Local Knowledge for World Market: Globalising Ayurveda Author(s): Madhulika Banerjee Reviewed work(s): Source: Economic and

Political Weekly, Vol. 39, No. 1 (Jan. 3-9, 2004), pp. 89-93 Published by: Economic and Political Weekly Stable URL: http://www.jstor.org/stable/4414468 . Accessed: 24/12/2012 07:21
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Local

Knowledgefor
Globalising

World

Market

Ayurveda

Thisarticle looks at some of the sites of contestationthat mark the encounter of ayurveda with globalisation,making it a marginal player in the medical market. Withenormouspressures being exertedby the dominantestablishment alternativemedical includingthe pharmaceuticals industry, systemshave been confined to marketingalternativeproducts. The real challenge for ayurveda in the global economy lies in defining the parametersand terms of those parts of its knowledge system that are considered adaptable to the market.However, in the scramble to protect markets and knowledge regimes, it is not yet understoodthat there is a deeper colonisation being played
out in the edging out of alternative world-views inherent in these medical systems.
MADHIULIKA BANERJEE

significant new government policies and initiatives in the UK, US and EuropeanUnion in the past 20 years or so that have shaped he story of globalisation of ayurveda does not fit either the terms of export of ayurvedic products/medicines. Given the of the two standardnarrativesthat we have come to expect size and attraction of these markets, the policies of these govin debates concerning globalisation. On the one hand, it *ernmentshave the power to reshape the internal structureof the' is not a simple story of the shrinking of domestic industry in ayurvedic pharmaceutical industry in India. The conclusion the face of a flood of global goodies. In fact, it is a story of Indian attemptsto locate the role for agency in this seemingly irreversible products going abroad and posing a challenge in the global process of structuraltransformation by listing the responses of market. The terms of trade are certainly an issue here, but this civil society - practitioners,industryand grass roots organisations is not an obvious case of unfair terms of trade in products. The - and identifying what I believe can still be done now. 'rolling back of the state' and the withdrawal of state support to domestic industrythat one associates with globalisation is also Encounters at Home not present in this instance. The Indian state is more active and interventionistnow than ever before. On the other hand, the story Globalisation in contemporary times is not the first occasion of globalisation of ayurveda is also not the story of opening up when ayruveda is being forced to transform itself as a result of of a new world of unlimited opportunities as a result of the rise an external encounter. In many ways, the story of globalisation of the herbal products industry worldwide. A certain kind of is a repeat of the encounter with colonial modernity that transopportunitieshas certainly opened up, but by closing down some formed the ayurvedas of the pre-modern times into modern otherpossible openings and by changing the very natureof what ayurvedic medicine as we know it today. Ayurveda has undergone was and has come to be recognised as ayurvedic medicine. The a substantial change in the past 150 years or so in India, through change is certainly not for the better. Indeed, there is a case for the colonial and then the post-colonial period. Contraryto popular regardingthese changes as downgrading of ayurvedic medicine images, pre-modern ayurveda was marked by various levels of and reducing it to a more rudimentaryform of herbal medicine. multiplicity - multiplicity of texts, diversity of practice and social This article presents fragments of this rathercomplex story by differentiation, with continuous historical changes anchored in looking at two sites of the contestation that marks the encounter an open-ended epistemology. Thus in the early phases of encounof ayurveda with globalisation. The first section goes back to ters with systems of medicine like unani, it was possible to adapt the first external encounter that defined modern ayurvedic and assimilate new ideas into the old without the danger of erasure pharmaceuticalsin the twentieth century India. A quick historical or being cast to the margins. The encounter with biomedicine overview of the developments in ayurveda in India during the in colonial times was, however, qualitatively different. Ayurveda colonial and post-colonial periods allows us to identify the pro- was cast as biomedicine's 'other', as the epistemological power cesses thatayurvedaput in motion in orderto meet the challenges of biomedicine reinforced the power of the colonial state. There it faced in the market for medicines and the realm of medical wereno doubtmanynationalistcontestationsof the marginalisation knowledge. While ayurveda succeeded in retaining a presence of ayurvedafrom civil society. There were the traditionalistswho in the market,the terms of this presence were circumscribed by wanted the pristine purity of tradition to be maintained as it was the dominant discourses of the pharmaceutical industry and and the neo-traditionalists who believed that the only way to save modern medical science. Conformity to these terms made for a traditionwas to make it conform to specific modern requirements truncationof the knowledge base, ratherthan the expected flow- of legitimacy. And then there was Gandhi, who believed that ering or developing expected from processes of 'modernisation'. ayurveda needed to be reflexive while maintaining its distance A quick review of the developments in the past decade enables from biomedicine. Eventually the neo-traditionalists' view preus to recognise that the impact of the second external encounter vailed, wherebyayurvedaused the space of the marketto mechanise that we now call globalisation is not qualitatively different from mass production of its medicines, the knowledge base for which the first one. In the second section, we shift our gaze to the other was created by collapsing the multiple traditions of ayurvedas end of this encounter, namely, the global north. We discuss into the 'great tradition' of ayurveda. This is what resulted in

