Power, Knowledge, Medicine (Ayurvedic Pharmaceuticals at Home and in The World)

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About the Book

If the presence of Ayurveda in modern times invites surprise, its renewed vigour in the age of globalisation gives rise both to romantic celebration and incredulous hostility. This kind of response suggests that our understanding of modern Ayurveda has not kept pace with the growth of the phenomenon itself It is not that Ayurveda has not been studied, but that much of the wealth of scholarship lies in highly specialised disciplines like Indology, Medical Research, History and Medical Anthropology. The big picture of contemporary Ayurveda eludes this scholarship.

The present book seeks to fills this gap by drawing insights from all the various disciplines that have analysed different aspects of Ayurveda, yet keeping its principal focus on making sense of some of the big changes that have marked the transformation of Ayurveda in the twentieth century. The author suggests that this transformation cannot be seen as purely cognitive, technological or economic change, for it involves an irreducible political play between regimes of knowledge and exercise of state power.

Tracing the birth of Ayurvedic pharmaceutical in colonial times, this book analyses how the working of post-colonial state, civil society and industry has shaped contemporary Ayurveda. It argues that processes of commercialisation and standardisation have resulted in pharmaceuticalisation of this ancient medical system accounting for both the resilience and shrinkage of Ayurveda as a medical system. The book would engage not just those interested in the phenomenon of Ayurveda or those involved in health policy but any social scientist interested in technological choice, knowledge and power or alternative modernity.

About the Author

Madhuuka Banerjee teaches at the Department of Political Science at the University of Delhi. Her work in the politics of alternative medical knowledge has been a result of her independent research interest. Parts of this work were published in journals before, but this is her first book. She is currently interested in community health groups using traditional medical knowledge in their work with disadvantaged communities towards greater health security.

Preface

The roots of this book go back to the debates on the politics of development in the late 1980s. The debates on the politics of technology, specifically around ‘appropriate technology’, seemed to have reached a point of stagnation by the early 1980s. Some of the literature was turning to ‘non-modern’ forms of knowledge for a breakthrough. The development debates also began to take alternatives paradigms seriously, thus forcing a rethink on the hitherto dismissed ‘pre-modern’ systems of survival and well- being in agriculture, medicine and irrigation. Equally importantly, many new social movements and non-party political processes had already started deploying these ideas in their political mobilisation. Yet there was a deep suspicion, intellectual as well as political, of the emancipatory potential of anything ‘traditional’. Those were heady days, full of excitement as well as confusion. As I look back at it after two decades, this book was born in that sense of political churning and theoretical uncertainty. It draws upon and seeks to contribute to the debates about politics of alternative development.

I was one among those fortunate to have an exposure to these political and intellectual debates at the Department of Political Science, University of Delhi where I studied for my Masters at the time. When it came to choosing my research field, it seemed natural to stay with this debate but approach it by studying one concrete instance. For my doctoral dissertation, therefore, I turned to one traditional knowledge system, Ayurveda, to understand the extent to which it could be the basis for an alternative health care - system. My inclination to studying the specifics, while addressing the larger debates mentioned above encouraged me to focus on the phenomenon of Ayurvedic pharmaceuticals, a subject so located in both the categories of ‘traditional’ and ‘modern’, that it urged unpacking of such abstract categories. At that time, as indeed largely still, there was no space in my discipline for the study of science and technology in general. A political scientist did not have the confidence then, as indeed now, that anyone other than an economist could explore alternatives to dominant development choices. This diffidence coupled with the tag of obscurantism attached to anything ‘traditional’ ensured that my study was received with; distinct lack of enthusiasm by my colleagues in the discipline of Political Science. This was mirrored in the barely disguised surprise and impatience from most doctors, scientists and Ayurvedic company executives-notwithstanding some wonderful exceptions-who I interviewed in the course of the research. It was hard to overlook that both sets of responses were saying to me that a political scientist could do better than study Ayurveda.

