I guess part of the thing is when you, when you, the ignorance that you see in terms of drugs is to an intelligent person who can look at things from a lot of different perspectives, it's pretty obvious and. Yeah. Well, one of the things that always, that always gets me my favorite is when caught is described as an narcotic. You know, just the whole word narcotic as we come so charged in our language. Yeah. And actually it's meaningless chemically. That's a legal definition. You know, I think from, I watched a lot of dragnet as a little kid and I think that's how Joe Friday used to refer to things as narcotics and I'm confident that he would paint caught to be a very, very dangerous substance. So what is a narcotic technically then? You said it's not a matter. Yeah, I guess it would be a, it's from narcosis, you know, which is like to sleep, but so, but it's an old term like, because now you would, you would say, oh, it's, you would break things down by the class of an opiate or a benzodiazepine or, or an analgesic or, I guess I always thought that the narcotics were the opiates. That's what I always thought they were. Uh huh. Yeah, that's separate. Yeah, that would be more, that would be more accurate. Yeah. But it's like a weird like World Health Organization type term. So when, when, so when you see things like people wanting to make caught illegal or put money into interdiction against it, like, do you see that as, um, I always break things down into ignorance, greed, or aversion. And you know, what, what is motivating people when they, um. Right. I think a lot of what motivates people is fear of the social consequences. I think a lot of people are afraid that when people chew caught, they do become lazy. They become a drag on society and they're an impediment to developments. I really think that is a large extent. There's another issue that you can't really deny about it. And this is one of the negative things we've caught. Is it the people who chew caught a lot. Uh, sometimes it becomes a drain on household budgets. So sometimes it, how expensive is it? Yeah, how expensive is it? Well, it depends, of course, on between the, the dry season and the wet season. I don't have a hard time. So compared to the price of a meal or something like that, like for, for one person's chewing session, could you compare? Yeah, it was, it probably one chewing session would cost, it would cost more than it would probably have a pack of cigarettes. You could, you could, you could feed a family for a day for what it costs. Well, okay. What about in cigarettes? So different exchange, like that's prison exchange. Right. Exactly. Exactly. Yeah, I'm not sure about that. But I know that it can't, that a lot of people, okay. So this is another one of the fair reputation that caught has is really straining households. And so the reputation, especially that, that women don't like caught, especially because they're male partners and sons, chukat and, and drag money away from the family. And you find that opinion, you find that opinion widespread, even among the smiley, nasty people. But what I found is when I went in and did my end up interviews and I had a team of people from the university helping me with this. When we did end up interviews, semi, semi structured surveys, we found that a lot of, there wasn't as much agreement on this in the poor areas of town where most of the Koch tours lived. There wasn't as much agreement on this. In fact, a lot of women were like, well, I'd prefer any chukat than any drager of all. Yeah. There's a lot of worst things you can do. And if you choose cotton, hence, he actually is protected. And he does things around the house. So I found that there's a, there's a wide variety of reactions to caught and it can be, it can be negative. A linguist friend of mine over there studies you male youth culture and they're kind of slang. And they're, they're all Koch tours. So he talks to me about noticing that sometimes the men and their friends will sit around dark living rooms all day chewing cots and if the children of the family feel like they don't have anywhere to go. And this really is genuine concern. And so I think sometimes people where it gets caught are looking at some of these behaviors. Yeah, looking at some of these behaviors. So it's really interesting studying legalization and legalization movements. I read about one's going on in East Africa. And one point that was made is that sometimes just talking about the social consequences of the drug weren't really enough to raise public concern about the drug so much. It wasn't until they started bringing up the health issues that people started paying attention. So sometimes I think people leverage health arguments essentially in order to make social arguments. And one of the problems with that is again, it gets the cart before, of course it's like it's caught the problem where it's caught a symptom and it's probably more complex than that. But I think to just blame caught alone is, is pretty short-sighted and not really taking a look at serious how serious the social issues of poverty, of lack of employment, and other kinds of issues that are probably more real and far more pressing than caught showing itself. It's a convenient something to attack, I guess, or I don't