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Public Policy and Ayurveda: Modernising a Great Tradition Author(s): Madhulika Banerjee Reviewed work(s): Source: Economic and

Political Weekly, Vol. 37, No. 12 (Mar. 23-29, 2002), pp. 1136-1146 Published by: Economic and Political Weekly Stable URL: http://www.jstor.org/stable/4411901 . Accessed: 24/12/2012 07:20
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Public

Policy

and

Ayurveda
Tradition

Modernisinga Great

The modernisationof Ayurveda has been the focus of both state and civil society organisations since colonial times. This paper argues that modernisationof Ayurvedaundertakenby both the state and civil society has been governed by a 'pharmaceuticepisteme' whichfocuses on retaining the usefulness of Ayurveda as a mere supplier of new medicines while dismissing its world view on the body, health and disease. This episteme continues to govern contemporary attempts to modernise the system, as is illustrated by the recently announced comprehensive policy on indigenous systems, the first of its kind since independence.
MADHULIKABANERJEE

or the first time in more than 50

years, the Indian governmenthas policyfor speltouta comprehensive the Indian Systems of Medicine and [GoI2001]. The questionof Homeopathy medicalsystemsis one of themostfraught areasof bothpolicy and politics, ranging to from the nomenclature1 the substance of theknowledge systems.Thenew policy of comesin thewakeof a number developments. Principalamong these are resurgence in commoninterestin the value of these systems worldwide,the realisation thatthereis a marketin which Indiacan claim a big shareand the significantnew and potentialof an establishedindustrial base.Inmanywaysit marks technological from the number an important departure of discreteinitiativestakenby the Indian both legal and institutional, government, since about the 1940s. The difference betweenthem,thatis theearlierinitiatives and this new policy is not simply in the scope, but also in the perspective and ideological orientationadopted toward and thesesystems.Thusa comprehensive of criticalunderstanding the presentdraft policy is possibleonly by locatingit in its it contextandthenprojecting to historical thefuture. thisarticle,I will specifically In of in analysetheexperience Ayurveda this within country giventhat,in the hierarchy the systemsindicated, occupies Ayurveda its the top level andtherefore, experience this wouldbeevocativeof therest.Further, analysis based on a thesis done earlier [Banerjee1995] will cover developments in bothstateandcivil societyinIndia,such of boththemanifestation andresponses that in to policy are understood totality. of has Themodernisation Ayurveda been the focus of both state and civil society sincethecolonialperiod.By organisations
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thelate 19thcentury, colonialstatewas the hostile to Ayurvedaand sought to quite removeit fromstateambits cantonments, and government hospitals medical colleges. Both Ayurvedicmedicinemanufacturing companies and the non-governmental organisations promoting the cause of cameintoexistenceatthattime, Ayurveda respondingto and contestingwhat they saw as stereotypes,distortionsand the maligningof an ancientmedicalknowledge systemof India.Theywerethenable to influencenationalist politicsenoughto find some kind of place in post-colonial it that policy.2Inthispaper, will be argued moderisation,undertaken Ayurveda's by thethreeactors,thestateandthetwoparts of the civil society,has beengovernedby what may be called a 'pharmaceutic that episteme'.Thisis anepisteme focused on retainingAyurveda'susefulnessas a meresupplier newpharmaceuticals of and its worldview on winking at/dismissing the body,healthanddisease.Further that, of whatseemslike a resurgence Ayurveda in contemporary times follows from this whether revival, of policy.So all attempts, as by the companies,revitalisation, by as the non-governmental and organisations as by the currentpolicy, repositioning, actuallyconformto this episteme.Is this what is best, equally,for both Ayurveda and the healthof modemIndiansociety? This is the broad question that will be addressedin this paper.

Policies Developmental of State


The policies that the state formulated in the immediate post-colonial years were reallya formalisation theconsenof sus about science and technology that

was arrivedat in the course of the anticolonial movement. The Nehruvian vision of the developmental statewas all set to cast India in the mould of mainstream modernityand would brook no obstacleon this path. It was determined to prove a point to the dominantpower in structures the international arenathat Indiahadthe capacityandpotentialto be in as advanced science andtechnologyas any other 'developed'nation.The terms on which both state and civil society institutions promoted Ayurveda in the havebeencompletely post-colonial period governed by the context of the hegescienceandthisrequires mony of modern seriousanalysisandcritique. is truethat It therewas an attempt acknowledge to and retainAyurvedaas one of the valuable traditional systems of knowledgeand a basis of technology relevant for the futuredevelopment the country. it of Yet was considered inconceivable or impossible that the parametersof legitimacy or quality control could possibly be elicited from withinthe 'great traditions' themselves or that they could posit a canvas of modernityof theirown. This is explicatedalmostwithoutexceptionin all the majorpolicy documents and reports that the governmentof India has publishedtill date and makes for fascinating reading and many analytic possibilities. And till date, in both discussions with senior government offithosedeeplycommitted cials, particularly to the cause of Ayurvedaand its rightful economy and position in contemporary society, this anxiety is writ large.Thus and commercialisation,standardisation professionalisation, alreadythe mainfoci of transformationin the post-colonial civil society, were and continueto be
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takenup for the developmental agendaof the state. Bhore and Chopra Committees Thefirstcommittee theBritishIndian of The government, HealthSurveyand DeCommittee, nowcommonly velopment by referred as the Bhore Committeewas to in "to appointed 1943.Thiswas appointed makea broadsurveyof the presentposition in regardto health conditions and healthorganisation BritishIndiaandto in make recommendations future for develop: ments"(1943 1). While it recommended measuresfor health condifar-reaching tions fromthe pointof view of biomedithat cine,itdeclared itwas"notinaposition to assess the real valueof these systems" (ibid:3). However,the spiritof its blueprintfor the healthservices of post-war Indiawas quite hostile to the role of indigenoussystems of medicinein it. The attitude omissionon the partof and the Bhore Committeeprovokeda great deal of publiccriticism,includingthatin the presidential addressof the All-India Medical Conferenceheld at Maduraiin 1946.As a consequence this,theHealth of Ministers' Conferenceheld in October 1946at Delhiresolvedto makeprovisions "for researchin and the applicationof scientificmethodfor the investigation of the indigenous systems..., for starting colleges and schools for trainingfor diploma and degree courses in indigenous systemsof medicineandfor postgraduate coursesin IndianMedicinefor graduates in Western Medicine" (quotedin Government of India 1948:6-7).Further, also it resolved to "absorb the practitioners of Ayurvedic and Unani systems of Medicine into the State Health Organisation giving them furthersciby entific training wherever necessary as health personnel,like doctors, physical trainingexperts (Ustads), sanitarystaff, masseurs, nurses,midwives"and"thatin theCentral CouncilandProvincial Health BoardsandCouncils,the Department and of Practitioners Indian Medicineshouldbe whereverposgiven due representation, sible" [ibid:7]. TheChopra Committee Indigenous (On Systemsof Medicine)was set up followits in ing thisandit submitted report 1948. Thiswas a crucialcommitteethatmarked from colopointsof departure important nial policy, while continuing muchof the spirit of the approachof the state and, remaineda point of referencefor many