It is not just the book and its author that changed in the last twenty years. As I completed my doctoral dissertation and set about rethinking my own formulations and reassessing the rapidly changing scenario, it became clear to me that the real challenge was to analyse the historical specificities of the transformation and the future potential of Ayurveda in terms of its political, economic and epistemic implications. As I set out to construct an empirically grounded, critical and comprehensive account of Ayurveda in the twentieth century, linking it to the basic questions of political economy, I realised that this could take the rather abstract debate between science and anti-science, modernity and traditionalism and between development and anti-development ahead and away, on a somewhat more productive track. It became clear that binaries like modernity and tradition were not very helpful in studying the historical specificity of Ayurveda in the twentieth century. I was convinced that the debates that helped kick-start my intellectual journey needed to move on. The present book is a product of this conviction.

The phenomenon that I set out to study itself changed in rather dramatic ways during this period of twenty years. While I had a strong intuition when I began, that non-modern knowledge systems would sooner rather than later gain in significance, I was not prepared for the unprecedented transformation in the trajectory of Ayurveda in the twenty years that followed. During this time, it exploded into the international market, assuming new forms and raising new issues. In this respect, it has proved to be very exciting and challenging. At the same time, the issue of alternatives being sought in ‘traditional’ knowledge-across the spectrum of development sectors in general-has come to acquire great significance. These changes in the subject as well as in my perspective required not just a revision but a recasting of the present study.

This book would never have been written, were it not for the initial, unequivocal support provided by Professor Charles Leslie. At a time when I was but a doctoral student with unformed ideas, unbearably discouraged by a prestigious academic institution where I first presented them, his enthusiastic response encouraged me to go on. Back home, I knew I could rely on the support of Professor Manoranjan Mohanty, my teacher and mentor at the Department of Political Science, University of Delhi, to supervise this somewhat uncharted course in Political Science. He bequeathed to me a reference point for all things academic and political, continuously posing challenges and providing great encouragement. He also persuaded Professor T. N. Madan that he would be ideal for sharing the supervision of this work. Professor Madan gave generously of his time and knowledge, guiding me through unfamiliar material in medical anthropology and sociology. From them both, I also learnt the ways of dignified, meaningful, inter-disciplinary exchange and sharing.

Two people were crucial in its publication. Had it not been for Harsh Sethi, I would have continued to take refuge in quotidian concerns and never have plucked up the courage to prepare the book for publication. Harsh kept up a gentle inquiry about its progress, until I made sure I had something to report next time we met at the car park, which was almost everyday! Ashis Nandy gave me the most generous and extensive comments, providing the much- needed catalyst and confidence to begin the revision and rewriting. My heart-felt thanks to them and a hope that they feel it was worth the effort of pushing me. I would like to acknowledge that Michael Dwyer initially gave me the incentive to actually complete a draft, though it needed Sanjoy Bhattacharya’s energy to finally take the manuscript to the publisher. His characteristic verve and enthusiasm made it fun to be a part of, despite the very hard work. Veenu Luthria, at Orient Blackswan, gave to this book support, advice, encouragement and solid inputs with the most consistent and amazing amount of warmth. I am deeply grateful to both for their inputs, as also the comments of an anonymous reviewer.

A great many people I met in the course of this complicated journey were warm and helpful. All the vaidyas I interviewed, gave generously of their time and energy-Or P. N. V. Kurup, Dr V. N. Pandey, Dr C. K. Katiyar, Dr Bhagwan Dass, Dr Ashok Vaidya, Dr Vilas Nanal, Dr Narendra Bhatt, to name but a few. Mrs Shailaja Chandra, Professsor Roy Chaudhury, Professor Mashelkar, Dr Ranjit Puranik, Shri Darshan Shankar, Mr G. Harirammurthi, Sheyphali Saran, all patiently made a great deal of time for my queries when they were most committed themselves. I was also privileged for the many that were supportive in their unique ways-J. P. S. Uberoi, Dhirubhai Sheth, Roger Jeffery, Padma Prakash, Aditya Nigam, Ligia Noronha, Peter d’ Souza, Ravi Rajan, and Apurba Baruah. Fellow academics who also became friends and interlocutors, or indeed the other way round-Minoti Chakravarty-Kaul, a real inspiration; Rama Baru, Roma Chatterjee, Daniel Miller, Harish Naraindas, Laurent Pordie, Shambhu Prasad, Ritu Priya, P. Rammanohar, Mahesh Rangarajan, Savyasaachi, Satyajit Singh, V. Sujatha, Asmita Wele, Dominik Wujastyk, were all important for the development and sharpening of my ideas. Praful Patel proved to be a wonderfully generous source for the fresh legislative and political sea-changes in Europe after 2000, as also a self-appointed publicity agent for all that I published! My warmest thanks to all, while none of them are implicated in any of the errors of this work.

