Drugs' stories and itineraries. On the making of Asian industrial medicines

In the shadow of the healing rainbow: belonging and identity in the regulation of traditional medicine in Mauritius

This article explores how traditional healing is regulated in the island of Mauritius. Drawing on postcolonial Science and Technology Studies and their encounter with socio-legal studies, it maps the emergence of the Ayurveda and Other Traditional Medicines Act of 1990, pointing out the selectivity of the notion of 'tradition' and its entanglement to broader nation-making processes, born in the process of its independence from Britain. While the social and political histories embedded in the text of the law favour the authorisation of some healing traditions and not others, outside its scope, other practices persist, and triggering competing visions about the island's healing futures. By bringing into the frame the plurality of Mauritius's healing landscape, where different traditions coexist despite their ambiguous legal status, this article accounts for the tensions in the regulation of traditional medicine, where the law produces its own inclusions and exclusions, and mundane legalities of everyday healing become sites of broader political questioning about the relationship between law, science, and nation-making.

Plant-Based Sustainable Development—The Expansion and Anatomy of the Medicinal Plant Secondary Processing Sector in Nepal

There is an increasing global demand for medicinal plants. Nevertheless, the nature and scale of processing in national-level medicinal plant production networks, and how this can contribute to sustainable development, are poorly understood. This study (i) uncovers and explains the emergence of the Nepalese medicinal plant secondary processing sector, (ii) characterises the enterprises and identify the obstacles they face, (iii) quantifies the volumes and values of processed species and end markets, and (iv) discusses the potential to contribute to sustainable economic development. Empirical data were generated from key informant interviews and qualitative (n = 13) and quantitative (n = 79) semi-structured surveys of medicinal plant processing enterprises. In 2014–15, the sector purchased 3679 metric tonnes of air-dry raw materials (across 67 products) for USD 4.0 million, producing 494 tonnes of end-products valued at USD 11.2 million. The sector is characterised by small enterprises. Rising domestic demand drove the increase in the number of enterprises. Key business obstacles were export barriers, low access to technology, infrastructure and service barriers, labour challenges, socio-economic and political instability, and the inefficient bureaucracy. The actions required to change from being a supplier of raw materials and producer of lower-value domestic consumer products to integrating into the global economy as an exporter of higher-value products that are sustainably sourced are discussed.

Law and biomedicine and the making of 'genuine' traditional medicines in global health

This paper explores the joint roles of law and biomedicine in constituting the boundary between legitimate and illegitimate (and genuine and 'pseudo') traditional healing. It argues that, as law and biomedicine have grown to share common understandings of the nature of knowledge, they have come to act as converging colonizing forces that displace and alter 'other' forms of knowing and ordering. Even as regulatory systems set out to recognize some forms of traditional medicine, they continue to operate on assumptions that disqualify knowledge, products, and actors, that do not resemble their biomedical counterparts. This leaves traditional healing systems potentially having to either operate outside the law or adapt to it by transforming themselves, potentially beyond the point of recognition, to fit better into the systems provided by law and biomedicine. The paper explores the series of dilemma this creates for those seeking to 'regulate better' traditional medicine.

Fluid Drugs: Revisiting the Anthropology of Pharmaceuticals

This review discusses a growing body of scholarship at the intersection of anthropology and science and technology studies (STS) that examines how drugs are rendered efficacious in laboratories, therapeutic settings, and everyday lives. This literature foregrounds insights into how commercial interests and societal concerns shape the kinds of pharmaceutical effects that are actualized and how some efficacies are blocked in response to moral concerns. The work brought together here reveals how regulatory institutions and health policy makers seek to stabilize pharmaceutical actions while, on the front lines of care, pharmacists, health workers, and users tinker with dosages and indications to tailor pharmaceutical actions to specific circumstances. We show that there is no pure (pharmaceutical) object that precedes its socialization. Pharmaceuticals are not “discovered”; they are made and remade in relation to shifting contexts. This review outlines five key areas of ethnographic and STS research that examines such fluid drugs.

Keeping the doctor in the loop: Ayurvedic pharmaceuticals in Kerala

Ethnographic inquiry into Ayurvedic commodification in Kerala revealed the prevalence of a distinct regional pharmaceutical market dominated by physician-manufacturers, oriented towards supplying classical medicines to Ayurvedic doctors. This stands in sharp contrast to mainstream Ayurveda that is observed to have undergone biomedicalization and pharmaceuticalization. This paper argues that Kerala's classical-medicine-centric pharmaceutical market constitutes an alternative modernity because it provided Kerala Ayurveda with a different route to modernization impervious to the biomedical regime, as well as endowing it with the institutional power to safeguard its regional identity. Although physician-entrepreneurs are its key architects, it is sustained by value regimes shaped by a unique regional medico-cultural milieu. Even when industrially produced, classical medicines remain embedded within Ayurveda's socio-technical network; unlike proprietary drugs sold as individual product-identities through non-Ayurvedic channels, they travel together as a pharmacopeia, distributed through exclusive doctor-mediated agencies. This clinic-centric distribution format is best conceptualized as an open-source business model as it made low-margin generics viable by packaging them with therapies and services. Besides ensuring better access and affordability, it provided resistance to pharmaceuticalization and intellectual property concentration. By keeping the doctor in the loop, it prevented medicines from degenerating into de-contextualized commodities; the service component of Ayurveda therein preserved went on become the unique selling point in the health-tourism market. The tourism-inspired proliferation of Brand Kerala eventually triggered a paradigm shift in mainstream Ayurveda - shifting focus from 'pharmaceuticals' to 'services' and from 'illness' to 'wellness'. Furthermore, interacting with hybrid Ayurvedas in transnational markets, Kerala Ayurveda co-produces new alterities countervailing the structurally dominant biomedical paradigm.

Contested Issues of Efficacy and Safety between Transnational Formulation Regimes of Tibetan Medicines in China and Europe

Tibetan medicines are key material objects for medical treatment and have become part of a global trend of 'pharmaceuticalisation', playing increasingly important political and socio-economic roles in an 'alternative modernity'. As I argue in this paper, they also have become key 'sites of contestation' between different epistemic values and styles of practice related to efficacy and safety that are reproduced in and through specific formulation regimes. Based on my multisited ethnography of production, prescription, and use practices of Tibetan medicines in China and Europe, this paper conceptualises three distinct formulation regimes, offering a heuristic model for transnational comparison-a classical, an industrialised or reformulated, and a polyherbal regime. The first two are the major orientations while the polyherbal is a conjoint hybrid with either the classical or the industrialised formulation regime. Globalised national drug safety regulations legalise and confer legitimacy to industrialised Tibetan formulas that follow biomedically defined efficacy, safety, and disease categories, while classical formulas produced by private physicians or small-scale cottage pharmacies are increasingly marginalised as producing 'unsafe' and at times illegal medicines, and need to find new ways for adapting and circulating their formulas.