In it alreadyknown and being discussed. These subsequent investigations. its report, is possible to delineatethreemain argu- rangedfrom the availability of certainplant ments.They are:(1) those of integration materials, or the knowledge of effective in teaching/education traditional of medi- substitutes, to the non-uniformity of relical systems;(2) those of standardisation able raw materials or chemical bases to be andrationalisation research produc- used in the manufactureof medicines. The of and tionparameters, to servemodern report states, "Pharmaceutical industry... primarily needs of commercial production and still in its infancy...few large firms of drug in (3) thoseof hastening specialisation the manufacture...Takenas a whole, it cannot traditional medicalsystems,with an em- be said that any uniformity of standards the involved of preparationsis being maintained by all phasison learning techniques in that,fromthe biomedical system.Each these firms. This, it is said, is due to the of these clearly illustratethe overallpo- difficulty of securing genuine crude drugs sition of the committeeand also of the of standard quality in the market" that parameters wereset andfollowedfor (1948:177). and While the committee bemoaned the fact Ayurveda all Indiansystemsof medicine for a long time to come. that the situation has not changed signifiTo beginwith,thereport says,"Science cantly since similar complaints made by is universaland medical science is no the Drugs Enquiry Committee of 1930-31 We exception. do notbelievethattherecan (of which too, R N Chopra was the chairbe separate systemsof westernor Indian man), it urged that these required urgent medicine.Such multiplicity systemsis resolution, if mass production of tradiof onlybelievedin andencouraged people tional medicines were to continue. Howby who have not clearlygraspedthe signifi- ever, it is important to ask why this comcance of the noble ideals as preached by mittee appointed by government, as also thegreatAcharyas Indian of medicineand all the othersthatcame subsequently,would thesavants western of medicine...Anything take for granted, the 'fact' that mass-scale, of value emergingfrom these shouldbe commercial production as need. This is a utilised for the benefit of humanityas question that is never asked because altera whole and without any reservation" native production structuresfor Ayurvedic of medicines were never articulated as an [Government India 1948:7]. This statement providesthe contextof issue, even when the government subsethe positionon integration theteaching quently established its own pharmaciesfor of of Ayurvedawith that of modernmedi- providing medicines to the health centres. cine.Thatis, sincetherecanbe no cultural It was trueof course, thatpeople need good different Ayurvedic/traditional medicines and that specificityof science, therefore, systems of knowledgecan be taughtto- this was a need which the government was Twoquestions gether. immediately emerge trying to respond to. By assuming how-. fromthis.One,how arethe parameters ever, that they would have to be necessarof and inquiry,investigation analysisgoing ily mass-produced, this reportreflected the to be determined? Two, is the 'rationality' ideology of production and distribution and therefore, higherscientificstatus dominant at the time. Thus the fact that the of biomedicine,as at the same time, the ancient texts providing methods for the and magico-religious hence 'unscientific' making of medicines in small amounts, it characterof Ayurveda,being assumed, cited as a problem. It could well have been when obviouslythe integration to be a strength, if the production decision to has of Ayurveda biomedicine not the make medicines at a decentralised level by into and otherway round? This againis a question well-trained vaidyas, in numberssufficient of the relationship betweenthe different for small, local communities all over the rationale different of medical This country were taken. Therefore, this was a systems. bringsus to the second and thirdaspects reflection of the overall myopia with reof theChopra Committee report. Theyare, spect to development policies, ratherthan the proposalsfor the standardisation and a specific problem with respect to rationalisation the product process Ayurveda. However, it has affected the of and of Ayurveda, as also the need for very significant, fundamental issue of the in It specialisation medicalpractice. must production of Ayurvedic medicines in an be remembered though,that by the time overall sense, because even when the this reportwas written,the realitycheck government set up its own pharmacies to was as follows. The mass production of supply to the dispensaries, it worked with had Ayirvedicmedicines beenon forover the typical sense of constraints that small 50 yearsandso theconcomitant problems production units have. That context of

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production was never utilised to explore the larger possibilities of linking technological/production decisions with health decisions, which any far-sighted health economics policy could well have. The third aspect, i e, of specialisation deals specifically with that of training in pharmacy, as a prerequisite for modern production and dispensation of drugs. On the one hand they accept unquestioningly, almost disregarding the history of science, that "conditions have however, changed and now the professions of Medicine and Pharmacy have everywhere separated, or are in the process of becoming so," [1948:177 emphasis mine]. On the other, they are also concerned that, "there is as yet no recognised training in pharmacy connected with Indian medicine...We are of the opinion that a class of pharmacists should be trained in the pharmacies attached to teaching institutions of Indian Medicine, should also be controlled by proper registration in the same way as is proposed under the legislation which has been enacted for the profession of pharmacy in connection with Indian medicine" [ibid:179 emphasis mine]. Thus the motive to classify and thereby control the functioning and more importantly, the direction of development of teaching of Indian Systems of Medicine was very clear. Following these discussions and recommendations, the most visible aspect of the development of Ayurveda in the next 25 years or so was the institutionalisation of its teaching and the professionalisation of its practice. The 'shuddha' Ayurveda as opposed to either the concurrent teaching of Ayurveda and modern medicine or the integration of the two in a single syllabus, has been documented ably by Brass (1972). Perhaps the most strongly worded statement on the issue came from the Udupa Committee Report of 1959 who stated, "We feel that the merit of Ayurveda should not have formed a subject of contention and the proving of such' merit to the authorities of modern medicine should not have been made a condition precedent for its recognition by government" (1959:8). Yet, soon thereafter, they suggest that "...the new syllabus chalked out by the 'Shudha Ayurveda' people is only a rehash of the old integrated system of medicine and that even the pure Ayurvedic institutions have included in their syllabus modern science subjects. The 'Shudh Ayurveds' all the time agreed that only one-eighth of the pure Ayurvedic

science (Ashtanga Ayurved), viz, Kaya Manufacture of Ayurvedic Medicines Chikitsa, was in vogue, while the remaining seven-eighths had to be revived and reintroduced...We are sure that in the The issue of the manufactureof pharmaprocess of this revival these very enthu- ceuticals in this period was only tangensiasts will feel the necessity of absorbing tially influenced by the disputes on the modern scientific developments while Ayurveda as a whole, as discussed above. giving it an Ayurvedic touch" [ibid:8, But the fact that, the standardisation of manufacture, as well as the validation of emphasis mine]. This last statement is clearly indicative efficacy were two crucial dimensions of of where influential policy-makers think this sector were understood very early on. is Ayurveda worth locating vis-a-vis the However, the response so far has been dominant biomedical system. It is spe- scattered over a number of statements, cially telling because on its very first page, initiatives and interventions made by this reportbemoans the decadence and set- government over this period of time. These back to Ayurveda "during the Mughal will be considered in detail here and the period,...because many of the texts of ways in which they lead up to the present Ayurveda were destroyed and practitio- policy. ners of the system were systematically The Udupa Committee is the first after discredited" [ibid:1]. the ChopraCommittee to discuss the issue Following the argument of this study, of pharmaceutical products, possibly bethis report did exactly the same thing, as cause one of the explicit terms of reference they accused the Mughals of doing, by the to it was to assess the nature, volume and kind of suggestion made above. The issues standards of Ayurvedic pharmaceutical of integration in education, as well as that products in the country. For this purpose of professionalisation of the practice of they issued a questionnaire to a number Ayurveda continue to be vexed questions of private pharmaceutical concerns and of policy, on more or less similar lines of pharmacies attached to government hosdifference. pitals or run independently by governThe relevant issue in this discussion is ment. While they conclude from the sales of course that there was so much discus- figures that"...Ayurvedic treatmentis very sion andfuroreover the purityof Ayurvedic popular in spite of the heavy consumption education, but no corresponding debate of modem drugs" [ibid:119], they point on questions of production. Undoubt- out what seem to them as serious and edly this was an importantissue until the obvious handicaps, some overcome and late 19th century. There were those like others continuing. An example of the Kaviraj Gangadhara Ray, "said to have former is that a majority of pharmacies laughed at practitioners who prepared seemed to be resortingto mechanicalmeans medicines before hand for their patients, of production adapted to the needs of calling them Badial, possessors of pills Ayurvedic science. They observe, "Itmay ready for common use" [Gupta 1976:376]. be recalled that the preparation by hand But the logic of mass production and by individualvaidyas was one of the seriousreturns to scale were dominant enough handicaps that made Ayurvedic practitioto be self-evident wisdom about produc- ner and Ayurvedic treatment less popular tion and so large- scale centralised produc- to the modern minded people" [ibid:119, tion companies emerged as the only emphasis mine]. Nowhere is this explained, possible institution of production of nor is there an accurate reference to the Ayurvedic medicines. But even today, 'recalling', perhaps because it seems to be when the debate seemingly has moved obvious to the committee. What it clearly on to quality, this underlying assumption implies for this analysis is that there is an is never questioned or the issue of alternate unquestioning acceptance of the dominant productionpossibilities ever explored. We ideology of production. have discussed elsewhere [Banerjee 195] The other significant point raised by this that this is evocative of the lack of a larger committee with respect to Ayurvedic vision of an alternative modernity. Yet, pharmaceuticalsis thatof the source books this need not be a cause for despair. There for the preparations. Again, the observais still a possibility that in the new phase tion on different texts being used by difof combating the forces of globalisation, ferent concerns, was pointed out as a the inspiration for making such a counter problem, with an obvious reference to the point may be possible. This is discussed lack of standardisation of the source in the section on globalisation below. [ibid:119]. This and the recommendations