Over the years, parts of this work were presented at numerous conferences and seminars-at the Developing Countries Research Centre, and the Friday Colloquium at the Department of Sociology, both at the University of Delhi, the Department of Sociology, Edinburgh University, the BASAS conference and the Divinity School, both at Cambridge, at the School of Oriental and African Studies, the Department of Anthropology, University College London, the Queen Elizabeth House and the Wellcome Institute, both at Oxford, the IASTAM conference in Halle, the Update Ayurveda meet organised by Nair Hospital, Mumbai, the International Association for the Study of Common Property Resources Conference, Vancouver, the Indian Institute of Advanced Study, Shimla, and the Department of Political Science, Panjab University, Chandigarh. I received invaluable feedback from many at these places and to them all, my warmest thanks.

I would like to thank the Seminar, Economic and Political Weekly, Contributions to Indian Sociology, for carrying parts of this work in earlier versions. I acknowledge gratefully that the companies I studied-Dabur, Zandu and Arya Vaidya Sala Kottakal-agreed readily to have me use their logos as part of the design element for the cover. But the design itself could orily have been designed by my favourite, Oroon Das-thanks to him from the bottom of my heart!

I was fortunate at both places where I taught as this book was done. A leave of absence from teaching enabled me to begin the first drafts of the book. I am very grateful to the Principal of my college then, Or Hema V Raghavan and the Teacher-in-charge of my department at the time, Dr Minoti Chatterjee, for support for this leave. Ujjwal Singh and Nivedita Menon at the Department of Political Science, University of Delhi, were the best comrades-in- arms that one could have wished for.

A Travel Grant from the Wellcome Trust Centre for the History of Medicine at UCL in the summer of 2002 helped with forging a comparative perspective with respect to Britain and China. The libraries I was privileged to work at: those of the Delhi University Library System, the Indian Institute of Public Administration Library, Jawaharlal Nehru University Library, Teen Murti Library, the National Archives, the Central Council for Research in Ayurveda and Siddha Library, the National Medical Library, that of the Centre for the Study of Developing Societies; of the Wellcome Trust Centre for the History of Medicine, London, the libraries of the University College and of the School of Oriental And African Studies London, of the International Development Centre (Queen Elizabeth House), University of Oxford and those of the Institute of Development Studies, at the University of Sussex. In every one of these places, the involved efforts of librarians and their warm support of those who took their work seriously was always a source of comfort when in doubt. Chandni Khanduja and Wasudha Bhatt - provided crucial research support at a critical time. Sujit Deb, ex-Librarian of the CSDS, Delhi, was the best one-person book acquisition system one could possibly ask for! A special word of thanks to Himanshu Bhattacharya-easily the most knowledgeable and ever ready troubleshooter for computing problems that there ever can be! This book has been an emotional endeavour, as much as an intellectual one, a learning process from the heart, as well as from the head. For that, there is one acknowledgement that is to be made which I believe is very necessary. It is to a whole generation of feminism in practice-in all the interstices of quotidian life-that has inspired and supported me on through all the phases of self- doubt and struggle that is the lot of anyone that wishes to write, particularly a woman. Many years ago I was deeply touched by the lives and writings of the women covered in the two collections edited by Susie Tharu and K. Lalitha. I want to thank them as the editors who brought to the contemporary reader, the struggles of so many women with the most terrible of hardships, simply to be able to learn to read or write or to practice their craft of writing. And from my own experience, I have come to believe that a new adage for our times is in order. Behind every success of a woman, there is invariably a phalanx of women that have egged her on! I was fortunate to have a virtual battalion-and I want to thank them all from the bottom of my heart: Nivi, for her warm friendship, ever-supportive shoulder, her unequivocal advice, the wonderful chats and her unique, enveloping love and generosity; Rachna, for the comfort of her concern; Apurva, for the many years of caring friendship and the wonderful support for writing in cool Bangalore; Vatsala, for just always being there; Farida for her unwavering appreciation and love; Manisha Priyam for her unfailing belief in me through thick and thin; Winnie and Pushpadi for their faith and support, specially with the children; my friends in Gargi College-Minotidi, Ira Bhaskar, Vidya Das, Radha Chakrabarty, Anjana Srivastava, Anjana Dev, Joya Bhattacharya Sinha, Radhika Kumar,V Sriranjani, Shilpi Banerjee, to name a few; my long-time friends: Aseema Sinha, Manisha Mishra; the many women, mere acquaintances included, who assured me that I was not being unfair to my children by my absences when I did my writing; and Minoti and Jamuna, for not only running our home so efficiently, but taking care of the children with great affection.