know whether there's an expression. It's a scapegoat. You can think of all mind altering substances can act as fuels or as things to decrease inhibitions or to increase energy levels. If the culture is directed in a certain way, especially if there's not like a long tradition of them being used, it's not surprising that, so you talk about the young guys. Could you talk a little bit about them? Because I thought that was interesting. They're like hip hop kind of like just urban, urban youth basically, right? They really are. And it's associated with a kind of a hip culture. Like you're saying, they've got their own slang and chewing caught is really cool. And one of the interesting things, this is a fascinating point that several people have made and I found it to be true in Madagascar as well. It's a way that young men are forging connections with each other and associations with each other in an urban environment that is multi-ethnic. So you find people cutting across ethnicities in order to establish bonds with each other based on new forms of identity that have a place in youth culture and where caught is also symbolically very important. And so I would point out as a cultural phenomenon, that's actually kind of an neat thing to see that people are making positive associations and connections with each other. They're coming together across ethnic lines. And in a very urban and a very modern form of identification, you know, if you look at listen to hip hop, do they listen to them? What kind of music do they listen to? Because I love music, I listen to a lot of malagase guitar music, but that's not an urban feeling music. That feels like... No, it doesn't at all. No, no. What they listen to more is that, and I know the kind of music you're talking about, that's more from the high plateau. The malagase music coming from the coastal areas sounds more like kind of world music, it sounds. Indonesian or something like that? No, it actually sounds a little bit more like African and Latin American-y a little bit. Do you have the names of artists? Do you know any artists that you remember? Oh, my mind isn't sleeping me right now. Is music like a big part of the milieu, like when you're there? Is it like, because I mean part of what I, it seems is like, it's like a drug where you said it's an urban drug or an urban whatever it is. Is it an urban stimulant? And like, are there people who are so poor that they don't even, you know, they don't have enough money for like, to buy a beer? So is there like, are you still talking about like, relative to the society, a pretty, they're like, they're, if they have enough money to buy cot, then they're hustling in their... Yeah, yeah, yeah. Okay, yeah, there's an interesting thing there, but going back to what we were talking about earlier, you asked if they listened to hip-hop, they do tend to idolize American hip-hop culture, even if they don't always listen to hip-hop music per se. But they tend to wear the baggy clothes and they kind of identified a stomach scent with hip-hop culture. I can read you another little part. This is from an interview that this linguist did, where he was asking about the relationship between, this is at the bigger questions of laziness and cultural perceptions of work. And so the, the linguist's name is Pierre Bima. So Bima asked if these, a group of these young men of life in the city is difficult. And this respondent who works seasonally at a port and does odd jobs the rest of the year, he replied in the slang, that of the youth slang. And this is, this is a quote from this young man. He says, "Difficult? Yes. You need money. There's no work. There are many, there are many unemployed people. That's what it is. Many young people are without work. Even though you need money to buy clothes, it is difficult. That means that the young men in this particular group called protocol must work at night. They must do operations, meaning stealing. There are those who sell cots. Some work at the ports and stock workers. Some live off the earnings on women. There are still others who specialty is stealing at the outdoor market because it is necessary to find attractive clothing, whatever it costs. I was hesitant about whether I should read this quote because it kind of puts them in a negative light. But what I, because what I found in my, in my actual interviews with people is that there is not actually a lot of stealing associated with, you know, sort of admits to stealing. It does not look like culturally valued. But in reality, I don't think the stealing, I don't think that's a huge, a real social problem. In my experience at, and I, I, it's a limited experience, but my experience at African markets where law enforcement is done by the people, you don't really, you know, there's no 911 to call. The, if you steal and you get caught, the consequences can be very severe. Like, you know, they might beat you to death or something like that. So, so it is, you know, I don't know if it's that poor, their Madagascar also. Yeah, I think in some ways, it's interesting that he talks so much about stealing because even though it may happen occasionally, it's not a dominant concern. And, you know, all those people interview 147 people, well, with the help of my research assistants, formally