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of a numberof other committees led to the drawing up of the Ayurvedic Formulary of India by 1978, which laid down guidelines for the essentials of standardised manufacture.The Ayurvedic Formularyof India and the subsequent debates and developments on standardisation. The Ayurvedic PharmncopoeiaCommittee was finally set up on the recommendation of the CentralCouncil of Ayurvedic Research in 1962. It was assigned the following functions: in an (1) To prepare official Formulary two parts: (a) Single drugs, of whose identity and therapeuticvalue there is no doubt; and which are fre(b) compoundpreparations practice throughquentlyusedinAyurvedic out the country. (2) To provide standardsfor drugs and medicines of therapeutic usefulness or necessitysufficientlyused pharmaceutical in the Ayurvedic practice. (3) To lay down tests for identity, quality and purity. (4) To ensureas faras possible uniformity, physical properties and active constituents; and (5) To provide all other information regardingthe distinguishingcharacteristics, methodsof preparation, dosage, methodof administration with various unpins or vehicles and their toxicity (1978:xxx). The formularywas preparedon the basis of consultations with a large number of practising physicians and establishments making Ayurvedic medicines. It was decided "thatwith a view to give maximum coverage to drugs and medicines used in general practice, the First Edition should contain medicines that are (a) manufactured on a mass scale for commercial purposes and are best sellers and (b) popularly used by leading Ayurvedic physicians in theirday-to-day practice"(ibid: xxxiv). As a result of this 444 preparationswere dealt with, with the hope that subsequent editions would cover major gaps. It is interesting that while the formulary is supposed to serve a 'technical' requirement in the manufacture of drugs, it established its justification largely in terms of sociological reasons. It stated, "The practice of the individual physician identifying drugs and preparing medicines himself for the use of his patients has been largely supplanted by the pharmaceutical industry...On account of increasing urbanisation,the tendency is towards more andmoredependence on readymadepreparation..." [ibid:xxvii].

Above all, the formulary is a work of 'translation' of a fascinating kind, which substantiates the basic argument of this study. It is writtenin English andthe pattern is such that each drug is defined and the methodof preparation, standardised as from the old texts, then stated. The sources are quoted, (literally chapter and verse) and the important therapeutic uses indicated. The weights and measures are in the metric system and a couple of indices at the end list everything formulawise or diseasewise. So, beginning at the very idea of a uniform text of formulations, to the actual layout of the formulary, 'repositioned' Ayurveda is clearly in evidence. What is interesting though, is that particularly in stating the methods of preparation, there are continuous references to age-old practices faithfully reproduced from the texts, as if the very institutions they had consulted before starting on this work, continue to follow these procedures. These include earthen vessels, fermentation processes in a heap of paddy or barley, slow pounding processes of 24 hours. There could be a one-off reference to variations, e g, "In large-scale manufacture,woodenvats, porcelain-jars or metal vessels are used in place of earthen vessels" [ibid: ], but there is no clarity on whether this is acceptable, or what the implications of these could possibly be. As will be discussed later, this is important precisely because these constitute important production decisions, which in turn seriously affect the character of these medicines in the long run, but the government is content with its narrow focus. There are two other dimensions which it ignores: one, the assessment of the efficacy of the drug, or its quality control and two, the form in which these are produced for the market. The very texts consulted for the process of preparation, also provide for the testing of the method of preparation.For the market,particularly in the arenaof competitive homogenisation, in which this seeks to intervene, it is increasingly becoming a question as to whether there can be 'objective' criteria for establishing the efficacy of a drug. Earlier, the reputation of the physician and that of the drug itself were criteria sufficient for people to believe in its value. Yet, for the physician's own satisfaction and professional credibility, there were criteria of tests to be done. Their absence proves a majorgap in the exercise. [In contemporary times, the new criteria for clinical evaluation being used in

commercial production have been a major point of contention between many players in the industry, governments and international trade bodies and agreements. A detailed examination is really the cope of another paper, but here an overview will be provided. Further,tablets, syrups and capsules are the forms of medicine that have become hegemonic in post-colonial India. By prescribing the dosage in metric measures, the field is left wide open for interpretation in terms of form. In a sense, this is an acknowledgement that market forces are likely to adapt any new form for their own purposes in any case, and so, ambiguity on the part of the government in the matter retains at least some aloofness and authority for it. Thereafter, the second and third volumes of the Ayurvedic Formulary have been published, that provide further details. Also, the government has been able to publish a very exhaustive the Ayurvedic Pharmacopoeia, which should go a long way in proviidng a guide to production anywhere in the world.

Establishing Efficacy
There aretwo ways in which the efficacy of Ayurvedic medicines can be established. The first is to take the claims of antecedent usage at face value. So given that these medicines have been in use for so long and have been known to be efficacious, that would guide their legitimacy in the present and for the future. The second is to put them through a process of clinical evaluation as developed for biomedicine and take those results as the guiding factor. Further, Ayurveda claims the knowledge of the exact medicinal propertiesof a large number of plants, but in order to create new drugs from them, the clinical evaluation of theirclaimed propertiesof medicinal plants. The bottom line here however, is that these are necessary in order to make these medicines acceptable to biomedical practitioners. The people who have relied on these medicines do so for historical reasons, though it is widely believed that the modern consumer is also only convinced by 'scientific validation' and not by historical claims. The government has two kinds of institutions involved in this activity - the Central Councils for Research in Ayurveda and Siddha (instituted by the health minister Raj Narain of the Janatagovernment of 1977-79) and the other, special scientific committees in

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the Indian Council for Medical Research. By now, both have produced a fair body of work in both sectors. The principal difference in the work of the two is that the councils do their work of validation in the Ayurvedic hospitals and departments of Ayurvedic colleges and universities while the ICMR research groups are based in the modern medical hospitals. This difference, in addition to the fact that the complete range of studies, whether pharmacologicalor clinical, are deemed to be capably carried out only in modern medical hospitals and colleges, has not lent the desired legitimacy to Ayurvedic medicines. It is interesting that in the researchefforts of the ICMR, the very best scientists and clinicians have collaborated and successfully established the efficacy of many medicines. But the same doctors are reluctant to accept any results that come from the councils because they do not trust them to be properly 'scientific'. This is evocative of the running thread of the dominant ideology as has been discussed in this paper and so one that needs to be urgently addressed by the government. What is important to clarify is that standardising the quality of the manufactured Ayurvedic medicines is a separate issue from that of validating the efficacy of Ayurvedic medicines. The first is clearly necessary for anyone who is to use the medicines, because all medicines produced by all medical knowledge should have basic standardsof quality and purity - they should be good medicine. The second is really necessary in order to respond to the hegemonic medical knowledge system, which can 'demonstrate' the effects 6f its medicines. In a country like India, the knowledge question is important, in the rapidly 'modernising' society where education, professional and lifestyle changes of a certain class has meant that all things based on traditionalknowledge are having to jostle for legitimate space. For the companies that make these medicines, it is very significant because it is a question of being able or not to sell in certain markets. Simply put, if Ayurvedic medicines are not able to demonstrate the efficacy that they claim, that too by using the criteria that regulating authorities of those markets have set as mandatory, then they cannot be sold there. Interviews with active researchers at the CentralCouncil for Research in Ayurveda and Siddha, New Delhi revealed that the currentpolicy emphasis is on the working