My family I will thank the last, because their contribution has been most special. My parents, continuously my source of inspiration and my source of strength at every possible stage of this work, could only be acknowledged by the dedication of this book. My sister Mukulika was with me continuously through every stage of the writing, with emails, with prompt phone calls at the slightest hint of anxiety at this end, ever ready to read a draft, to provide a home in London and the great support of numerous references and books over the years; and Julian proved her able partner as ever, specially with the books. My ‘baby sister’ Krittika became friend, counsellor and confidante over the years of struggle with this work, commenting on my drafts, commending new ideas and revelling in my academic work despite having to give up hers and chart fresh courses of her own; and Elliot, her partner, brought new levels of laughter and an alternate workstation at the most crucial junctures. Mummy, Poonamdidi and Neelamdidi, grew to understand and provided great emotional support for this work. My husband Yogendra, despite enormous pressures of his own work, made this book his own. He not only read, commented upon and tirelessly edited every single draft I wrote, but also proved to be the most unlikely, yet crucial interlocutor I could have hoped for. To them all, my deepest thanks.

My daughter Gungun is the only person who ever asked me why I have to write this book, and I do hope that when she is old enough to read it, will feel it was worth all the fuss! And my son Pele, who came just before the final stage of finishing the book and learnt to firmly believe that the real ogres in the fairy tales were actually publisher’s editors that rang up and scolded Ma if she didn’t finish, was the best reason to finish it at last!

Introduction

In the last few years there has been a noticeable upsurge in the use, manufacture and presence of Ayurvedic products in the Indian and international markets. What it essentially means is that a venerated three-thousand-year-old medical system and culture is accessible and available now in a large range of products like cosmetics, tonics, tablets, syrups and creams-’modernised’ and user-friendly Ayurveda. Viewed as part of a ‘new’ trend of herbal products round the world, it can be celebrated as a natural extension of the contribution of ancient Indian knowledge to the world or as a part of the recent ‘ethnic’ market trends and thus escape analytical attention. Yet on reflection, there is something paradoxical about the idea of a ‘modern’ Ayurveda which invites us to raise questions. What accounts for this sudden revival? In which parts of the national and international markets is it being revived? Is it uniform or selective? Even more so, is it a revival of the ‘old’ Ayurveda, or is it something new altogether?

The answers to these questions are not far to seek for any systematic observer of this phenomenon. Clearly, the new herbal industry has rediscovered an old resource, easily available, adaptable and applicable to the needs of the modern consumer. This revival is selective and partial, inasmuch that, it is less of a phenomenon in India, where it has its origins, than in the global market. In India too, it is a niche market of the urban upper-class consumer. It wouldn’t be difficult to see that Ayurveda is becoming increasingly accessible to those who never had it before and, at the same time, it is moving away from or indeed being taken away from those who lived by it so far. It is quite plain that the Ayurveda of today is not in the least the same as that of pre-modern times, that is before the British came to India. It has experienced a dramatic transformation in the last hundred years or so.