and a bunch of people informally, nobody is saying, oh, they steal all the time, they steal, and there is not a real ongoing concern. But it's interesting to just show their attitude towards, towards money. They, and they're just, it gets a little flavor of them culturally. Clothes are important. They like to wear new clothes. And yeah, there are a lot of people who can't, who can't afford even that. Yes, there are a lot of people who can't afford beer. There are a lot of people who, who they could probably afford cigarettes, because we can buy cigarettes one by one. But there are people who are definitely a lot poorer. So these people who are chewing caught at all do have so many of their disposition are probably not the very poorest of the four. That is a good point. But a lot of them, what they do is they'll work, they'll work odd jobs. Well, some of them live at home still. If they're young enough, they still live at home, they eat at home, and they'll do an odd job during the day, you know, just to get enough money to, to chew their caught. Some of them, if they live on their own, they just live very bare bones. They're not necessarily married. You know, they might work washing cars or something in the afternoon, just for enough money that you caught in their bare existence. You were on what part of the island were you, where you caught Diego Suarez is? Very far north. The far north. Okay. And is there, you said that there, you know, with it that, especially with the youth that caught use transcends ethnicity or it, it's a bridge between ethnic groups. On other parts of the island, is there a demand for caught or is it, is it the kind of thing that's growing? Yeah, that's a good question. Yeah, let me just say that, that this, it bridges not only ethnic groups, but it bridges even class distinctions and neighborhood distinctions. So it's really a unique and very interesting phenomenon for all of that. So about the larger demands, yeah, there are more and more shipments being sent to other parts of the island. So there are the airport, it's a major commerce at the airport of sending cots to the capital city, to the other regional capitals. Anywhere there's an airport, people develop connections, they develop ties. And so caught traders will take their wares to the airport. They used to just sort of send them kind of illicitly underneath the airplane, they should kind of sneak it on. But now it's very well established, it's very well structured, they pay, it gets sent over, it's unaccompanied baggage, and then somebody at the other end will get it, they'll, they find ways of sending money back and forth, and so they sell it. So there, but it's, like you find with cots in say the United States and Europe, where it's a lot of it's chewed by Somali populations, a lot of times caught in those places is chewed by the populations of the people from the North who are really used to it. So in the capital city, the biggest market for caught will be people who are originally from the Divasauras area. But they can't, and they don't ship it outside of the country for two reasons. Partly you get the need for speed thing, but on the other hand, that's not a sufficient explanation because we know that it's sent from a sacrifice to all over the world. It's mostly because they don't, and it is illegal in almost any place where they would want to send it to, that's, that the market has been saturated by any African caught. So in the reunion island, as French owns, there's a lot of going back and forth between Madagascar and reunion islands, it's actually renamed as part of France, it's an overseas department, and it's illegal there. So from what I've understood, it's that people don't send it over in any kind of commercial quantities, and partly as the market is really saturated by all this East African stuff, where there's a full infrastructure in place, both in terms of air and lands, to move the stuff out. So it's much more like towards this, the end of being more not industrial, but more agribusiness oriented than the small, small, old farmers like that. Is that right? Like, so if you look at a place like Kenya, or if you look at Ethiopia, then they're growing it on a much larger scale, in some places at least. Yeah, yeah, I don't know, I think still a lot of the farms are owned, I don't know how big any of the farms are, I still think they're not huge, it's interesting to get a lot more concentration of people selling, that's what I'm understanding. So when you saw, when you were looking at land use, what did you identify as like, because I gather that like all, I don't want to say unspoiled, but all places where the forests are still intact, the pressure is unceasing. And so what are the big threats to, you know, because there's still a lot, I mean, my vision of the island is that there's still some jungle left and some unspoiled, unlocked, unmind. Yeah, those areas are getting fewer and fewer, and this area where caught is grown, is around the borders of the Amber Mountain National Park, where it's been actively protected since the late 80s. It was originally set up as a protected area in the 1950s in the colonial era, and then after the colonial era, it wasn't really, the boundaries were enforced so much. In the late 80s, early 90s, a