Introduction

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the birthof the ayurvedic pharmaceutical.However, in following the logic of capitalist production and the new health choices of the 'consumer', what ayurveda actually succeeded in doing was to cast itself in the mirrorimage of biomedicine. The 'other' thus became a 'double'. Thus there was significant loss of its distinctiveness at this stage, a marginalisation of the knowledge system despite its successes in the market and this moment was also thatof withdrawal.This was the first outcome of the encounter of ayurveda with external forces. The post-colonial state, committed to the dominant scientific world view, nevertheless set up ayurvedic education, practice and manufacture. Precisely because of its basic commitment, however, state policy could never provide a distinctive path of development of the Indian system of medicine. Thus it mostly fostered ayurveda's persona of the double. The principal changes in this period were led by the market driven pharmaceutical industry. Two of these structural changes, processes of commercialisation and standardisation,deserve to be mentioned. Processes of standardisationimplied standardisingevery stage - the raw materials (mainly medicinal plants), the process of manufactureand quality control of the products. One of the most difficult areasof standardisationwas thatof raw materials, mainly medicinal plants. Standardisation of the manufacturing process of ayurvedic medicines required choosing between kinds and levels of technology, negotiating between the provisions of the texts and the logic of returns to scale dominated this choice in this industry, as the history of most manufacturing concerns in India show [Banerjee 1995]. The third aspect of standardisation was quality control of the final product, where ayurvedic pharmaceuticals followed the practice of controlled and randomised clinical trials, the basic means of establishing medical conclusions for drugs in experimentation and the main legal requirement for biomedical products to be put on the market. It was assumed by the market and accepted by manufacturers that they would be the criteria for standardisation of ayurvedic preparations to be accepted and marketedas 'medicines', despite the dissimilarity in the knowledge base of the medical systems. The three dimensions of commercialisation were product profiling, positioning and packaging. Product profiling is signified by the different strategies adopted by ayurveda to juggle with the form, content and importance of its products in order to be a viable force in the market.Positioning involves identifying the targetconsumer group for which the new ayurvedic products are being made and creating the politics of images by which a 'traditional' product can be sold to a 'modern' consumer. The changing patterns of packaging demonstrate the shifting locus of the social character of any commodity, often involving vital shifts in the trajectories of production. The standardisation of various aspects of the manufactureof ayurvedic pharmaceuticals coupled with commercialisation led it to become like any other pharmaceutical,indistinguishable in any sense and devoid of its specific identity based on its origins in a very different medical system. Thus ayurvedic preparations moved from being drugs to concepts, where the conceptual essence was distilled to the active principle and delivered to the consumer without the burden of the rest of the medical system. The full potential of this encounter, during the colonial period and even after, whereby ayurveda could have posed a real challenge to biomedicine, was not realised and instead ayurveda settled for a marginal place in the medical market and imagination. The second encounter, under the conditions of what is described as 'globalisation', is heralded in the dominant media as marking a period when ayurveda overcame this structural