This book is about describing and explaining the transformation of Ayurveda-what it was and what brought about this sea change. Some aspects of this transformation have been noticed and widely commented upon-from medicines being dispensed to individual patients to becoming available off the shelf; from being made by a vaidya (practitioner of Ayurveda) in a small rasashala (pharmacy), to being mass produced by manufacturing companies; from being identified with a region or a school to becoming ‘positioned’ as brands; from being a knowledge system accessible to the elite to one available to many; and, above all, from being a medical epistemology to, simply, a collection of pharmaceutical recipes. This transformation involved the processes of standardisation of production and commercialisation of distribution and legal regulations to circumscribe its applicability. These three processes have created three discursive communities that dominate discussions on modern Ayurveda-scientific researchers, market professionals and public policy makers and analysts. These communities operate in virtual isolation from one another and thus there is little by way of an understanding of the intersection of these three realms that constitutes the real life world of modern Ayurveda. Further, there are community health groups and movements that have developed some understanding of the knowledge and use of Ayurveda and similar medical knowledge systems that poor and marginalised communities have. They have increasingly focused on enabling communities to effectively mobilise, conserve and use this knowledge to build structures of healthcare that make them self-reliant, rather than depend on the state or the market that do not seem to care for them.

For all of these discursive communities, the common frame of reference for Ayurveda is that it is a ‘traditional medicine’-a category which foregrounds the importance of Ayurveda belonging not so much to the past but to ‘us’. Born of a nationalist self-consciousness, it is very important for each of these communities to claim that unlike so much of our present and possibly our future which comes from outside of our history and society, Ayurveda is something that belongs to ‘our collective’ past, while clearly, it has a significance for our present and future. Thus ‘traditional’ is not an adjective, in the sense of ‘traditional’ as opposed to being ‘modern’, an unchanging, solid category that is rooted in the past. It is almost used as a proper noun-and that is the sense in which we use the phrase ‘traditional medicine’ when we refer to Ayurveda and other like systems of medical knowledge throughout this book. Yet, it is not possible to ignore the complexity that this terminology carries with it. This is explained in later parts of this chapter and self-consciously carried through this book.

Though there is a small but significant academic literature in the field of medical anthropology, history of medicine and sociology of health that throw light on some aspects of these three fields, what is not available is an analysis that attempts to understand the interaction of all these with each other and with the knowledge system of Ayurveda. This book aims to do precisely this. It will thereby respond to significant new trends, both global as well as those confined to India. The familiar interaction between the three discursive communities in India is now gaining momentum and intensity at the global level. Governmental and intergovernmental organisations like those in the United States and in the United Kingdom, as also the European Union and the World Health Organization are hard put to make policies, laws and regulations for this burgeoning market. This market is under great pressure from entrenched interests of multinational pharmaceutical giants producing biomedical products and competing with this new industry. This urgently calls for an informed intervention on these issues but it is not possible simply because the literature for this is unavailable. In India, there seems to be a rediscovery of Ayurveda by policy makers, exemplified by the first government policy that focuses on the Indian Systems of Medicine. Similarly, existing community health groups that have had an ambivalent relationship with Ayurveda-indeed all traditional/indigenous or non-modern medical knowledge systems-have begun to discover their potential and many new groups and movements have increasingly taken them up in earnest. The starting point of this book is a realisation that the transformation of Ayurveda is not simply the creation of a new, efficient and efficacious set of drugs. It is not a result of a triumph of scientific rationality, nor was this transformation guided solely by economic logic of efficiency and profit. The birth of modern Ayurveda was also not scripted by the fiat of a nationalist state. This realisation leads us in this book to placing this technological transformation in a historical perspective of twentieth-century modern India and to an examination of the terms that constitute it in academia. The main body of the book looks at the technological decisions that shape it in industry and the market; and the larger political processes that are negotiating tradition and modernity in this field. This attempt to map the power geometries of modern Ayurveda deploys three sets of conceptual frames: those of Capital and Technology, Knowledge and Culture, and Power and Politics. A short explication of each of these is in order before proceeding further.

