Public Policy and Ayurveda

Modernising a Great Tradition

The modernisation of Ayurveda has been the focus of both state and civil society organisations
since colonial times. This paper argues that modernisation of Ayurveda undertaken by both the
state and civil society has been governed by a ‘pharmaceutic episteme’ which focuses 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.
MADHULIKA BANERJEE

F
or the first time in more than 50
years, the Indian government has
spelt out a comprehensive policy for
the Indian Systems of Medicine and
Homeopathy [GoI 2001]. The question of
medical systems is one of the most fraught
areas of both policy and politics, ranging
from the nomenclature1 to the substance
of the knowledge systems. The new policy
comes in the wake of a number of develop-
ments. Principal among these are resur-
gence in common interest in the value of
these systems worldwide, the realisation
that there is a market in which India can
claim a big share and the significant new
potential of an established industrial and
technological base. In many ways it marks
an important departure from the number
of discrete initiatives taken by the Indian
government, both legal and institutional,
since about the 1940s. The difference
between them, that is the earlier initiatives
and this new policy is not simply in the
scope, but also in the perspective and
ideological orientation adopted toward
these systems. Thus a comprehensive and
critical understanding of the present draft
policy is possible only by locating it in its
historical context and then projecting it to
the future. In this article, I will specifically
analyse the experience of Ayurveda in this
country given that, in the hierarchy within
the systems indicated, Ayurveda occupies
the top level and therefore, its experience
would be evocative of the rest. Further, this
analysis based on a thesis done earlier
[Banerjee 1995] will cover developments
in both state and civil society in India, such
that both the manifestation of and responses
to policy are understood in totality.
The modernisation of Ayurveda has been
the focus of both state and civil society
organisations since the colonial period. By
the late 19th century, the colonial state was
quite hostile to Ayurveda and sought to
remove it from state ambits – cantonments,
government hospitals and medical colleges.
Both Ayurvedic medicine manufacturing
companies and the non-governmental
organisations promoting the cause of
Ayurveda came into existence at that time,
responding to and contesting what they
saw as stereotypes, distortions and the
maligning of an ancient medical knowl-
edge system of India. They were then able
to influence nationalist politics enough to
find some kind of place in post-colonial
policy.2 In this paper, it will be argued that
Ayurveda’s modernisation, undertaken by
the three actors, the state and the two parts
of the civil society, has been governed by
what may be called a ‘pharmaceutic
episteme’. This is an episteme that focused
on retaining Ayurveda’s usefulness as a
mere supplier of new pharmaceuticals and
winking at/dismissing its worldview on
the body, health and disease. Further that,
what seems like a resurgence of Ayurveda
in contemporary times follows from this
policy. So all attempts, whether of revival,
as by the companies, revitalisation, as by
the non-governmental organisations and
repositioning, as by the current policy,
actually conform to this episteme. Is this
what is best, equally, for both Ayurveda
and the health of modern Indian society?
This is the broad question that will be
addressed in this paper.
I to the cause of Ayurveda and its rightful
Policies of Developmental State
The policies that the state formulated
in the immediate post-colonial years
were really a formalisation of the consen-
sus about science and technology that
was arrived at in the course of the anti-
colonial movement. The Nehruvian
vision of the developmental state was all
set to cast India in the mould of main-
stream modernity and would brook no
obstacle on this path. It was determined
to prove a point to the dominant power
structures in the international arena that
India had the capacity and potential to be
as advanced in science and technology as
any other ‘developed’ nation. The terms
on which both state and civil society
institutions promoted Ayurveda in the
post-colonial period have been completely
governed by the context of the hege-
mony of modern science and this requires
serious analysis and critique. It is true that
there was an attempt to acknowledge and
retain Ayurveda as one of the valuable
traditional systems of knowledge and a
basis of technology relevant for the
future development of the country. Yet it
was considered inconceivable or impos-
sible that the parameters of legitimacy
or quality control could possibly be
elicited from within the ‘great traditions’
themselves or that they could posit a
canvas of modernity of their own. This
is explicated almost without exception in
all the major policy documents and re-
ports that the government of India has
published till date and makes for fasci-
nating reading and many analytic
possibilities. And till date, in both dis-
cussions with senior government offi-
cials, particularly those deeply committed
position in contemporary economy and
society, this anxiety is writ large. Thus
commercialisation, standardisation and
professionalisation, already the main foci
of transformation in the post-colonial
civil society, were and continue to be