out of TLC profiles of most drugs. Now that the export market is definitely opening up and the government seems to be lobbying hard for medicines to be sold outside, there is a clear recognition that this would be the minimum requirement and that therefore this should be the focus. Now that the WHO guidelines on quality control have come, they are becoming the bench mark for all testing done by the researchcouncils and any initiatives by the government have to be based on them. This is echoed by the statement of the IndianAyurveda Congress about the focus of its most recent conference: A very clear emphasis has been placed to draft a strategy for evolution of internationally acceptable standardsfor conducting researchin alternativesystems of medicine...DuringtheCongress,it is hoped that progress would be made towards evolutionof methods,whichwill be acceptable to 'Drug Regulatory' authoritiesof various countries. How this would be achieved is a task, which requiresclose cooperation and collaboration between researchers engaged in modern scientific research and the practitioners of Ayurveda, including its researchers [http:worldofayurveda.net]. This clearly reflects the same anxiety about somehow establishing the credentials and acceptability of the Indian Systems of medicine, referred to in the opening paragraphsof this article. This is also the basis for creating what are designated as Good Manufacturing Practices, now included formally in the relevant law, the Drugs and Cosmetics Act (both discussed in detail later). Interestingly of course, the former is for the export market, while the latter are for the local market. The state, being the site of all these contestations, yet having some autonomy from them, needs to respond to both of these aspects. Most of the initiatives so far showed the heavy influence of the hegemonic knowledge system, as in the production system discussed above. It is the new policy that seems to strike some kind of balance for the first time. It does this by exploring the possibilities of integration between the different systems of medicine. While the idea of the integration of systems, as has been discussed in this paper itself, is not new to government policy in India, the terms of integrationare new. There are two beacon lights available for this. The first is the critical revaluation of the parametersof the controlled clinical trials conducted by the scientists of the

ICMR. More than20 years ago, Chaudhury argued that The controversies, challenges and problems that arise when carryingout clinical trialsof plantswith anti-fertility properties can be appreciated betterif viewed against, (a) a backgroundof the historical use of medicinal plants, (b) the past experience in screeningsuchplantsforpharmacological activity,and (c) an understandingof some of the relevant concepts of the indigenoussystemsof medicinewhereplants havebeentraditionally utilised(1980:474). His insistence on this position, as also that the pattern/protocolof clinical trialsshould be drawn up from joint consultations of practitioners from different systems of medicine together, seems to have impacted the new policy. It argues that, the challenge is to design studies and to motivateallopathichospitalsto undertake trials to establish the benefits likely to follow using traditional whether approach directlyor as an adjuncttherapy.Research haveto bedesignedkeeping methodologies inmindtheindividualistic nature the tradiof tional diagnosis and the holistic aspect of traditionaldrugs [MOHFW 2001:17]. What is significant about this is the parity thatis accordedto the biomedical and traditional knowledge systems, by an eminent mainstreamscientist. This would certainly be one of the most obvious ways in which some communication would be restored between the hithertoantagonistic systems. The second beacon light is from a number of experiments in 'integration' of different medical traditions, already being carriedout by non-governmentalorganisations in many partsof the country. If a truly serious, consciously political strategy of integration is to be worked out, that is, one that addresses the knowledge aspect of the question and also that of involving the different stakeholders, then this is surely a good opportunity. As in the mandate of the Medicinal Plants Board however, this needs to be spelt out clearly and the necessary participants identified in order to bring them together. This will be better understood once some of these organisations have been discussed laterin the paper.

Government Manufacturing Units


Another aspect of government policy is that of state manufacturing units of Ayurvedic medicines. State pharmacies were set up in the post-colonial period in order to supply medicines directly to the state dispensaries and health centres which

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with associated hadAyurvedic physicians them.Thesehavegrownwithtime,though to not alwaysproportionate the demands The information availamade them. latest on of ble on the number licensedpharmacies is as of April1998.The centrally-assisted and pharmacies the statewisenumberof are pharmacies showninTable1[MOHFW that The associatedinstitution 1998:316]. was set up in 1978 was the IndianMediin cinesPharmaceutical Corporation, RamUP, nagar, witha view to meetthedemand of units undercentraland state governments, which the lattercould not fulfil. In theDrugsandCosmeticsAct (1940), thedefinition a 'drug'excluded"mediof cines andsubstances exclusivelyused for withthe orprepared use in accordance for or Ayurvedic Unanisystemsof Medicine". Whenit wasamended 1964,it ensureda in over and limited control theproduction sale in of thesemedicines, thefollowingways: shouldbe carried out (1) Themanufacture underhygienicconditions,underthe supervisionof a personhaving prescribed qualifications; (2) the raw materialsused in the preparation of drugs should be genuine and properlyidentified;and (3) the formulaor the true list of all the in shouldbe contained thedrug, ingredients displayedon the label of every container. All manufacturers followtheabove now However, manyusers,particuprovisions. larlyvaidyas,do notfeel thatit servesany particular purpose. Two consequenceshave resultedfrom thisinstead. One,thatoftentheingredients listed on the label, are those required by the quotedformulation, are no longer but in The available themarket. buyer actually of these medicinesis not awareof such changesand so, may be paying for only afterall. Since thatcannotbe a substitute it demonstrated, is possible that openly non-standard substitutesare being used, which may at best be ineffectualand at worstbe harmful the patient.In fact, a to vaidyatold me that youngandcommitted thebiggestcompanies the market, in used the most shockingnatural plant material forthesepurposes, there noagency but was or institution which was available,to either check or apprehend practice. this

thesemedicinesarebeingmade.So in two both parts,thisnew set of rulesdelineates the actualrequirements premises,polof lution and control other facilities also the as kinds of machinery are now mandathat of tory for the manufacture broadclassificationsof medicines.The latterparticularly seems to be carefullydone because the lists for Ayurveda/Siddha separate are from that of Unani, given that the types of medicines notexactlythesame.The are 'hygienic conditions'just mentionedin the earlieramendment here spelt out are in termsof the factorypremises, clearly location surroundings, and water buildings, supply,disposalof waste, storageof raw materials,packagingmaterialsand finished goods and the workingspace. For the first time, thereare specificationsof the healthclothingand the healthconditions/hygieneof workers.Besides, there area clearsetof instructions about keeping distribution thoseof market comrecords, folplaintsandqualitycontrolprocedures lowed. It is interestingthat for the last, which, it has been repeatedlystressedin thisarticle,is sucha major areaof concern bothfor government big industry, and the standard is requirement thatof following the specificationsof the AyurvedicFormulary.But a most interesting exception has been made in the case of "teaching institutions and registered qualified Vaidyas,Siddhasand Hakeemswho prepare medicineson theirown to dispense to theirpatients notsellingsuchdrugs and in themarket exemptfromthepurview are of the GM" [MOHFW2001:342]. Role of Indigenous Practitioners