Capital and Technology-Capital, the prime mover of mass production in the modern period, that enabled the reaping of returns to scale, was first used to manufacture Ayurvedic medicines in the late nineteenth century in India. The logic of the entrepreneurs planning to make Ayurvedic medicines was that if Ayurvedic medicines were cheaper than their biomedical counterparts, a larger number of people could afford them and the new competition offered by the European medicines market could be effectively countered. Given that the raw materials were cheap at the time, as also local labour available to work with locally made tools, overall production costs were expected to remain low. Progressively, however, Ayurvedic medicines became much more expensive than before, prompted by several developments- the raw materials became increasingly expensive, increasing mechanisation of production that required expensive imports of latest technologies from Europe and the competition with allopathic medicines which increased the pressures on entrepreneurship to continuously innovate on the form of the medicines. Simply put in these terms, however, it seems like the story of a nascent industry struggling and unable to cope with the keen competition offered by a sophisticated and superior product of modern science and technology, that of the modern pharmaceuticals.

This is not true simply because neither capital nor technology deployed for the Ayurvedic medicine industry had the free play of the market and they were continuously restricted on a number of fronts, both external and internal. This happened, first, by the power of the colonial state that provided protective discrimination to both the finished pharmaceutical products of Britain and Europeas also the processed raw drugs, ostensibly, because they were better standardised by sophisticated chemical processes. Second, the volume of capital available for investment in heavy technological choices, that too in an industry like that of Ayurveda, was limited because a bulk of the capital generated in the colonial economy was moved to Britain. Third, perhaps the most important, even when it was possible to conceive of a radical move like the industrialisation of production of Ayurveda, it seemed normal to opt for the model of a centralised, mass production of homogenous and standardised commodities. It was not possible to envisage an alternative route to mass production or mass availability without the in-built handicaps of such an enterprise. The purpose of ensuring that a large number of people have regular and easy access to medicines (or any other product for that matter) by a means of production that was decentralised and numerous, was not conceivable at that time.

Thus the particular logic of capital deployment and expansion, evident in the technological choices made by entrepreneurs was accepted by them as a given and this proved to be the means by which Ayurveda was put on the fast track, the direction of which was not carefully worked out. This trajectory of industrialisation ignored cognitive realms of Ayurveda that did not fit into this particular template of progress, but overtook them by its power. This had implications on the quality of the medicines which were homogenised, with limitations in the forms in which they could be produced. This was in sharp contrast to the diversity available before and the most important implication was on the prices of these medicines-they became more expensive than their rivals and their own predecessors. Thus the transformation of Ayurveda through capital investment required capital’s mediation with the developments within the knowledge structure of Ayurveda, those in positions of power in both colonial and post-colonial states and the legal regulations that circumscribed Ayurvedic pharmaceuticals, as and when they were allowed to exist.

What is even more significant is that this trajectory of industrialisation and capital investment did not alter even in the post-colonial context, as the post-colonial elite was content to follow trajectories set in the colonial period. This lack of autonomy of capital then, made for an even more uneasy incorporation of Ayurveda into global capital. What we have referred to above as the incompatibility of Ayurveda with the template of a certain trajectory of industrialisation leads to a selective appropriation of those aspects that allow such incorporation. Once that happens, then the logic of product markets and legal requirements in different parts of the international market dictate which parts of Ayurveda could be selected and transformed into select kinds of products apt for the global market.

A case in point is the new category called ‘nutraceuticals’-recognised food supplements for particular health and illness conditions. Many preparations of Ayurveda could very easily be marketed under this label instead of as ‘medicines’, since the legal requirements of proving efficacy of these preparations as medicines are very difficult to meet. Thus, many Indian manufacturers have taken to this ploy, because of which it gets easier to sell Ayurvedic products, bringing both export earnings as well as recognition to it. But a far deeper paradox is being simultaneously created. Ayurveda, as a supplier of nutraceuticals, detaches itself from the intrinsic medical aspects of its knowledge system and loses its legitimacy on this count. And once lost, it would be hard to reinstate. For manufacturers, it would be a matter of continuing to reap the benefits for as long as they are available, and then move on to something else. But this power of capital erases the power of those who could claim it as an accessible medical system they identify with, culturally, without providing a viable substitute. This is the geometry of power then, with respect to capital and technology. We examine next the conceptual frame of Knowledge and Culture.

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