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y JOEL M. HANNA Department of Physiology, University of Hawaii, 1960 East- Bray and Dollery: COCA AND ALTITUDE STRESS West Rd., Biomed T-608, Honolulu, Hawaii 96822, U.S.A. ypadu powder and can remember the time when their fathers 8 xii 82 and grandfathers used it regularly. On the other hand, certain Bray and Dollery have presented some rather interesting evidence that the use of coca leaves is not limited to high-altitude populations. It is difficult to take issue with this point, since the evidence is overwhelming. However, their remark "There is no reason to believe that this action (coca potentiation of amine reabsorption) would have any greater effect at oxygen pressures prevailing at 3,000 m than at sea level" does require districts in the vicinity of Tefe-including some virtually on the outskirts of the town itself-are characterized by widespread coca use, notwithstanding the fact that the population of these districts neither considers itself Indian nor even evidences a great deal of "Indianness" in its genetic or cultural traits. some clarification. One of the major consequences of life at high altitude is a continual physical stress resulting in an elevated sympathetic tone. Use of cocaine-containing coca leaves would thus potentiate this stress response, perhaps promoting greater neurotransmitter economy or enhancing the response itself. In any case, the continual hypoxic stress is limited to high elevations, and coca use would prove of special benefit there. Such a mechanism could be responsible for the persistence of coca use among high-altitude populations in the face of official pressures toward its elimination. by TED C. LEWELLEN Department of Sociology, University of Richmond, Richmond, Va. 23173, U.S.A. 25 x 82 People (including anthropologists) can function perfectly well at 12,500 ft. or above without resorting to artificial stimuli. This is clearly evident in the declining use of coca in the Lake Titicaca area, where I did my fieldwork. Though I did not specifically study this issue, I am under the impression that among the Peruvian Aymara three separate factors militate against coca chewing. First, those who are relatively acculturated, through circular migration to wage-labor jobs on the by ANTHONY HENMAN coast, tend to view coca chewing as old-fashioned. Second, the Department of Anthropology, IFCH-UNICAMP, 13100 Campinas SP, Brazil. 9 xi 82 Seventh-Day Adventists (about 11% of the population in the communities I studied) reject coca as they would any stimu- As an ex-student of Warwick Bray's who left London with his lant and associate it with Catholicism and the traditional reencouragement in 1973 to study the use of coca in Colombia, ligion. Finally, public education, usually taught by young mes- I can only welcome the thorough and incisive treatment of tizos, demeans those Indian values the state perceives as negathe theme in this paper. The kind of biological determinism tive. Thus, though coca remains an essential ingredient in inherent in the correlation of coca chewing and human sur- Aymara ritual, its casual, daily use is largely confined to those vival at high altitudes has all too often been misappropriated who are old and/or relatively unacculturated. by the narcotics agencies, and the resulting cant has led to at least one ludicrous piece of legislation that has direct bearing on the issues discussed by the authors: the prohibition of On the other hand, the value of coca-chewing for preventing soroche is widely known, and the leaves are sometimes used for this purpose even by urban cholos or mestizos. The father the use of coca in Peru at altitudes below 1,500 m, promul- of a family I lived with in Cochabamba, Bolivia, would use gated with the encouragement of the U.S. Drug Enforcement Administration in 1978. coca only when he drove up to 15,000 or 16,000 ft. to hunt bizcacha. My only major reservation concerns the replacement of the correlation between coca chewing and high-altitude living with Altitudes under 15,000 ft. would not be a problem for someone who is altitude-adapted and in good health. However, there the less spurious but nonetheless imprecise "link . . . between coca use and the persistence of relatively unacculturated Incan be little doubt that high altitude is significant when it is combined with poor nutrition or disease. In such cases the dian communities." Anthropologists have always experienced some difficulty in defining "Indianness," and in recent years many have moved away from genetic, cultural, and/or histormild stimulant of coca may be, if not essential, at least useful in carrying on normal activities. Since the poorer communities are also usually the more traditional, the correlation between ical criteria towards the more explicit but no less problematic self-identification. In line with this thinking and the authors' argument, one would not expect