The countryhas a largestock of health of manpower comprising private practitioners in various systems, for example, Ayurveda,Unani, Siddha,Homeopathy, has etc. Yoga,Naturopathy, Thisresource not so for been adequately utilised.The of practitioners thesevarious systems enjoy high local acceptance and respect and exertconsiderable influence consequently on healthbeliefs andpractice. is, thereIt fore, necessaryto initiateorganisedmeasures to enable each of these various systems of medicine and health care to Good manufacturing practices for develop in accordancewith its genius. effortsshouldbe Ayurvedic medicines: These are included Simultaneously, planned in the latest Rules of the Drugs and made to dovetail the functioningof the of CosmeticsAct and are supposedlya re- practitioners thesevarioussystemsand to the 'conscious'new consumer integratetheirservice, at the appropriate sponse of Ayurvedic who wouldlike to levels, withinspecifiedareasof responsiproducts, be assured the bestconditionsin which bilityandfunctioning, theover-all of in health

care deliverysystem, speciallyin regard to the preventive,primitiveand public healthobjectives.Well consideredsteps wouldalsorequire be launched move to to towardsa meaningful phasedintegration of theindigenous themodern and systems. Inaccordance thestructures with agreed uponin theearlyplanning years,thestructureof the centralhealthservicewas such thatthe dominant positionwas attributed to biomedicineand the indigenoussystems of medicine,Ayurveda,Unani and Siddhawereincorporated the regular into structure. Later,Homeopathy, Yoga and were also included,and the Naturopathy terms and arguments which this was on doneis a fascinating story.Butclearly,the and optionthatwasbeingfavoured propagated by the governmentwas the allopathicsystem,with its biggestoutlaysfor hospitals, dispensaries, doctors nurses, otherparamedical Thismeant staff. primarily that the emphasis remainedon the elaborate expensiveinfrastructure, and on and big hospitalsin metropolises central towns, combined with a disregardfor primaryhealth centres and provisionof basic amenitieswhich would help in the maintenanceof health. Thus, even the epidemiologicalaspect of biomedicine, which would have focused on these aspects, was ignored. The policies thatemergedwith respect to the Indian Systems of Medicine reflectedthe lop-sidedunderstanding the of desirable of secnature the health-service torin generalandthe relativesignificance of the systems of medicinein particular. The generalview is manifestin the fact that outlays to the Indian Systems of Medicineduplicated exact pattern the as for the biomedicalservices, ratherthan creating an alternativestructurefor it altogether,in keepingwith their method of treatment perspective health. and of The for allocation Indian Systemsof Medicine in the Five-Year Plans has grown from Rs 0.40 crorein the FirstPlanto Rs 85.39 crorein the SeventhPlan.Not only is this a small figurein absoluteterms,but also particularly eloquentwhen comparedto the outlayon the rest of the healthsector (refer Tables 3-6). The most eloquent, of however,is the classification entriesin
theAnnualReports of the ministryof health

andfamilywelfare havenotchanged (which for pattern manyyears).Thereareseparate entrieson health,hospitals,dispensaries, and etc, withcentral statewisefigures.But on close examination becomesevident it thatthesearemadein sucha waythatthey

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include only the allopathicsystem. For information to relating anyof theseaspects of the ISM, an altogetherseparateentry on them needs to be located.It indicates fromthisthattheISMis in a positionakin to that of an oddity in the ministry's to activitiesand seems almostperipheral it.Thiswasalsoin evidencein thecolleges and examinationboardsand other such educational infrastructure were prothat vided from the very beginning by the far similarprogovernment outstripping visions in the indigenoussystems. II

Developmentsof Last Decade


The limited focus of the post-colonial state with respectto the IndianSystems of Medicine,was reflectedamply in the positionit occupiedin the large ministry of healthin the centre.In the 1970s,when populationbecame a majorissue within andoutsideof developing it countries, was to later expanded includefamilyplanning, to improved familywelfare.ISMwaseven thena smallsection,thechargeof no more thana joint secretary. it was only in But the 1995, with an increasingrecognition of the significance of this area and its in bothdomespotential thenew markets, tic andinternational, it was given the that withinthe statusof a thirdnewdepartment with a full-fledgedsecretaryin ministry, in charge.This development, termsof the in meaningsof changinghierarchies public administrative has institutions, meant to basicallymuchmoreautonomy conduct its affairs.One of the most positive outcomes of this autonomyis its changing with industry. relationship In March2001, this was in evidenceat a conference organised jointly by the of Confederation Indian (CII)and Industry the Departmentof ISM, called 'Good Health in the New Millennium'. The conferenceinterestingly organisedat was the initiativeof the CIIandgiven the new tenor of the government'sactivities and it orientation, was possibleto buildsome some linkageswith industryand further, actorsin the civil society. This was quite a milestoneevent andfor the firsttime it is perhapspossible to envisage partnerships in progressbetween the different actorsthathaveplayedsignificant rolesin the development/modernisation of But Ayurveda. whatthe outcomefor this turnsout to be, particularly in partnership the face of the rapidlychanginginternationaleconomicandtrading environment,

clearyet.Therearea number is notentirely of arenas wherethisis possibleto envisage, One of though. suchis that medicinal plants. Even at this conferencethe CII presito dent, in his speech referred the possibilitiesthatthetraditional medicine industryandthoseof its rawmaterials, particucouldmean India for larlymedicinal plants, in the world market.He offered that an in could expansion theusageof theformer well be encouraged apprising different by industries to (affiliated theCII)abouttheir continuing significance and providing incentives to their workers and like etc, organisations, reimbursements, so they would use them. About medicinal plants and India's possible gains in the world market,he was awareof the contradictions.While there was enormous demandon the one hand,therewas great concernfor the depletionof biodiversity as a resultof overharvesting the other. on He suggestedthatin thiscontext,theinput of companies cultivatetheseplantsand to to createherbal wouldbe a worthgardens while activityboth in termsof intentand profit.As it happens,the primeminister, who graced this historic occasion, announcedwith greatflourishthe creation of a MedicinalPlantsBoard,that would look at all these questions closely and advisethegovernment making on policies on this important new area. While this announcement beenmadebefore,this had time roundit did resultin the creationof thisboard thefirstcommittee and meeting was held in September2001. This boardis a nationallevel body of the government India,"constituted of to look afterformulation, with coordination ministries/departments, ensuringsustainableavailability medicinal of plansandto coordinate matters all to relating theirdeand use" velopment sustainable [MOHFW 2000:2]. It includesa numberof bodies and groups,withingovernment across ministriesand outside of it and certain major playersfromthecivil society- both companies and non-governmental organisations.It has designatedseveral committees, to focus on the different conseraspects,the cultivation, including vation of rare and endangeredspecies, research,demandand supply,on patents and intellectualpropertyrights and on Thus,it is designated exportsandimports. a number functions,relating each of of to these activitiesand could well be a very institutionin one of the most important significantnew arenasof governmental activity in the years to come.

The policy that set this boardin place is veryconsciousof thenational interand national now at work.Whilethe pressures demandfor medicinalplants grows because of the increasing market herbal for thereis a veryrealawareness of products, overharvesting depletion irreplaceand of ablenatural resources. boththeproducSo ersandthesustainable development lobby areconcerned. Giventhatso muchof the in negotiations the futureare going to be around thesenatural such resources, aboard could well play a very important in role the projecting best Indianinterestsin the international arena.It remainsto be seen as to whetherit exercisesit potentialand to how thehierarchies powerwithinthe of different organisationsand institutions involved, respondto these questions. The traditionalmedicine knowledge and digitallibrary, conceptualised developed by the governmentresearch and institutions development includingCSIR laboratories the country,will go online in on December15, 2001 enablingaccessiexaminers worldwide. bilityto itforpatent About 3,500 formulations Ayurveda, in followedby Siddha Unaniwithdetails and about the plants and their combinations willbeputuponthewebsite.The secretary of ISM and Homeopathy, of government Indiatold Pharmabiz.com one of the that majorobjectivesto have a digitallibrary in placewasto ensure thepatent that drama with regardto turmeric not reis played that peated.She argued at a timewhenthe west is clamouring plant-based for health care products, the Indian Institute of Medicine(IIM)andits practitioners need to be more organised,qualityconscious andproactive. "Wenowneedto streamline the standardisation drugs, spruce up of R&D and manufacturing facilities". Draft National Policy As is evidentthen,a number developof ments have made it possible for governmentpolicy to gravitate toward national a oriented the toward ISM. policyexclusively Therearemajorpointsof departure demonstrated this policy. First,thereis an by overtsupport theISMyet significantly, for it is not arguedfor on the basis of their With lineageorinnate superiority. theclear statement they have not been apprethat ciatedenoughfor the roletheyplayin the health of the country,there is insteada conscious positing of the pragmaticuse of these systems. The policy states that given the huge government - funded

