Book Review

A Brief History of Cocaine: From Inca Monarchs to Cali Cartels: 500 Years of Cocaine Dealing

N Engl J Med 2006; 355:1182September 14, 2006

Article

A Brief History of Cocaine: From Inca Monarchs to Cali Cartels: 500 Years of Cocaine Dealing
Second edition. By Steven B. Karch. 188 pp., illustrated. Boca Raton, FL, CRC Press, 2006. $39.95. ISBN: 0-8493-9775-8

When the Italian explorer Amerigo Vespucci reached the coast of Venezuela in 1499, he saw people obsessively chewing coca leaves and noted their degraded state. The archeological record suggests that the chewing of coca in South America dates back as far as 4000 years ago. After the Spanish conquest, coca use exploded among native forced laborers, and so did its profitability. In this painstakingly researched history, Steven Karch shows that the lessons of the first documented cocaine epidemic, which occurred in colonial Peru, have been forgotten several times over. The story is both fascinating and enlightening. Who knew that in the years leading up to World War II, imperial Japan cultivated and sold cocaine through companies such as Mitsubishi to help finance its military and expansionist ambitions, all the while ostensibly cooperating with the efforts of the League of Nations to curtail drug trafficking? Or that early in the 20th century, the first cocaine cartel was made up of a group of European drug companies?

The profitability of coca as a cash crop; the existence of weak, corrupt, or nationalistic governments; the plight of impoverished peoples; and above all, the strong demand for this most addictive of drugs are themes that repeat throughout the book. So, too, does the theme of frustrated efforts to address the problems related to cocaine. Karch shows not only how crop substitution, crop suppression (implemented today with the use of chemical herbicides), interdiction, and increased international cooperation have been tried repeatedly, but also how they are, arguably, serving the war on drugs no better today than they served the Spanish viceroy or the League of Nations in past eras. Thus, the book makes for a discouraging critique of contemporary drug policy, both international and domestic.

What should society do in the face of dangerous addictive drugs such as cocaine and heroin? The book does not offer a new strategy, and implicit in this story is that if an easy solution were to exist, someone would already have found it. Karch is a practicing pathologist who became interested in cocaine while conducting autopsies on its victims. Here he offers a detailed analysis of drug policy through the centuries. It is up to us, as citizens, physicians, and policymakers, to study these pages for clues to a better way.

Edward V. Nunes, M.D.
Columbia University, New York, NY 10032
nunesed@pi.cpmc.columbia.edu