1136 Economic and Political Weekly March 23, 2002

taken up for the developmental agenda of
the state.
Bhore and Chopra Committees
The first committee of the British Indian
government, The Health Survey and De-
velopment Committee, by now commonly
referred to as the Bhore Committee was
appointed in 1943. This was appointed “to
make a broad survey of the present posi-
tion in regard to health conditions and
health organisation in British India and to
make recommendations for future develop-
ments”(1943 : 1). While it recommended
far-reaching measures for health condi-
tions from the point of view of biomedi-
cine, it declared that it was “not in a position
to assess the real value of these systems”
(ibid: 3). However, the spirit of its blue-
print for the health services of post-war
India was quite hostile to the role of in-
digenous systems of medicine in it.
The attitude and omission on the part of
the Bhore Committee provoked a great
deal of public criticism, including that in
the presidential address of the All-India
Medical Conference held at Madurai in
1946. As a consequence of this, the Health
Ministers’ Conference held in October
1946 at Delhi resolved to make provisions
“for research in and the application of
scientific method for the investigation of
the indigenous systems..., for starting
colleges and schools for training for di-
ploma and degree courses in indigenous
systems of medicine and for postgraduate
courses in Indian Medicine for graduates
in Western Medicine” (quoted in Govern-
ment of India 1948:6-7). Further, it also
resolved to “absorb the practitioners
of Ayurvedic and Unani systems of
Medicine into the State Health
Organisation by giving them further sci-
entific training wherever necessary as
health personnel, like doctors, physical
training experts (Ustads), sanitary staff,
masseurs, nurses, midwives” and “that in
the Central Council and Provincial Health
Boards and Councils, the Department and
Practitioners of Indian Medicine should be
given due representation, wherever pos-
sible” [ibid:7].
The Chopra Committee (On Indigenous
Systems of Medicine) was set up follow-
ing this and it submitted its report in 1948.
This was a crucial committee that marked
important points of departure from colo-
nial policy, while continuing much of the
spirit of the approach of the state and,
remained a point of reference for many
subsequent investigations. In its report, it
is possible to delineate three main argu-
ments. They are: (1) those of integration
in teaching/education of traditional medi-
cal systems; (2) those of standardisation
and rationalisation of research and produc-
tion parameters, primarily to serve modern
needs of commercial production and
(3) those of hastening specialisation in the
traditional medical systems, with an em-
phasis on learning the techniques involved
in that, from the biomedical system. Each
of these clearly illustrate the overall po-
sition of the committee and also of the
parameters that were set and followed for
Ayurveda and all Indian systems of medi-
cine for a long time to come.
To begin with, the report says, “Science
is universal and medical science is no
exception. We do not believe that there can
be separate systems of western or Indian
medicine. Such multiplicity of systems is
only believed in and encouraged by people
who have not clearly grasped the signifi-
cance of the noble ideals as preached by
the great Acharyas of Indian medicine and
the savants of western medicine...Anything
of value emerging from these should be
utilised for the benefit of humanity as
a whole and without any reservation”
[Government of India 1948:7].
This statement provides the context of
the position on integration of the teaching
of Ayurveda with that of modern medi-
cine. That is, since there can be no cultural
specificity of science, therefore, different
systems of knowledge can be taught to-
gether. Two questions immediately emerge
from this. One, how are the parameters of
inquiry, investigation and analysis going
to be determined? Two, is the ‘rationality’
and therefore, the higher scientific status
of biomedicine, as at the same time, the
magico-religious and hence ‘unscientific’
character of Ayurveda, being assumed,
when obviously the integration has to be
of Ayurveda into biomedicine and not the
other way round? This again is a question
of the relationship between the different
rationale of different medical systems. This
brings us to the second and third aspects
of the Chopra Committee report. They are,
the proposals for the standardisation and
rationalisation of the product and process
of Ayurveda, as also the need for
specialisation in medical practice. It must
be remembered though, that by the time
this report was written, the reality check
was as follows. The mass production of
Ayurvedic medicines had been on for over
50 years and so the concomitant problems
already known and being discussed. These
ranged from the availability of certain plant
materials, or the knowledge of effective
substitutes, to the non-uniformity of reli-
able raw materials or chemical bases to be
used in the manufacture of medicines. The
report states, “Pharmaceutical industry...
still in its infancy...few large firms of drug
manufacture...Taken as a whole, it cannot
be said that any uniformity of standards
of preparations is being maintained by all
these firms. This, it is said, is due to the
difficulty of securing genuine crude drugs
of standard quality in the market”
(1948:177).
While the committee bemoaned the fact
that the situation has not changed signifi-
cantly since similar complaints made by
the Drugs Enquiry Committee of 1930-31
(of which too, R N Chopra was the chair-
man), it urged that these required urgent
resolution, if mass production of tradi-
tional medicines were to continue. How-
ever, it is important to ask why this com-
mittee appointed by government, as also
all the others that came subsequently, would
take for granted, the ‘fact’ that mass-scale,
commercial production as need. This is a
question that is never asked because alter-
native production structures for Ayurvedic
medicines were never articulated as an
issue, even when the government subse-
quently established its own pharmacies for
providing medicines to the health centres.
It was true of course, that people need good
Ayurvedic/traditional medicines and that
this was a need which the government was
trying to respond to. By assuming how-
ever, that they would have to be necessar-
ily mass-produced, this report reflected the
ideology of production and distribution
dominant at the time. Thus the fact that
ancient texts providing methods for the
making of medicines in small amounts, it
cited as a problem. It could well have been
a strength, if the production decision to
make medicines at a decentralised level by
well-trained vaidyas, in numbers sufficient
for small, local communities all over the
country were taken. Therefore, this was a
reflection of the overall myopia with re-
spect to development policies, rather than
a specific problem with respect to
Ayurveda. However, it has affected the
very significant, fundamental issue of the
production of Ayurvedic medicines in an
overall sense, because even when the
government set up its own pharmacies to
supply to the dispensaries, it worked with
the typical sense of constraints that small
production units have. That context of