to find the use of coca among coca chewing and tradition may have some basis in biology. The adaptive value of coca should not, therefore, be entirely ruled out, though the stresses it alleviates are general ones those who, despite their ancestry, no longer consider them- that are merely amplified at high altitudes. selves Indians and are not seen as such by the surrounding In any case, the authors present a good case that coca chewpopulation. ing did not evolve primarily as a response to the stresses of In at least two areas that I have researched personally, altitude, and thus they provide a welcome corrective to some however, the data plainly do not support this view. One is the perhaps overzealous attempts at a direct correlation between region of southern Cauca, Colombia, where the use of coca by the Spanish-speaking peasantry-including, incidentally, the biology and culture. descendants of African slaves-contrasts notably with the more typical Andean pattern of the Paez of Tierradentro. This is a theme developed in some detail in my book Mama Coca (Antonil 1978), where I also point out the converse case of by MICHAEL A. LITTLE Department of Anthropology, State University of New York, Binghamton, N.Y. 13901, U.S.A. 1 xi 82 the Guambiano Indians of Silvia, who have abandoned the use of coca almost completely in recent years, and this despite the survival of a life-style which in most other respects is con- Bray and Dollery have done a very scholarly job in demonstrating that coca use was quite widespread in pre-Hispanic times in the Andean nations and that it was not exclusively siderably less "acculturated" than that of the Paez. a high-altitude practice. This information weakens, of course, The other area, surrounding the town of Tefe in the Brazil- the hypothesis that coca use confers some advantage on ian state of Amazonas, I visited only more recently (1981). coqueros at high altitude, but it does not falsify it. Testing The only self-defined "Indians" in this region, the Miranha this hypothesis is a difficult task requiring numerous studies. cultivate the coca bush today exclusively for medicinal pur- It is a task that no rational investigator should attempt withposes, though some of the older men still know how to prepare out enormous resources and time. Vol. 24 No. N 3 * June 1983 277
Two points in the paper do require clarification. First, the authors suggest that in the discussion following Fuchs's (1978) paper the assumption that the coca habit is intimately connected with the stresses of life in the high Andes was never challenged. Both Little (1978) and Mazess (1978) were skeptical of Fuchs's (1978) polycythemia hypothesis and of the meaning of the altitude-hypoxic-stress correlation. Second, the observation by Bray and Dollery that coca use is strongly related to degree of Indian culture was suggested in one of the comments on Fuchs's paper (Little) and probably by many other observers before that. by E. PICON-REAiTEGUI Instituto de Biologza Andina, Universidad Nacional Mayor de San Marcos, Apartado 5073, Lima, Peru. 25 xi 82 The scrupulous perusal of the literature on the ecology of coca and coca chewing in ancient and modern America carried out by Bray and Dollery must be welcomed by all those concerned with coca-chewing and high-altitude problems. The subject is introduced with seriousness, and the conclusions are based on reputable sources. I agree with the authors when they state that any relationship between coca chewing and hypoxia may be a spurious one, linked to the culture of certain autochthonous groups. by ANDREW FUCHS SILLEN Department of Anthropology, National Museum of Natural History, Smithsonian Institution, Washington, D.C. 20560, U.S.A. 18 xii 82 Bray and Dollery have presented a fine literature review on the archaeology and ethnohistory of coca. I was particularly interested in the documentation of widespread precontact and early-contact use of the leaf, since it so well demonstrates the unique and special nature of Andean coca chewing: in this region, in contrast to others, the practice has tenaciously survived. As I understand it, they have no argument with the idea that coca may provide pharmacological relief from polycythemia, but they do object to one line of evidence on which that idea was based: the correspondence of coca chewing with altitude stress. However, apart from their inosculation of historic and modern usage, there are two other differences between the argument I put forth in 1978 and Bray and Dollery's casual paraphrase of it. These are their confusions of (a) coca use with coca chewing and (b) altitude (a geographical phenomenon) with polycythemia (a physiological one). With regard to the first item, the authors stress the importance of Amazonian usage. They correctly emphasize that the method of coca preparation differs in the lowlands, as does the species of coca employed (Plowman 1981). For these reasons, together