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ABSTRACT
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.
Ethical approval
The study on which this paper is based has received ethical approval by the Institutional Review Board of Washington University in St. Louis.
Acknowledgments
This project was funded by the National Science Foundation and Wenner-Gren Foundation for Anthropological Research, and has received institutional support from Washington University in St. Louis. I am deeply grateful to the Ayurvedic community of Kerala and all other respondents for their generous sharing of knowledge and experiences. I thank Glenn Davis Stone and Mark Nichter for their support during the course of the study, and for the valuable feedback on this paper. Many thanks are due to the three anonymous reviewers whose critical queries have significantly helped in improving this paper.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. A usage preferable to ambiguous and contentious terms such as traditional/indigenous/non-western.
2. Formulations from any of the 56 classical texts approved by The Drugs and Cosmetics Act (DCA), 1940.
3. The study was anchored in Thrissur district in Central Kerala, hub of Ayurvedic manufacturing in Kerala, with field sites extending to three adjacent districts, and a few isolated sites in southern and northern Kerala. Respondents included key Ayurvedic stakeholders: doctors, manufacturers, wholesalers and retailers of raw/finished medicines, hospital/spa owners, therapists, patients/consumers, government officials and office-holders of manufacturer/practitioner associations. Data were also gathered from participant observation at six Ayurvedic conference-cum-industrial expositions, industry-meets and workshops. This paper draws mainly on data gathered from manufacturers and distributors.
4. Data on medicine production were gathered through semi-structured interviews of one or more managerial staff of 35 Ayurvedic companies, three of which were from outside Kerala. Based on annual turnovers between 2008 and 2010, companies were classified as large ($6–10 million), medium ($1–6 million) and small (below $1 million).
5. Based on qualitative judgement arrived at with inputs from various stakeholders.
6. An estimated $120 million in 2008.
7. Also one of India's top ten.
8. These include: three representing Kerala's traditional proprietary-focused segment confined to conventional over-the-counter drugs (e.g. cough syrups/pain balms); one representing the post-mid-2000s small but controversial anti-obesity/aphrodisiac-focused segment; and, a traditional company undergoing strategy-shift post-2005 acquisition by an Indian-American healthcare company (classical products constitute 60% of its turnover).
9. Source: production/marketing managers of two large Ayurvedic companies.
10. Distribution related data were collected from two wholesalers, 15 Ayurvedic agencies, four medical representatives and 18 raw-drug shops.
11. Elsewhere in India, raw-drug shops are commonly wholesale-focused.
12. Under Schedule E.1: DCA 1940.
13. The first two branches opened in 1916 and 1932; agencies began to crop up during late 1930s (source: Research Department, AVS).
14. In 2011, there were 16639 registered Ayurvedic practitioners and an equal number of unregistered vaidyans in Kerala.
15. For details see Bode (Citation2008, 187–196).
16. Compartmentalization of Ayurveda and biomedicine into parallel yet compatible modalities.
17. For example, Patoladi decoction is named after the primary herb-ingredient Patola; Dashamoolarishtam, an Ayurvedic wine with 72 ingredients is based on the drug-class Dashamoola (‘ten-roots’).
18. There is still a vibrant ‘purist’ (shuddha) Ayurvedic segment in Kerala strictly adhering to artisanal pharmacy practices.
19. Ayurvedic oils, ointments, jams, powders and pills last for 1–3 years; wines and mineral preparations have no expiry date.
20. Bengaluru, March 2012.
21. Less than 5% of the national health budget is allotted to non-biomedical systems.
22. 13% of SDP (cf. 1% in West-Bengal).
23. 126 Ayurvedic hospitals and 898 dispensaries (in 2013).
24. Source: Personal communication from Dr P.K. Warrier, Managing Trustee and Chief Physician of AVS (21 December 2010), and multiple interviews with Dr T.S. Muraleedharan, Head of Research Department and Chief-Technical Services, AVS.
25. Including consumer-goods giants such as Hindustan Lever (with Arya Vaidya Pharmacy) and large hospitality-chains such as Taj Hotels (with Sahyadri Pharmaceuticals).
26. Of the estimated 10,000 documented formulations (Balachandran and Govindarajan Citation2007), less than 10% are industrially produced.