marginalisation and arrived on the global centre stage. On this reading, the effects of 'modernisation' and 'globalisation', the two external encounters have been opposed to each other. The first encounter was all about the domestic marketwhile the second concerns mainly external markets. The changes in the first were crudely imposed from outside by political power, while the changes this time are internally arrived at. The first encounter displaced ayruveda from its position as the reigning system of medical knowledge, while the second one promises to rescue it from its marginal status and restore something of its lost prestige. Yet a closer look reveals more continuities thanruptures between the experience of these two encounters. Both involved changes in the inernal structure of ayurvedic medicine to suit the requirements of the external maket and conform to the standardsof an alien medical system, largely due to assymmetry of political power. The most obvious and noticable development associated with the period of globalisation is a marked increase in the role of the state along with a rapid expansion in the market for the ayurvedic industry. This led to a series of policy initiatives in the 1990s culminating in the Indian Systems of Medicine (ISM) policy document. The amendment of the Drugs and Cosmetics Act (1940) leading to setting 'good' manufacturing practices (GMP) for manufacturers of ayurvedic medicines, was passed in late 2000. The returns to these developments were limited, however, the research not enabling Indian manufacturing to become competitive in overseas markets, and the GMP only slowly making a difference. The emphasis on competing in the world market foregrounded two issues common to both government and industrywith respect to the Indian system of medicines, medicinal plants and traditionalknowledge. Over-harvestingand regeneration of the former, in addition to prices and collection, have been problem areas. It was only with the twin pressures of rapidly growing international herbal medicine industry and the sustainable development lobby that it was identified as a cause for concern. An unprecedentedresponse followed: attempts were made to foster a new spirit of collaboration between government and industry on these issues, in evidence at conferences and forums organised between 2000 and 2003. The most tangible outcomes have been both initiatives of the government: the Central and State Medicinal Plants Board (September 2001), the Tiwari committee report on the state of medicinal plants and the computerisationof traditionalIndian medicinal knowledge in the form of the traditional knowledge digital library. Most significant however, was the first separate policy statement on the Indian systems of medicine in 2001. Hithertoa small paragraph at the end of the larger health policy document, it indicated recognition of the growing strength of this sector by thiestate. This document identified both civil society actors and the state as stakeholders in the interests of the ISM for the first time, no doubt in the spirit of the new parlance of 'governance'. In attempting to accommodate and reconcile all the conflicts of the last hundred years over ayurveda, however, it failed to consolidate all the gains that had been made during this time. For instance, there was recognition and provision for new areas of researchbutits linkage with productdevelopment, with attractive offers to industry that could have enticed them to investment, was not explored. Thus it missed the opportunity to posit the acceptable terms of globalisation for ayurveda, by strongly advocating the possibility that state and civil society actors can together be a formidable force in positing new terms of legitimation for traditional medicine (TM) at the international level. It allowed itself to be dictated by the overwhelmingly narrow

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perspectives on profits and profitability that Indian industry subscribes to in limiting its legislation. It did not persuade them to creative alternatives that could have long-term implications to protectand promote the Indian systems of medicine as a whole, ratherthanjust some of its products. The most damning evidence of this belittling was in the fact that in the first WHO policy documenton traditionalmedicine thatappearednearly a year after the Indian document, there was no mention of India's position or achievements in this sector Notwithstandingthis renewed attention to ISM, the basic blind spots in state policy since independence continued. The government was simply not ready to commit resources to the ISM in the public health sector, despite platitudes to the contrary. It also continued to neglect the condition of state pharmacies that were meantto manufacturemedicines to supply to the ISM state health services. In fact, a possibility inherent in the earlier system of state intervention, that of establishing parity with biomedicine, was reversed now. This possibility was represented by new research from a special working group in the Indian Council for Medical Research and from some university departments of pharmacology that demonstrated the real possibilities of alternativeperspectiveson validationandassessment of qualitycontrol. This researchhad not yet reached a stage of productdevelopment, which would have required a committed investment from industry. Yet it had the potential to challenge the terms of cognitive exchange between the two medical systems. Globalisation has meant turning one's back on such basic questions and on the challenge of using ISM as an effective means of accessible and affordable health service for ordinary citizens.