with the recognition that there are even some other cultural differences between Andean and Amazonian Indians, in 1978 I distinguished explicitly between Andean coca chewing and other contemporary forms of use. In contrast, Bray and Dollery insist that any explanation for Andean chewing needs to lump Amazonian and Andean usage. I think it is appropriate to question this novel conjunction, even at the risk of seeming undemocratic. As for the second, I argued that Andean coca chewing was not a function of altitude, but was instead related to ethnic, occupational, age, and sex criteria that also happened to identify those individuals most susceptible to polycythemia. For example, I noted that, at all but the highest altitudes, adult men chew where women and children do not. As a substitute, Bray and Dollery suggest that an "equally strong correlation emerges when the incidence of coca taking and the degree of 'Indianness' of the chewers" is considered. But since so many Andean Indian women and children don't chew, the authors' suggestion that coca chewing covaries only with ethnicity negates the cultural heritage of this part of the population. In short, the correspondence between modern coca chewing and polycythemic stress is neither spurious nor shaky, neither assumptive nor disproven. Of course coca has been used in a manner and place other than the high Andes, but that does not address the central issue of whether the Andean Indians who chew it derive pharmacological relief from it. That issue will only be resolved by the design and execution of the appropriate field research. by LINDA PATIA SPEAR Department of Psychology and Center for Neurobehavioral Sciences, State University of New York, Binghamton, N.Y. 13901, U.S.A. 22 xi 82 Two major conclusions reached by Bray and Dollery in their article are (a) that the use of coca in Peru and Bolivia is predominantly a function of cultural values and historical antecedents and (b) that coca acts as a general stimulant at all altitudes and does not have differential physiological effects on the noradrenergic system of particular benefit to individuals living at high altitudes. As a psychopharm,acologist, I wish to address my comments to this latter conclusion. As the authors point out, cocaine blocks noradrenergic reuptake into the nerve terminals from which it was released, with the effect that the amount of norepinephrine available at the site of action is increased. Bray and Dollery go on to state that "there is no reason to believe that this action would have any greater effect at the oxygen pressures prevailing at 3,000 m than at sea level." While I agree with this statement, it is important to consider that the effectiveness of cocaine on a particular individual's noradrenergic system may be influenced more broadly by the functional level of activity of the entire noradrenergic system. For example, if an individual's noradrenergic system is already working at peak levels of efficacy, further increases in noradrenergic activity induced by cocaine seemingly would have little beneficial effect; on the other hand, in an individual with a submaximally functional noradrenergic system, use of cocaine may well increase noradrenergic activity to peak levels of efficacy. Thus, when considering possible differential effects of cocaine at different altitudes, one must look at the effects of altitude on the entire noradrenergic system, not merely on the uptake system that is inhibited by cocaine. Indeed, it appears that the lowered oxygen availability characteristic of high altitudes may well influence functional activity of the noradrenergic system. Both the rate-limiting hydroxylating enzymes (tyrosine hydroxylase, tryptophan hydroxylase) in the synthesis of monoamines such as norepinephrine and one of the enzymes in imonoamine degradation (monoamine oxidase) require molecular oxygen for activity, and thus their activities are affected by oxygen availability. Moreover, the stresses presumably associated with adaptation to high altitudes may also influence central and peripheral noradrenergic activity. Thus, high altitude may alter noradrenergic activity through interactions among alterations in the activity of oxygen-dependent metabolic enzymes, stressinduced effects on noradrenergic activity, and possible compensatory modulations occurring within the nervous system in response to these disruptions in homeostasis. While the effects of high altitude on noradrenergic activity have not been carefully investigated in humans, experimentation in other animals suggests that chronic exposure to a hypoxic environment beginning early in life does produce alterations in the activity of oxygen-dependent metabolic enzyme systems controlling the synthesis and degradation of norepinephrine and other neurotransmitter systems (e.g., Vaccari et al. 1978a, b). 278 CURRENT ANTHROPOLOGY
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