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facilities that an effective best known for its critical approachto medicinal plants used in traditional infrastructure of utilisation thesewouldserveto augment traditional knowledge the issueof astro- medicine. (ii) Ensurequalitycontrol of At thepublichealth plantremprogramme. the same logy beingfreshin everyone'smind.Cel- drugsderivedfromtraditional time, it addressesissues of access and ebration,becausepoliticalagendasoften edies by using modem techniquesand suitable and standards goodmanuin delays or applying equity,system neutrality offering ser- get waylaid by bureaucratic choice. Most impor- hostility and in this instance, quite the facturing vices andexpanding practices.Followingthis, came the ChiangMai Declaration 1988 enof it however, clearlytakestheposition opposite is evidentlythe case. tantly of promoting medical pluralism and titled, 'Saving Lives by SharingPlants'. It recognised medicinal that introducestrategies to mainstreamthe III plantsareeshealthcare,bothin selfInfluence International sentialin primary of indigenous systems of medicine. This health medication in national and fromthe services, way it marksa radicaldeparture Organisations Committee position quoted viewing with grave concernthe fact that Chopra TheWorldHealthOrganisation earlier in the paperand that which pro(WHO) manyof theplantsthatprovidetraditional medicinesas "Finished and modem drugs are threatened. This videdthe subtextof all subsequent policy hasdefinedherbal thatcontain as thenfocusedattention theissuesthreatlabelledmedicinal on interventions. products thoseof Second, the policy states envisages a active ingredientsaerial or underground eningmedicinal plants,including or habitat destruction and unsustainable of changein the orientation researchand partsof plants,or otherplantmaterial of output theISMdevelopedby the ICMR combinations thereof, whether in the harvestingpractices,and the continuing It and cultures. councils.This document crudestateorasplantpreparations" andthe research [WHO disruption lossof indigenous The sameWHOdocument would seem though,fromthe subsequent reflects the benefits of many years of 1996:178-83]. questioning and rethinking on these adds that medicines containing plant focus providedby boththe WHOandthe that the most imknowledgesystems,bothby thosewithin materialcombined with chemically de- nationalgovernments, economicvalue was them and those without. This will have fined activesubstances, includingchemi- portant thesignificant for plantsusedtodayandthe far-reaching implicaitons thequestions cally defined, isolated constituents of of themedicinal and of standrdisation vlidationthathave plants, are not consideredto be herbal great potentialof the plant kingdomto discourseon medicines. dominatedthe government providenew drugs.What is relevantfor In 1978theWHOandtheUnited Nations this discussion is that given the change thisissueforso long.Thiswillbe discussed in moredetailinthenextsectionanalysing ChildrenFund(UNICEF)came out with of emphasis in the internationalmarket withthegoal of with the new possibilitiesof the herbal of influence theinternational organisations. theAlmaAtaDeclaration this Third, policyis a firstin recognising providinghealthcarefor everyonein the medicine sector, that the focus of the of in different'stakeholders' the worldby the year2000. In support that WHO seems ot have moved away from identifying mediand medicine thatof herbal to on ISM.Thisimpliesthattherole goal,WHO,UNICEF theWorldCom- traditional policies of thecivil society,i e, boththecompanies munity endorsed traditionalmedicines cine. The latteris moreinclusivethanthe worldwideand underscored former,and allows for the entry of the medicines and the non- programmes manufacturing sector. The medical biomedical pharmaceutical role of traditional in the important governmentalorganisationsengaged healthcare implicationsof this, for both policy and issues aroundAyurveda,is seen to be systems in providingprimary to important includeand involve in any to 80 per cent of the world's population politics, are very significantand will be It initiative. further recognises [WHO 19781.In the 1980s, therewas a discussedlater. government on Theinfluenceof thesedevelopments that this step could help actualisesome continuous,if marginalsupportfor reof medicine. thedecision-making theIndian governquestionsthatseem to remainat the aca- searchon issues of traditional demiclevel simplybecausethereis a lack But these were mostly on the pharmaco- ment in this sphere, has an interesting of political will and institutionalinfra- logical and toxicity aspects,in tune with trajectory.With the Alma Ata (1977) of strucures to implement them. A very the requirement 'validation'of herbal Declaration'semphasis on the primary issue in this context is that of medicines of any kind, put forwardby health care system, a greater role for important Medicineand Healthfor All, The increasing hegemonic scientific institutions.Given Traditional sustainable development. from scientists dominatethe thefocushadto be shiftedsomewhat marketfor medicinalplants,whetherfor that mainstream of directexportor for the growingmanufac- scientificcommittees the WHO,thatis the biomedical,largehospitaland urbanIn turing sector of Ayurvedic medicines, not surprising. thatsense, the analysis centredapproachof our health service. of a depletion of biodiversityand of the "WHO,while being a technical Withthe ChiangMai Declaration 1988 implies so therehas to be a concertedattempt by agency of the United Nations, is also a and a series of meetingsand conferences and industry government non-government political agency which reproducesand later, these two policy imperatives,of to politicalpositionsthroughits primary health service and traditional organisations tacklethe problem.This distributes So can be seen as one of the moresubstantial technological discourse and practices" medicine,seem to have been married. to medicine continued bevalid. nowtraditional and positive policies of liberalisation, [Navarro 1984:165], systemsarebeing In 1987,the40th WorldHealthAssem- positedasthemaininstruments claims of which are being made by ofrealising the the objective of providing holistic and for so long. Howevver,most bly adopteda resolutionreaffirming government at and the uncharacteristically, willhascomefrom Alma Ata Declaration gave two fur- cheaperhealthalternatives the primary healthcare level. and an institutional intervention thatcan ther mandatesto the WHO: shiftcan be observed as be causeforconcern well as celebration. (i) Initiatecomprehensive programmes But an interesting like authored evaluation, stray prepara- through publications that Concern,becausethe politicalclimate in for the identification, Herbal entitled is whichthis sectoris beingprojected not tion, cultivation and conservation of by Ranjit RoyChaudhury, Economicand PoliticalWeekly March23, 2002 1143

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Medicine for Human Health (1992). It

contains the most searing criticism of mainstream scientificresearch,"Thereis this continued refrain that medicinal plants being used for the alleviationof and symptoms of illnesses at the primary healthcare leve should be evaluatedfor efficacy. This insistence on testing by western-trained scientists,mouldedin the allopathicmode of thinking,...couldbe (ibid:77). Again,"Oneimpordangerous" tantstep in any new approach to wipe is awaytheattitudes developedoveryearsin the training providedby the westernsystem of medicine"(ibid:79);and a similar of critique the international organisations, "there is no sign of any international involvconsortium a joint programme or ing WHO. The United Nations and the WorldBank,for example,like the Tropiin cal Diseases Programme, the field of medicinal (ibid:77).Then plantsresearch" he goes on to offer the most radicalof alternatives,a fragmentaryexample of which is as follows. "Itwould be ideal if an innovative and imaginativeresearch of aimedat the development programme afewselected is setupbetween herbal drugs an interestedand leading Universitydepartment,a pharmaceuticalhouse and WHO and, if necessary, other United Nationsorganisations such as the United Nations Development Programme" (1992:80). While none of these 'ideal' solutions find actualexpressionin laterWHOpoliis cies, the forceof the argument reflected in some recognitionand accommodation of clearlyconflictinginterests. The latest in this sequenceis the WHO Guidelines for Quality Control of Medicinal Plant This Materials. is a set of guidelineslaying downverydetailedinstructions could that be used to set standards international for markets. theusageof wordsin thetitle But is most striking. Not medicinal plant even products havebeenin (as medicines, for some time now in the market), vogue butsimplymaterials. is possibleof course It that brevityis the reasonfor this usage, given thatmedicinalplantsareprocessed into a wide rangeof things - like intermediateproducts,raw materials,as well as medicinesand other products.So the only inclusive term could have possibly been'materials'. However, giventhetrend of the slow erosion of legitimacyto the medicinesof 'traditional' systems in the international market,this word does not seem innocent of reducing traditional medicalsystemsto simplyplantmaterials.