Encounters Outside India

Globalisation has opened another site of ayurveda's encounter with the world outside. This is reflected in recent developments in the global north - the European Union, the United Kingdom andthe US - and policy changes in the World Health Organisation. Consumer attitudes and demands have increased the significance of their own complementary and alternative medicine (CAM) and the presence of medicines/products from other medical systems like ayurveda and Chinese medicine. This fast growing marketof nearly US $ 7 billion is making a dent in the dominant biomedical pharmaceuticals market, which wields enormous power over these governments. No wonder the pharmaceutical giants have been able to get their governments to create new policies and initiatives with respect to the CAM sector, mainly in terms of the safety of products. The argument is that unlike modem pharmaceuticals the products of these systems cannot be called medicines because they have not passed the stringent tests for safety and efficacy. Yet it is precisely these criteria that we have demonstratedto be the axis of control over the character of ayurvedic medicines in India, leading to their being formatted afresh in the past 100 years. This axis acquired new power as a resultof the new initiatives being undertakenin the global north. The WHO, which has all along been dominatedin its perspective on health care by the models of industrialised countries, with grudgingexceptions in its policies, is now additionally influenced by the power of the Chinese presence in this sector. The Chinese state has resolved the questions of safety and efficacy in ways thatthe Indian state has never been allowed to do because of the continuing contestations it has been subject to. Their dominance in the WHO would naturally strengthen those trajectories within the Indianstate that visualise a 'scientised' trajectoryof developmentfor ayurvedathat has not been completely successful so far.

The combined power of this axis, then, could lead to two contradictory developments at the same time: it offers great opportunities to industryto supply 'herbs' and 'supplements' considered safe and desirable for consumers, on the one hand, and reduce ayurvedic medicines to a rudimentary form to meet standards of safety and efficacy imposed by an alien tradition,on the other. These terms are insidious, with the capacity to effectively marginalise ayurveda as a system of medicine in the long run. The WHO first recognised the significant role that traditional medicine can play in improving health care as partof the landmark Alma Ata ('Health for All by 2000') Declaration of 1978. Their low cost, accessibility, and people's faith in them made them an ideal panacea for the public health care delivery programmes of developing-country governments. It was assumed, however, that these systems would be 'integrated' into the system such thatthey followed the norms and structuresof the modernmedical system. WHO left the detailed institutionalisation of this idea to individual country governments, and kept its focus limited to guidelines for the manufacture, assessment, clinical evaluation, appropriateuse and quality control of herbal medicinal products and medicinal 'plant materials'. Thus even in 2000, a workshop in south-east Asia concluded with the recommendation that traditionalmedical knowledge on wellness and prevention should be distributedpurposefully to conventional medical practitioners and policy-makers [Bodeker et al 2000:3]. It was the radical changes in European and US markets and subsequent policy developments effected by the EU, UK and US governments referred to above, that transformed the status of traditional medicine systems worldwide. These governments set up task forces and advisory committees, instituted formal research laboratories, and recognised herbalists and their associations as important stakeholders in the policy process, thereby elevating these systems from the bottom rung policy option of developing countries to those with great credence in the developed world. It was only by 2002 that the WHO found it important to bring out a separate document on traditional medicine policy. The politics of this document merits a detailed critical analysis on each of the core aspects covered, i e, safety, efficacy and quality, access and rational use. Here we will concentrate on the ideas on efficacy and quality in the perspective of 'integration' of traditional medicine. "The 'integration' of TM/CAM with national health care systems, as appropriate, by developing and implementing national TM/CAM policies and programmes", is one of the stated objectives in the WHO document (2002:5). In a footnote, the term 'appropriate' is explained to "refer to TM/CAM health care that does not cost more and which is no less safe and efficacious than recommended allopathic care for the disease or health problem"(2002:43). There are two points here: that of cost and the other of safety and efficacy. In the political economy of developing countries on the whole, one would be hard put to find the allopathic system offering cheaper means of health care, except where the industryaroundTM/CAM has to compete openly in the marketwith it, as is the case in India. The WHO document, however, refers also to the large numbers of people in developing countries who have access to the practice of TM that is not dependent on the market at all, which would certainly be cheaper thanallopathic medicines. Tying in the safety and efficacy factor of the alternatives, however, targets those that have entered national and international markets for competition and would not be accepted until the standards set by biomedical and pharmaceutical research have been met. This is evident in the way some challenges in this aspect are outlined, namely, "lack of research methodology, inadequate research base and lack of