lot of international money came in to help support conservation. And so the boundaries have been pretty well enforced since then, and so that has managed to keep up at the Amber Mountain forests relatively protected, not that there's not illegal cutting. One of the issues that I've discovered is that on the west side of the Amber Mountain, there's still a lot of logging, so logging is always a threat. That's another thing that is a little bit frustrating to read about. People tend to like to blame local people for cutting down the forest anywhere in the world, whereas in a lot of instances, there's a lot of logging going on that's much, much bigger in scale, you know, people coming in from the outside and logging. So in other places in Madagascar, right now like the Musuala Peninsula, there's a big problem with illegal logging going on that doesn't come down to the local people, it comes down to international logging issues. Yeah, so so COT actually, one of the things, coming back to talking about COT as sort of an incredible boon to the local economy. So you have this place, Madagascar, which is one of the poorest places on earth. And so people about this kind of home and grown economy, growing COT, selling COT, the markets, the market is going crazy for it. Farmers make a lot of money, traders make a lot of money. It's really the fuel of the local economy. It's sort of the, it's not referred to as the North's green gold. And kind of it's sort of economic development on our own terms, which is again, one of the reasons I was fascinated with it is because really it is aside from any kind of international aid aside from the outside of the global capitalist economy. You have this little homegrown economy that functions very much on capitalist principles. And it's going, it's going really well and keeping a lot of people with food and clothes and that sort of thing. One of the arguments that I make in the book, at least I start to explore this issue of when you're looking at drugs and health, is one of the reasons it's important to look at a drug like COT in a holistic perspective is because the questions of health are so much broader than just what happens to consumers. But if you take this kind of a critical medical anthropology or sort of a broader political economic perspective, you realize that health is also connected to standard of living. And if you're too poor to afford healthcare, that's going to affect your health as well. And that these farmers, the COT farmers, are really earning a lot of money, the traders are earning a lot of money that is in effect, indirectly affecting their health by giving them the money to go to doctors and to take care of their health and to buy healthy food. So these are some of the factors that I think are also important when considering COT as a drug is looking at what is its overall effect in the community where it's found. And that's where not only consumption is important, but production and distribution. So I try to look at the drug from a real multifaceted perspective for that reason. They're looking at health broadly speaking, health and drugs as a broad issue as well. Yeah, it's so nice to read a book that does that. I think as a society, we're kind of with drugs, we're kind of where we were with things like sex education a hundred years ago. And so far as there's the belief that, oh, this is something we shouldn't do and this is something we shouldn't talk about. So we're not going to talk about safe sex or, you know, things that will reduce teenage pregnancy or pregnancy in general. Because it's just not, you know, either it's bad or it's not something that people do or there's either, you know, there's value judgments or whatever. And to me, the use of substances, whether it's, you know, coffee or cigarettes or cot or marijuana or alcohol or I think, you know, as far as you go back in time, you're going to find that that's those are things that people did. And there are ways that people did them and lived good lives. And it was part of part of the quality of their life and there are ways that people did them that were maladaptive. Yeah, I think the dangers of looking at any drug in and of itself have been a good or bad. And looking at it in that kind of a black and white way that any drug can be used or misused. And I think we do our own disservice to our kids and the traditional training that my kids are getting in the schools, which is like all drugs are bad all the time. Yeah, so I mean, to me, that would be like the equivalent of abstinence only education, which is, first of all, it doesn't work because that's why we succeeded as a species is because those drives are very strong. And kids being kids, they're going to do, you know, that's part of life, you know, as a teenager, just like they're going to experiment with alcohol, and, you know, I find it interesting that, you know, we can say on the one hand, oh, you know, you can, you know, you can practice contraception or you can make sure that you, you know, protect yourself, but we can't say there's a safe way to drink. And there's a way other than abstinence. Such mixed messages as well, because then they go home and they, and they get their parents in trouble. And it's like 1984 for drinking a beer, you know, they're like, they