Apartfromthis, the detailsof the guidelines continueto emphasisethe clinical and pharmacological aspects,of the kind thatRoy Chaudhury passionatelyarso gued againstnot 10 years ago. It is interesting however,thatthe latest of thenational does policy government refof lect someof thesentiments RoyChaudhury'scrusade,whenit identifiesthe different and stakeholders commonprogrammes andintereststo be pursued consoin nancewith each other."Anenvironment for collaborative research soughtto be is struccreated,by establishing integrative turesfor research,bringingtogetherthe and variousstakeholders assigningfunds to support these activities" [MOHFW 2001:16]. Globalisation and Ayurveda In the global economy,whereinherbal productshas alreadybeen identifiedas a profitableenterprise,the support-strucresourcewise wellasinlegalterms, as tures, arealready Withthedrastic beingcreated. changes in the patentlaws imminentin India,two forces will play an important role. One, the processesof manufacture will become patentable, facility which a transnational companieswill be able to avail of beforeany of the Indiancompanies, because of the sheer size of their research development and divisions.Two, thealready initiated processof thecreation of gene banksin the industrialised countries,will give themrightsalso to genetifor callyengineer plantvarieties medicinal purposes, now in accordancewith the requirements identifyin the market. they This will, in fact, completelystandon its headthe conception manandnature of in Ayurveda,thatis, thatthey belongto the samecosmologyfromwhencethe source of sustenanceas well as succourcomes. abdicatedits cosHaving systematically mology as well as form to these larger ideological-political forces, Ayurveda cannot combat these forces within the of and parameters production the market. When these structures actuallybegin to functionin thewaytheyaremeantto, then it is likely thatthe hostof smallmanufacturers Ayurvedic of medicines themarket, in will be effectively competedout of the market.So a combination new patent of laws andthe creationof gene-banks, will wrest the control and capacity of local over ownresources and entrepreneurs their markets. Thus, in the sphere of mass medicines pass will production, Ayurvedic

on to the controlof the new tradingregimes. But that is not all. It is important see thatthe 'herbal'/ to the 'natural' as muchconcepts,as the are label for a certain variety of products. Also, that this concept is actuallymore in a important preparing spaceandmindset for the market, already created in the industrialisedcountries. There, it had stemmed from the dissatisfactionwith modem biochemicalproducts,both medicinal and cosmetic. Over time though, theseproducts cometo slowlyoccupy had theentirespacefor 'alternatives'. Thereby commodithey have soughtto substitute ties for what was being increasingly recognised thosesocietiesas a concrete by and comprehensive political need. I believe thatthistrend, morethan products the that to themselves, is beingtransposed the countries. Thatit can be posdeveloping sible to providea salve of the 'natural' by certain marketing products claimingthose properties,ratherthan leave it open for contestation political in terms. together So, with all the otheridentifiedconcerns,as those of the taking over of the natural resourcesof the developingworldby the new tradingregimesand the knowledge of theirprocessanduse by the new patent this regime, is infactamoredeeplypolitical takeover,not yet beingfully appreciated. In the scramble protecting markets for the andknowledgeregimes,eacha verylaudable and necessary political agenda, a is deepercolonisation not yet understood. Thatit is beingplayedout in termsof the alternateworld views (inherentin these medicalsystems)beingedgedout,thatthe reasonfor this lies not only in the overwhelminghegemonicforces of dominant sciencetechnologyandtrade, thevery but and policies of 'standardisation scientisation' undertakenby the south Asian regimesinthelast50 years,theseareissues thatneed urgentrecognition. has been As so argued far,thisis theprocess consistently whereby the real process of exploring modernities was multiple/alternate/diverse quelled.It could not be squashed though, becausepoliticalmovements, albeiton the fringe,kept this politicalprojectalive in some way. This is where one of the significant flaws of the current policy lies. It of emphasisestoo muchthe requirements the international market,in termsof the agendait is settingfor itself. Its self-confessed priorities the standardisation are of for requirements the export marketand the good manufacturing practicesfor the

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local, as also the long-awaited regulation and coordination the medicinalplants of market.All of these policies are in reof sponseto thepressure the international market and the industrial groups that stand to benefit from these developments. Hence the activeinteresttaken in this respect by the CII and the support provided to its moves by the different of associations manufacturers.cannotbe It reiterated enoughthatwhile it is wise to make these moves, because they are worthwhile and relevantanyway, there is another side to this.It is countriessuch as India,with textual medical traditions like Ayurvedaalreadygeared with the research institutions the governments and behindthem,thatcan lend some measure of challenge and new directionsto the issues of standardisation regulation and by beingdemanded the differentfacetsof theinternational arena. canChina, So given theirexperience, it looksliketheforces but of globalisation going to prove to be are fartoo powerfulfor suchchallengesto be made concrete.

IV Civil SocietyandAyurveda
As indicatedearlier,two parts of the civil society have been importantfor units industrial-manufacturing Ayurveda: of Ayurvedicmedicinesandnon-governEach of these has mentalorganisations. been active in modernising and foregroundingAyurveda in the public domain, particularlyin the face of its in urban decreasing credibility thedominant It to market. is interesting notethatforthis mandate,they have followed the same for trajectories a long time - highlighting basedon historical Ayurveda's credibility experience, trying to demonstrate its innate'scientific'valueandalso showing its relativevalue counterto those of biomedicine. Increasingly however, there seems to be a significantdivergencein theirpathstakenby thesetwo partsof the civil society. While industryand market arefollowinga seriesof trendsguidedby marketand its the potentialinternational influence on the urbanconsumer,some nongovernmental are organisations deliberatelychartingout a differentcourse of on action. Theyareconcentrating Ayurveda as a knowledgesystem of medicinethat offers not only differentkinds of medicines for illnesses, but also a holistic on perspective health.The latterhas been pointedout as one of the majorcasualties

of themodernist of perspective healthcare like alongwiththoseon development, the and policies with respect to agriculture vis-a-visthe environment. Much industry of theresponse thesenon-governmental of is of organisations to thiscritique development offered both by academics and activistsin the last 20 or 30 years.Given how powerfullythey are now lobbying withbothgovernment industry the and on basis of their solid work on the ground, this is bound to have very important for implications the futuredevelopments in/of Ayurveda.We will look at each of these in turn. The market Ayurvedic for medicinesin India today displays great variety and complexity.India Today once reported, "Takean ancientprescription, a dash add of essence, enclose it in attractive packaging and back it up with high decibel methods.Whatyou get is burmarketing in geoningbusinessandheftyreturns one of the country's oldest industries" (1989:109). This actually indicates the precise mannerin which more and more manufacturersare worming their way into whathasbeenanalreadyestablished and sense industry is actually goodbusiness now. Thereare a myriadnew companies is at everyday,andthe market expanding a fastpace.Broadly though,if we examine the kindsof manufacturers, find they we are of three types. There are ones that manufacture medicines Ayurvedic proper, ones that make mostly cosmetics and personal care products and those that makewhatareknownas patent medicines made on the basis of (new formulations established Ayurvedic knowledge). Of these,theones thataregrowingthefastest arethe secondvariety: thoseof cosmetics and personalcare products,so much so that well-established companies of medicines strengthening are this Ayurvedic of their operations, Dabur and part HimalayaDrug Companybeing significantcasesinpoint. Thereis another dimension to the market, however, which is the burgeoning of health resorts and retreats.Again, this aspect rejuvenation has a fairlywide rangefromthosethatare seriousalternate therapycentresto those thatprovide package of therapy, a deal diet and quiet to the harried upperclass consumerof todayandarethereby of the part acceptedworldof healthor eco tourism. Thisdevelopment so significant the is that Indiangovernment takenseriousnote has of it and includedit in the new policy discussed above.