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internationaland national standards for TM/CAM products and lack of registration and regulation of practitioners" (2002:20). However, this is simply not true. The history of research and the contestations of the terms of research in both India and China, to take but two examples, is more than half a century old. In both countries, these contestations have been recognised, but different resolutions have been arrived at by both the scientific community and the TM practitioners and researchers. What is interesting is that the Chinese pattern is recognised by WHO to be a possible yardstick for its standards, along with the newly established research centres and programmes of the US and UK. This, we argue, is related to the larger point on integration. China's model of integration of its TM into the public health system reflects an acceptanceof the frameworkof researchand the world view of the treatment of biomedicine rather than battling the differences,thanhas been the case for instancein India.It makes a space for traditionalmedicine in practice, but on the terms set its by biomedicineand has surrendered perspective and philosophy of healing, while simply continuing the use of the remedies. This is most amenable to WHO's capacity for actively taking traditionalmedicineon board.Itallows for the hegemony of biomedicine to continue while making a respectable space for the traditional. Insisting that the latter should be evidence-based, must be accessible and be governed by principles of rational use makes the space for the dominant establishments of science, industry and regulators respectively, to continue to exercise their power. In addition to years of successful implementation of this model, China is the world's largest exporter of medicinal plant materials and products in the past 50 years. This demonstrated might in the international market sets up a trap: the more you adapt to the dictates of the dominant scientific and markettrends,the more you are likely to succeed. In the light of the enormous pressures from the dominant pharmaceuticals industry in Europe and the US, which would be willing to make hay as long as the sun shines on herbal medicines, this position would be crucial. Not only would it not affect their basic infrastructure of research and productdevelopment, they would be able to exploit it for profit very easily. This is substantiated by the policies and regulations being initiatedby the EU, US and UK, which we will discuss now. The most important point that needs to be made with respect to EU or the US/UK is that the issues their governments are grapplingwith are somewhat different from those of India. They aredealingwith a rangeof therapiesand therapeuticsystems, many of which are oral traditions and not bound by the codification in texts. This welcome space made for oral histories and traditions once again in Europe brings back the very first clash and process of marginalisation that the Enlightenment must have wrought in Europe - the canonisation and sanctification of knowledge that can be verified and validated by palpable criteria,and a denial of any other.This is in evidence in the urgency of the EuropeanUnion to pass strict norms of medical products and practice, causing great difficulty to the many CAM systems operating there. This of course includes the medical traditions indigenous to Europe. Europe has had a long herbal medical tradition, functioning mainly on Galenic principles. Many herbalists of these traditions practise to this day and are as much at a disadvantage as those from other cultures. Hence the response of appeal and defiance has come from both kinds of practitioners, in an organised and unorganised fashion. ESCOP (founded in June 1989) is an umbrella organisation representing national phytotherapy associations across Europe, especially in their discussions with Europeanmedicines regulators.Since 1996 it has been a company limited by guarantee in the United Kingdom, to advance the