don't understand, it just makes no sense to them. And at school, they're given no cognitive map for figuring out how it can be that their parents can drink a beer after work and have that be okay. And they'll kind of pave the way, actually, for drug abuse, I think, by not giving them that kind of a sense that drugs can be used or misused, and you got to be paying attention to more cell things. Like, does it get in the way of your ability to function? And there's a lot of reasons why, you know, kids that they shouldn't be doing drugs, but I think there's a more effective way of teaching them that, actually. Right, right. That is, unfortunately, not, not the case right now. I think there, and that kind of model is still, and part of the problem to me is, you know, when you, when you say something like that, then it's, like you said, it's confusing because children will see, you know, media figures, what have you, Michael Phelps with a bong. And they can say, there's some cognitive dissonance there. They've been told that this is bad, bad, and then, you know, they see people who are successful, and then there's like, oh, maybe everything I've been told is a lie, or they, you really don't know what to believe. So, yeah, this book is so good because it provides information that is very objective, and it's obviously grounded in a lot of research and experience. So I really, I found that very refreshing up. Is there anything else that you want to read from the book? And then I'd like to ask you a question. There's, when I was reading your book, I kept coming across this person's singer. Oh, yeah. Meryl Singer is actually, he's one of the editors of his book series, and he's one of the leading figures in medical anthropology, particularly in critical medical anthropology. And he makes a lot of really important points. He's actually been quite an inspiration to me because he is encouraged, a perspective that says you can't just look in an isolated context of the relationship between drug user and drug, you know, and other anthropologists will agree to the extent you have to open it up to a larger cultural context. So, including context is important for what he and other people like him. He's not the only one. Add to the mix is that what we also have to look at is some of the broader political and economic questions that come into view, like looking at the war on drugs. Let's try to be really honest about what that has to do with our perceptions of drugs with our treatment of people who use drugs and with what's going on in the world at the time. So, so he doesn't take it. He's a very holistic person. He takes interest. The only other part that I picked out to read was something from the conclusion. And I'll start here with, yeah, I'll just start reading part of the conclusion. And asking the question, why would anyone outside of Madagascar care about cuts? And this comes back to a question that my son asked me when he was 10 years old. And you know, I was spending all my time studying caught and writing about caught. And he said, Mom, I don't mean to be disrespectful or anything, but who really cares about caught? So I, you know, I sort of took it as a challenge. Like, okay, why does this matter? Right? So first what I say is first caught provides a significant scholarly case study of cultural and economic survival in the global margins. That's the story of them surviving, even amongst the poorest of the poor. And it just speaks to the ability of people to really survive. Second, in a more applied sense, it has relevance for analyzing the effects of drugs in general, and for conceptualizing interventions that can account for the complexities of their effects. Taking a stand on caught or in any drug requires complex evaluation of their multiple effects, which may include both negative and positive aspects. It can be beneficial to some and harmful to others, for example. Understanding these complex dynamics requires holistic understanding grounded not only in individualistic mental and physical health perspectives, but also in political economic, social, and cultural contexts. As stated previously, the danger in analyzing any drug lies in black and white, often more realistic thinking that fails to see the complexity of the issues at a stake. In disciplinary education for healthcare workers, with a strong grounding in social as well as natural sciences is an important step for an effect of interventions. And what I would just add there is that, yeah, when you take a look at caught, when you did what I did in a holistic sense, you're not going to come out with caught as good a period, caught as bad a period. But even as it's come out so far in our discussion, there are some negative aspects, and there are some positive aspects. And if you want to do something about caught, say, you know, a healthcare worker, a public health perspective, have to be able to balance those kinds of things and look at them, put them all together into the mix and realize there's no simple straightforward answer. Sometimes it requires you to think more holistically and more complexly about solutions. That's great. Yeah, that's true. So I really thank you again. I really enjoyed it. So yeah, the part you talked about people who are poor, he talked about people, he