Economic and Political Weekly March 23, 2002 1137

production was never utilised to explore
the larger possibilities of linking techno-
logical/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 at-
tached 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 impor-
tantly, the direction of development of
teaching of Indian Systems of Medicine
was very clear.
Following these discussions and recom-
mendations, the most visible aspect of the
development of Ayurveda in the next 25
years or so was the institutionalisation
of its teaching and the professionali-
sation of its practice. The ‘shuddha’
Ayurveda as opposed to either the concur-
rent 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 thereaf-
ter, 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
1138
science (Ashtanga Ayurved), viz, Kaya
Chikitsa, was in vogue, while the remain-
ing seven-eighths had to be revived and
reintroduced...We are sure that in the
process of this revival these very enthu-
siasts will feel the necessity of absorbing
the modern scientific developments while
giving it an Ayurvedic touch” [ibid:8,
emphasis mine].
This last statement is clearly indicative
of where influential policy-makers think
is Ayurveda worth locating vis-a-vis the
dominant biomedical system. It is spe-
cially telling because on its very first page,
this report bemoans the decadence and set-
back to Ayurveda “during the Mughal
period,...because many of the texts of
Ayurveda were destroyed and practitio-
ners of the system were systematically
discredited” [ibid:1].
Following the argument of this study,
this report did exactly the same thing, as
they accused the Mughals of doing, by the
kind of suggestion made above. The issues
of integration in education, as well as that
of professionalisation of the practice of
Ayurveda continue to be vexed questions
of policy, on more or less similar lines of
difference.
The relevant issue in this discussion is
of course that there was so much discus-
sion and furore over the purity of Ayurvedic
education, but no corresponding debate
on questions of production. Undoubt-
edly this was an important issue until the
late 19th century. There were those like
Kaviraj Gangadhara Ray, “said to have
laughed at practitioners who prepared
medicines before hand for their patients,
calling them Badial, possessors of pills
ready for common use” [Gupta 1976:376].
But the logic of mass production and
returns to scale were dominant enough
to be self-evident wisdom about produc-
tion and so large- scale centralised produc-
tion companies emerged as the only
possible institution of production of
Ayurvedic medicines. But even today,
when the debate seemingly has moved
on to quality, this underlying assumption
is never questioned or the issue of alternate
production possibilities ever explored. We
have discussed elsewhere [Banerjee 195]
that this is evocative of the lack of a larger
vision of an alternative modernity. Yet,
this need not be a cause for despair. There
is still a possibility that in the new phase
of combating the forces of globalisation,
the inspiration for making such a counter
point may be possible. This is discussed
in the section on globalisation below.
Economic and Political Weekly
Manufacture of Ayurvedic
Medicines
The issue of the manufacture of pharma-
ceuticals in this period was only tangen-
tially influenced by the disputes on
Ayurveda as a whole, as discussed above.
But the fact that, the standardisation of
manufacture, as well as the validation of
efficacy were two crucial dimensions of
this sector were understood very early on.
However, the response so far has been
scattered over a number of statements,
initiatives and interventions made by
government over this period of time. These
will be considered in detail here and the
ways in which they lead up to the present
policy.
The Udupa Committee is the first after
the Chopra Committee to discuss the issue
of pharmaceutical products, possibly be-
cause one of the explicit terms of reference
to it was to assess the nature, volume and
standards of Ayurvedic pharmaceutical
products in the country. For this purpose
they issued a questionnaire to a number
of private pharmaceutical concerns and
pharmacies attached to government hos-
pitals or run independently by govern-
ment. While they conclude from the sales
figures that “...Ayurvedic treatment is very
popular in spite of the heavy consumption
of modern drugs” [ibid:119], they point
out what seem to them as serious and
obvious handicaps, some overcome and
others continuing. An example of the
former is that a majority of pharmacies
seemed to be resorting to mechanical means
of production adapted to the needs of
Ayurvedic science. They observe, “It may
be recalled that the preparation by hand
by individual vaidyas was one of the serious