scientific status of phytomedicines and to assist with the harmonisation ot their regulatory status at the European level. Since 2000 the EU has drafted a series of directives that seriously restrict the practice of herbal medicine, with the intent of a suitable balance on consumer choice and public safety. This would requirethe proving of efficacy and regulating and licensing practice. It is clear that state power views herbal traditions as too much outside the system and have therefore created alternative frames for describing medicines as 'well established medicines', which in principle gives greater flexibility in the use of bibliographic data for this category of medicines to meet the requirements to demonstrate safety and efficacy. Another category, 'traditionally used medicines', is under consideration. Together with the EU, the medicines control agency of the department of health of the British government is important in these interventions. Its work was supported by the setting up of the Lord Hunt commission on traditional medicines, which has set up dialogues with a great many members of the herbal sector, including that of ayurveda. There was public outcry over its infamous declaration in January 2001, when it listed ayurveda among those traditionalmedicines as 'unscientific'. In response, many groups of both scientists and industry have made representations to the committee, revealing the deep differences and fissures within them as well; but for the first time, this issue is openly in the realm of international politics as it never has been before. Another UK government agency that is associated with the work is the herbal medicine regulatory working group, set up to report the form that herbal medicines regulation should take for the statutory profession and negotiate with all the different stakeholders identified by the UK government. These recommendations would hold for imported herbal medicines as well, beginning with the very definition of 'herbal'. This would not be technically an inaccurate description for the entire range of ayurvedic medicines, and would severely restrict the market in Britain for Indian manufacturers. This is being fought hard by some groups of ayurvedic practitioners and lobbyists, but not with a great deal of success. What is significant is that the lack of success is because of the perception within the ayurveda industry that fighting the terms at this stage might mean a loss of even a corner of the market that may be possible yet. This is complemented by the development of what authority in Europe wishes to define as 'borderline products', those that the industry worldwide is happy to position as neutraceuticals and cosmeceuticals, simply names for dietary supplements and cosmetics. For some time now, herbal products, even medicines, have been marketedin this category, because the legal structures of their definition allowed benefit to the ayurveda companies. But this going to have a serious impact on the export orientation of ayurvedic companies, inasmuch they would not be exporting 'medicines' at all. For reasons different from the national level therefore, ayurveda will be losing credibility in the international market as a medical system and will have to become a supplier of neutraceuticalsand cosmetics simply in orderto remain viable. Both political lobbying and legislation progresses in this sector will thus outline the character of development of these systems as a whole for a long time to come. In the US, there are two broad institutions of government responsible for fresh research and regulation for herbal medicines. They are the Agency for Health Research Quality (AHRQ) and the National Centre for Complementary and Alternative Medicine (NCCAM), both under the department of health and human services (HHS). The AHRQ essentially works with the public and private sectors to "build the knowledge base for what

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works - and does not work". NCCAM, one of the seven national institutes of health established and funded by Congress in 1998, supports rigorous research on complementary and alternative medicine, to train researchers in CAM, and to disseminate information to the public and to professionals on which CAM modalities work, which do not, and why. Their four primaryareas of focus are research, research training and career development, outreachandintegration.To integrate scientifically-proven CAM practices into conventional medicine, they announce published research results, study ways to integrate evidence-based CAM practices into conventional medical practice and support programmesto develop models for incorporating CAM into the curriculumof medical, dental, and nursing schools. The pattern of researchin these organisations will profoundly affect perspectives on standardisation of herbal medicines everywhere in the world. While these are different from earlier studies, inasmuch as they attempt to be sensitive to the worldview of the systems they analyse, some basic shortcomings remain. Interestingly, the most importantof these - that the medicine or supplement should be studied in the form and context in which recommended in the traditional practice system - is what has been overcome in new protocols fashioned by the ICMR research group on traditional medicine in Indiareferredto above. What it demonstrates definitively is that while costs of research are much higher, scientificallyspeaking,such protocols areeminently viable. Where does this revelation leave us? That doing a limited trial is better thannot at all, since that way we can at least sell garlic in the form of a dietary supplement. But for that conclusion to be acceptable, we have to agree that being able to sell is more important than being able to treat in accordance with a particular system. There are of course counter-currents. In the same world that hosts the globalising forces there are scientists (from the National Instituteof Medical Herbalists in the UK) who are trying to argue for using a Goethean perspective to offer a clear alternative perspective on the terms of evaluation of herbal medicines, in orderto respect their healing perspectives. Whitelegg argues that "even if hundreds more trials were performed along orthodox lines we would not necessarily be substantially nearerto defining non-conventional medicine adequately" (1997:1). However, in thematrixof power, with respectto the decision-makingon agendas for researchthat will influence policy, it is the various bodies in the governmentsof the US, UK and EU that continue to play the most importantrole. The voice of the NIMH scientists is in a sense as lost in this political wilderness as that of the scientists in India. These governments also control internationaltrade regimes, the legitimising trends of consumer products, as also the markets forherbalmedicinalproducts.Thereforeit means thatthe scientific and commercial parameters for the participation of the Indian herbal medicine industry, or indeed that of other parts of the developing world will be firmly set by them. So the government, academia and industry in India, as indeed in parts of the world where traditional medical systems still have strong roots, must garnerevery single resource they have to influence the structures of power, if they are to survive as independent entities at all.