said people who are poor and who have a sense of hopelessness or more likely to use psychotropic substances and in turn to suffer from drug use-related diseases in addition to experiencing lower general health status. And I don't know, I mean, my experience as a physician is that drug use, psychotropic drug use, is ubiquitous throughout society. And you know, it might be that people, it might be alcohol or some drug that's more socially accepted. But I think it, you know, and in fact, I see really the diseases, a lot of the diseases I see are diseases of affluence that are from an excess of either, you know, being able to buy beer for really cheap or being able to buy, you know, a gigantic 32-ounce Coke and fried chicken for $1.49 because it's subsidized and those are the, that's kind of the sequelae of that, which are diabetes and obesity and pathology. So I don't know, I kind of think that, you know, the poor are more vulnerable to all sorts of things like, you know, they're vulnerable just by virtue of the fact that they're poor. But I don't know that they use drugs anymore or any, yeah, I think those the same as our attempt to look at to what extent are different segments of society disproportionately perhaps or not disproportionate to ask, are any segments of society disproportionately negatively affected by things? And I think he's trying to look at the extent to which the poor might suffer maybe in different ways than wealthy. But it's interesting if you look at those things like the like the diabetes and all of that, there's huge socioeconomic correlations between relatively in the United States. A lot of the diabetes more concentrated among slower income people for whom those those foods are. Yeah, because they're eating that. So you were contrasting that with the drugs, you were saying that. Yeah, I think that, yeah, I mean to me the, and in fact, you know, maybe the excesses of somebody who's high functioning might be tolerated is long because they're not spending time in the public space or they're not under the same amount of scrutiny that poor people are. Let me see is there is there anything else you want to say? Let me see if there's anything parts that are like I really highlighted. Yeah, take your time. Yeah, I really, the whole cultural, I'm not, I don't have an anthropology background. So just reading about cultural medical anthropology was for me very, I learned a lot and I really appreciated that you talk about it. But you don't, some of the texts I've read can get very deep into the theory. And you don't do that, which I really appreciated. Yeah, thank you. Yeah, that's my goal. That's one of my goals with this is to have something that is accessible. And I really make me very happy to hear that you found it useful from your perspective as an MD that is very much to me. And I hope other people can find it useful from their own their own multiple perspectives. How did you get interested? I'm just curious to tell you about interested in the study of drugs and how you got into it. Well, because that's partly, it's always been an interesting mind from when I was an undergraduate, just pharmacology. And that was, that was the class that kind of made her break, was make or break for getting into medical school. And I had, it was chemistry. And I had, yeah, this is interesting actually. So I had failed chemistry, organic chemistry twice. And I was, I was smart, but I just didn't like to study. So I found a lot of those kind of students. Yeah, yeah. And so I had an experience with MDMA when it was still legal. And so it was like, yes, somebody said, oh yeah, there's this really this drug that's really great. And of course, you know, now, now I would say, oh my god, who made the drug? Where did it come from? You know, China came from China. Isn't that that place where they put poison in the baby form? Yeah. I don't know if I'm interested in that, but those were different days. And again, it was like, it was legal. And because it was legal, they're part of criminalizing something is when you create a black market, there's incentive to manufacture it in a clandestine fashion, because you'll get arrested if not. And so the the manufacturer of it is not the same purity that if I'm just buying vitamin E or something that's just a chemical, which this was at the time. So I had a very positive experience with that. And I thought, oh, maybe I want to learn to make this, you know, how do I make it? And so well, you have to know organic chemistry. So I, so that was what got me to apply myself in organic chemistry. And since I failed it twice, I had to take the upper division organic chemistry to show that. And I really, I did very well. And just by virtue of my interest, and I realized halfway through that there's, you know, there's no way that I'm interested in cooking something like this up. And for that matter, they act. Yeah, so but whatever, it spurred my interest in in pharmacology. And then the whole debate around why was it being made illegal, in spite of the fact that I saw that, oh, it could be, it could be used in a very positive way. And that the people who were, who were putting those arguments forward were not Timothy Leary types. You know, they weren't like, oh, let's just throw everything to the wind and drop