An important elementin themarket and the shifts in its priorities, the ways in are whichinternational capitalis movingand the kindof priorities is settingfor itself. it At the conference I referredto earlier, Mashelkar pointedoutthatas the worldis going digital herbal, India should not find it hardto finditself a placein thesun. It seems though, that our markets havealready figuredwhichway the wind is blowing since the early 1990s at least and for them, they go the way the world goes. As in so manyexamplesof the last hundred yearsor so, the capitalistappropriationof the critical and challenging ideaspositedby Ayurveda slowlytaking is place, but what is even more interesting is that the state is endorsingthis shift. Locating Ayurvedasuccessfully in this arenaof the civil societyis circumscribed thereforein two ways. On the one hand by the manufacturers' abilityto construct it in a way thatmakesit seem accessible to a particular kind of consumer,and on the other,to construct drugsandcosthe metics marketsuch that it can position 'tradition'in a form that sells. The most recententrant this market in are 'Nutraceuticals' basicallymeaning food supplementsand complementsto medicines. Thisis oneof thefastest regular thesedaysandis likely growingindustries to drawmanyplayers- both alreadyexisting firms and new ones, preciselybecause of their liminal positioningin the market. They have neithermedicinalnor cosmeticvalue, but areincreasingly consideredimportant two reasons.One, for becausethe urban middleclass in Indiais conscious of food not having enough nutrient valuebecauseof adulteration and thatdietaryregulation medicaalongwith tion is becoming increasinglyimportant even with biomedicine.But what is imto portant pointout is thatthis trendalso clearly shows the way forwardfor biomedicine, wherein the necessity for including a diet and thereforerecognising the need for dietician,is now seen as a scientific requirement, which the Indian physicianseems to be unableto do. But herbal of practitioners all kinds,definitely the Ayurvediccannot prescribewithout So 'parhez'(regulation/abstinence)! this shouldbe seen as strengthening directhe tion of the new 'integrated science' - this is very importantto delineate the way towardthe new agendafor alternatives. Much more confident position that can show a way out by pointingto the way forward,ratherthan back.

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Given the recognitionof the significance of Ayurvedain the publicdomain, its promotion been the task of many has a civil society organisationin the last hundred yearsor so. Theseincludea large of number smallpublishers engagedin the and distributionof popular production on literature the concepts, methods and sources of Ayurveda, those that run hospitals and dispensaries providing Ayurvedictreatmentand drugs, and inthosethatareengagedin docucreasingly, mentationand researchon the sources, localpractices the valueof Ayurveda. and While there is a great diversity in these and organisations theirbrief with respect to Ayurveda,there is no doubtthat they have contributed significantlyto keeping thediscourse activity and around Ayurveda It verymuchin currency. mustbe pointed out though,thatheretoo, the influenceof international fundingon non-governmental organisationsis obvious. The interof has national critique development paved thewayforanumber significant of developknowlments with respectto traditional edge systems.It has fosteredthe idea that knowledge greaterrespectfor traditional systemsis crucialfor sustainable development practices. Furtherthe concept of rewardingindigenous communities for the knowledgethey sharewith scientists and the market,which makes it possible to preserveandaccess this knowledgefor of posterityand access to largernumbers people. There have been organisations in many developing countries, including ours, thathave been arguingsimilar positionsfor years earlier,but the hegemonicknowledgestructures were able to confinethemto themargins systematically for a verylong time.The consolidation of in thechallenges theyface,particularly the arenahashelpedconsolidate international in the voices of protest the margins our of as countries well. This does not come without its fair The shareof controversies however. docuof mentation threetypes of knowledgeaboutthe actual medicinalpropertiesof for plants,the procedures medicinesthat can be madefromthemand,healthpractices - are increasingly understood to be a valuableresourcethat needs to be urgently documented, else they would be lost. Most of this knowledge is richest in the 'developingcountries',where the recognitionof such issues by local and governments thenthe abilityto financially supportsuch tasks is not high on their priority. But following from the

international critiqueand recognitionof the urgency of this issue, financialand ideological supportfor such activitiesis availablefrom international civil society The that organisations. controversy arises from such supportis about knowledge and appropriation its subsequent 'proprietorship'.The worstcase scenarioenvisagedin thisis thatthisis simplya devious methodof stealing this knowledgenow and ultimatelymakingit availableto the to powerfulmarketsabroad exploitcommerciallyat a laterpoint in time. Given the deeply politicalnatureof these positions, the differencesover this issue are becomean issue of likely to increasingly now a classic standoff betweendifferby ent kindsof civil society organisations 'socialmovements' 'NGOs'.Whileit and is not possible to simply classify this in suchblackandwhiteterms, inthefield, but butit captures some of the essence of the lay of the land. The other importantissue being addressedby someNGOsis thatof bringing differentmedicalsystems closer to each otherand to attempt complement to their impact on one health problem.At one to level,thisis similar whathasbeingtalked about by governmentsand corporations around world.At another, manner the the in whichthseorganisations attempting are it areradically different. is necessaryto It do a full-fledged to makeanyclaims study on theirbehalf,buta generalobservation is pertinenthere. Given that groupsof well-trained doctorsfromdifferent medical systems work togetherto solve local health situations, they use the varied resources of health systems knowledge thatthey have at theirdisposal,to set up a genuinecommunication amongthem.It is possible then, that the scope of their work could well be in terms of pathto breakingapproaches scientificinquiry andnot simplypragmatic of programmes intervention. V

seemsto weighthesignificance thenonof market smaller and forcesasfaraspossible with those dominant.Whetherit will be successful maintaining balance in this from the draftto the finalpolicy stage,remains to be seen.[O

Notes
[Theauthorwould like to speciallythankthe many members of the departmentin the ministry and the CentralCouncil for Researchin Ayurveda,for their ready help and cooperation in making informationon governmentpolicy and initiative available.] 1 Ayurveda,Unani and Siddhaare the principal systems indicated, while a host of 'folk' and tribal remedies jostle for recognition. 2 All of this is very well documented and analysed in both historical and sociological work well known by now: that of Arnold (1993), Brass (1972), Bala (1990) and Leslie (1976).

References
Arnold, D (1993): Colonising the Body: State Medicineand EpidemicDisease in Nineteenth India,OxfordUniversityPress,Delhi. Century Brass, P R (1972): 'The Politics of Ayurvedic Education:A Case Study of Revivalism and Modernisationin India' in L I Rudolph and S H Rudolph (eds), Politics and Education in India,Harvard UniversityPress,Cambridge. Bala, P (1990): Imperialism and Medicine in Bengal: A Socio-historicalPerspective,Sage, New Delhi. Banerjee, M (1995): Power, Culture,Medicine: A StudyofAyurvedic Pharmaceuticals India, in PhD thesis awarded by the Departmentof PoliticalScience,Universityof Delhi,currently being substantiallyrevised and updated. Chaudhury,R R (1992): Herbal Medicine for Human Health, World Health Organisation, New Delhi. Leslie, C (ed) (1976): Asian Medical Systems:A ComparativeStudy, University of California Press, Berkeley. Government of India (2001): Draft National Policy on Indian Systems of Medicine, ministry of health and family welfare, New Delhi. Gupta, B (1976): 'Indigenous Medicine in Nineteenth and Twentieth Century Bengal' in C Leslie, Asian Medical Systems: A ComparativeStudy, Univeristy of California Press, Berkeley. Indianedition 1998, Motilal Banarsidass, Delhi. World Health Organisation(1978): Traditional Medicine, WHO, Geneva. -(1996): WHOTechnicalReportSeries, No 863, Annex II, 'Guidelines for the Assessment of Herbal Medicines', pp 178-83. MOHFW (1998): Annual Report, New Delhi. - (2001): Annual Report, New Delhi. Navarro,V (1984): A Critiqueof the Ideological and PoliticalPosition of the BrandReportand the Alma Ata Declaration', International Journal of Health Services, Vol 14, No 2, pp 159-72.

Conclusion
The new policy therefore addressesissues that are alreadyat the cuttingedge of markets international and negotiations. and Standardisation validationof traditional medicalproducts the issues of and of integration diversemedical systemsinto thehegemonic medical one,suchthatthere maybe orderin the medicalworldarethe concerns articulated by the dominant Yet powersin science andthe markets. it

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Economicand PoliticalWeekly March23, 2002

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