instances. This is related to the idea of the herbal or the natural, as it has evolved in the west in the past 20 years or so, which is more than the label for a certain variety of products. There, it had stemmed from the dissatisfaction with modern biochemical products, both medicinal and cosmetic. Recognition, however, that this was not simply because the products were limited, but that an alternativeworld view, a systemic overhaul was required, had very limited currency. Over time, alternative products have come to occupy the entire space for alternative medical perspectives. This way, the existing structureof science is not disturbed, yet people can feel thatthey are accessing the goodness of ancient medical systems. So while it seems that the presence of these systems has increased in contemporary society, in real terms it has not, the productscannot be confused for the systems. So what ayurveda needs to worry about (together with all other betterknown concerns, with respect to natural resource use by new trading regimes and knowledge of their process by new patent regimes) is in fact a more deeply political takeover, not yet being fully appreciated. In the scramble for protecting markets and knowledge regimes, each a very laudable and necessary political agenda, it is not yet understood that there is a deeper colonisation being played out in the edging out of alternative world views inherentin these medical systems. And the reason for this lies not only in the overwhelming hegemonic forces of dominant science, technology and trade at the global level, but the very policies of 'standardisationand scientisation' undertakenby post-colonial states. This is the process whereby the real process of exploring multiple/alternative/diverse modernities has been quelled. Yet, there is hope because this political project has been kept alive by some political movements on the fringe. Viewing the poor as the intellectual carriersof knowledge of medicinal plants, for instance, would transform the perception and the reality of intellectual property rights. That corporations, both global and local, use them is now exposed, but it is important to proffer a concrete challenge to this system. Groups that are documenting and helping people to enter the market in an organised fashion serve as the base for this. The more successful have been the viable production of medicines at smaller scales for health needs ratherthanjust markets. The most ambitious of these is a project that awaits articulation - to bring poor persons' perception of illness and wellness together with new efficacy studies referred to above - and newly designed laboratory studies of treatment entities and not just drugs, and locate this at the centre of the discussion of standardisation.It is only when anthropologists and scientists working together within the largerframework of public health in development deploy this can it be successful. No doubt this will entail vigorous politics from the fringe that believes that another world is possible!!S3 Addressfor correspondence: madhulikab@vsnl.net

References
Banerjee (1995): 'Power, Culture, Medicine: A Study of Ayurvedic Pharmaceuticalsin India', PhD thesis awarded by the Departmentof Political Science, University of Delhi. Bodeker, G, R Jenkins and G Burford (2000): Proceedings of a Parallel Conferenceon Symposiumon TraditionalMedicine at the International HealthResearchfor Development (Cohred)held at Bangkok,Thailand, October 9-13. Whitelegg (1997): 'An AlternativeScience for HerbalMedicine', European Journal for Herbal Medicin, Vol 2:1-7. WHO (2002): Traditional Medicine Strategy 2002-2003, World Health Organisation,Geneva.

Bringing People/Politics

Back In

The real challenge for ayurveda in the global economy lies in defining the parametersand terms of those parts of its knowledge system that are considered adaptable to the market. Even if its products do well in the market, it needs to be recognised that the knowledge system is being viewed simply as a source of

a bag pharmaceuticals, of recipesto be takenout andin isolated Economicand PoliticalWeekly January 2004 3,

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