out. And not that I'm opposed to that, to the idea of objecting to the status quo, but they were reasonable people. And then you sort of, you could see the hypocrisy or the ignorance in people's arguments. And then, you know, so then I had to decide, oh, well, you know, do I pursue that? Or do I pursue something that's very separate from that? Because really in medicine, the, the realm of substances is kind of ceded to the psychiatrist. And I'm an anesthesiologist, so that's really what I do. But I've also done training and pain management. And so that's a whole, so anesthesiology is extremely pharmacological. And it's, it's, it's like a person or a dog would behave the same way, because you're just dealing with physiology. So it's much, it's much less multidisciplinary in its practice. But then I've also had experience doing pain management, which is very different, because then you're dealing with people who are awake. And it, then the whole, it's much more complicated. And, and you see, you know, the, the results of people's lack of understanding about the difference between a medicine and a poison. And that just be, you know, for, for example, physician prescribed opiates kill over, as many people as die in car crashes every year. So that's 15 to 17,000 people a year. Die from overdoses of, of physician prescribed opiates. And really what that is, is it's because people, there's a small subset of people who are abusers, and they are, you know, they're, but then I think there's a lot of people who are just naive and have never been told. Oh, if you take three of these oxycontans, it's not like taking three Vicodin, and it can kill you. And so especially in, in conjunction with alcohol. So, you know, you know, like Whitney Houston is, is somebody you know about because she's famous, but she died really from alcohol and benzodiazepine overdose, which is like valium and alcohol. And so the most dangerous drugs are, ironically, are the ones that are available with a doctor's prescription and doctors bear some responsibility because they give them to the patient and they don't tell them, don't take this with alcohol. Yeah, don't drink or, and for example, with benzodiazepines like valium type drugs, they cause amnesia, especially if you drink. And so some people will take it and then forget that they took it and then take it again and forget that they took it. And so in terms of mortality, recently a study came out where they showed that taking benzodiazepines is as dangerous as smoking cigarettes. So, yeah, so all of that is interesting to me. So it's really refreshing to see, but the thing is when you look at the dialogue of drug education or drug interdiction, it's, you know, this is, you know, why should cut be illegal or I think if we just stuck to the drugs that have a long history of relatively safe use and let people use them, which they're going to do anyway. Which they're going to do anyway. Yeah, in your example, just really point out, yeah, a substance isn't going bad in and of itself, it's all how it's used. Yeah, yeah, amphetamines, I mean, in the 60s, they used to say speed kills and amongst people, even of my generation, I'm on the west coast and there was always that, there was that knowledge that, you know, that's really what they say killed the hippie movement was the injection of amphetamines. And that it was, it was very destructive because for, yeah, for obvious reasons, but now that they, that those drugs are in vogue and are being written, you know, that's very common for psychiatrists to write for those drugs. And they're able to do so safely because the, the root of administration is, is oral rather than intravenous or insufflated and the dosages are controlled and monitored. So it's interesting when you get a substance like cot that because on the flip side of that, people are stupid. And if you give them free beer, a large percent of them will get drunk and get into fights because whatever alcohol is disinhibiting and, and but so when you have a substance like cot that is, it just, it seems extraordinarily benign as far as drugs go. It really is. Yes. Yes. It's absolutely, I would totally agree with you on that. It's like a strong cup of coffee. And one of the things that's very fascinating is the role of culture in affecting the, the effects people will feel from a drug. You know, some, your people learn to experience certain drugs. You know, you, you, people interpret their experiences depending on the cultural context they're in. And people say, like, sometimes you hear with marijuana people smoke at the first time or, you know, they, they don't feel anything. And part of the reason I think might be, maybe there's a physiological reason for this part of it is because they haven't completely learned how to feel it. Because it is very culturally bound. And so you look at affection, something like cot. If, if you're just going to chew cot outside of any cultural context whatsoever, you might feel a little bazillo, a little bit like you feel on, you know, you drink a lot of coffee. But really the, the real joy in chewing cot comes from these cultural contexts that elevate it to an art and a social and a really, really beautiful social experience. So, you know, the drug effects are, are cultural and the, and the culture inter, inter, interacts with the pharmacology and really fascinating ways. What is that a really fascinating to me as an anthropologist? Other studies of drugs point this out, say, with alcohol that people's, people's response to alcohol is very heavily conditioned by the cultural context in which they drink it. Yeah, I always was, when I first read, I think, is it in Colombia or somewhere where people will drink it and be very serious and sit around and talk about their problems and cry, but it's not, it's not what I, you know, the Oktoberfest experience that you see. Yeah, exactly. That's very cultural. The Oktoberfest, the Baccanalia experience, is very, very, very culturally prescribed. And so when you see really radically different experiences of, say, Native American communities or amongst the Irish or amongst, you know, different ethnic, different ethnic groups respond differently. And a lot of that is cultural. Right. Which is really fascinating. So, to the extent that a drug is good or bad, that's another reason why you have to look at the context is what kinds of behavior is encouraged by the ingestion of that particular kind of drug. Are people encouraged to act stupid and crazy and being harmful to themselves and others when they're experiencing the effects of a certain drug? Well, then there might be good cultural reasons, cultural/pharmacological reasons why it would be problematic or not. Yeah. Okay. So, do you have any new books coming out? Oh, no, not at this point. How long did it take you to write this? I'm sorry? How long did it take you? Oh, wow. Oh, well, it took me a long time. I got back from the field in 2005 and I was chair of my department at that point. I was chair of the Anthropology Department here. And so, it took me a long time to really get myself down to writing. I would write little bits and pieces. I would write a chapter here, a conference paper there. And it wasn't until after I stepped down from being chair of my department that I really contacted the press and started some discussions about it. And at one point my editor said to me, okay, so we'd like to step up the publication date. You think you can have it done by, I don't know what it was. This is in January, let's just say, can you have it done by say, March or April? And I thought, no way, but I'm going to do it anyway. So, I really pushed myself. It was having a deadline that really made it possible for me to finish. But you see the book as a product of years of writing. Yeah. Yeah. And lots of research. And like I said, I really enjoyed it and I learned a lot. And I recommended it highly to people with specific cultural interest in the area or on, like you said, the whole medical social. If you are into the medical, the social, the anthropological, the ecological, it was very, very enjoyable and interesting. So, thank you. Wonderful. Thank you very much. [Music]
Khat, the fresh leaves of the plant Catha edulis, is a mild psycho-stimulant. It has been consumed in Yemen, Ethiopia, Eritrea, Djibouti, Somalia for over one thousand years. Khat consumption is an important part of Yemeni social and political life. During the early part of the twentieth century, Yemeni dockworkers brought khat to Madagascar, where other members of the Malagasy population have adopted its use.
In her excellent book Drug Effects: Khat in Biocultural and Socioeconomic Perspective (Left Coast Press, 2012), Lisa L. Gezon, Professor and Chair in the Department of Anthropology, University of West Georgia, analyzes the production and consumption of Khat on the island nation of Madagascar. Taking a cultural, medical, and anthropological approach, Gezon looks at the use of khat in pharmacological, cultural, political, economic and environmental contexts.As a student of plant drugs/medicines/intoxicants, her summary of the manner in which khat’s effects have been mischaracterized by many so called experts has echoes of reefer madness inspired characterizations of cannabis and its users.Like so many drugs, khat is a powerful force in the local economy, and the factors that have allowed khat to provide income for small hold farmers rather than becoming part of a centralized and commercial monoculture are worthy of further analysis.
In addition to teaching me about the specifics of khat consumption in Madagascar, the background material provided a great primer on CMA approaches to substance use, as well as on the history, pharmacology and policy surrounding Catha edulis.
I have been thinking a great deal about the economic forces that influence the consumption and availability of drugs.There are similarities and differences between poppy production in Afghanistan or the Golden Triangle, cannabis production in the Emerald Triangle, and khat production in Madagascar.The peaceful and widely distributed economic benefits of smallholder farming on Madagascar make this study particularly fascinating.
Lisa Gezon was a pleasure to interview, and was very patient with my still developing interviewing skills.Her research included extensive field work as well as research, and the book is almost encyclopedic in its synthesis of the literature, the findings of her studies as well as her excellent and insightful analysis.
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