handicaps that made Ayurvedic practitio-
ner and Ayurvedic treatment less popular
to the modern minded people” [ibid:119,
emphasis mine]. Nowhere is this explained,
nor is there an accurate reference to the
‘recalling’, perhaps because it seems to be
obvious to the committee. What it clearly
implies for this analysis is that there is an
unquestioning acceptance of the dominant
ideology of production.
The other significant point raised by this
committee with respect to Ayurvedic
pharmaceuticals is that of the source books
for the preparations. Again, the observa-
tion on different texts being used by dif-
ferent concerns, was pointed out as a
problem, with an obvious reference to the
lack of standardisation of the source
[ibid:119]. This and the recommendations
March 23, 2002
of a number of other committees led to the
drawing up of the Ayurvedic Formulary
of India by 1978, which laid down guide-
lines for the essentials of standardised
manufacture. The Ayurvedic Formulary of
India and the subsequent debates and
developments on standardisation. The
Ayurvedic Pharmacopoeia Committee was
finally set up on the recommendation of
the Central Council of Ayurvedic Research
in 1962. It was assigned the following
functions:
(1) To prepare an official Formulary in two
parts:
(a) Single drugs, of whose identity and
therapeutic value there is no doubt; and
(b) compound preparations which are fre-
quently used in Ayurvedic practice through-
out the country.
(2) To provide standards for drugs and
medicines of therapeutic usefulness or
pharmaceutical necessity sufficiently used
in the Ayurvedic practice.
(3) To lay down tests for identity, quality
and purity.
(4) To ensure as far as possible uniformity,
physical properties and active constitu-
ents; and
(5) To provide all other information re-
garding the distinguishing characteristics,
methods of preparation, dosage, method of
administration with various unpins or
vehicles and their toxicity (1978:xxx).
The formulary was prepared on the basis
of consultations with a large number of
practising physicians and establishments
making Ayurvedic medicines. It was de-
cided “that with a view to give maximum
coverage to drugs and medicines used in
general practice, the First Edition should
contain medicines that are (a) manufac-
tured on a mass scale for commercial pur-
poses and are best sellers and (b) popularly
used by leading Ayurvedic physicians in
their day-to-day practice” (ibid: xxxiv). As
a result of this 444 preparations were dealt
with, with the hope that subsequent edi-
tions would cover major gaps.
It is interesting that while the formulary
is supposed to serve a ‘technical’ require-
ment in the manufacture of drugs, it es-
tablished its justification largely in terms
of sociological reasons. It stated, “The
practice of the individual physician iden-
tifying 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
and more dependence on readymade prepa-
ration...” [ibid:xxvii].
Economic and Political Weekly March 23, 2002
Above all, the formulary is a work of
‘translation’ of a fascinating kind, which
substantiates the basic argument of this
study. It is written in English and the pattern
is such that each drug is defined and the
method of preparation, as standardised 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 disease-
wise. 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 prac-
tices faithfully reproduced from the texts,
as if the very institutions they had con-
sulted before starting on this work, con-
tinue to follow these procedures. These
include earthen vessels, fermentation pro-
cesses 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, wooden-
vats, porcelain-jars or metal vessels are
used in place of earthen vessels” [ibid:1],
but there is no clarity on whether this is
acceptable, or what the implications of
these could possibly be. As will be dis-
cussed later, this is important precisely
because these constitute important pro-
duction 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 arena of 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 satis-
faction and professional credibility, there
were criteria of tests to be done. Their
absence proves a major gap 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 inter-
national 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 interpret-
ation 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, ambi-
guity on the part of the government in the
matter retains at least some aloofness and
authority for it.
Thereafter, the second and third vol-
umes of the Ayurvedic Formulary have
been published, that provide further de-
tails. 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 are two 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 evalu-
ation as developed for biomedicine and
take those results as the guiding factor.
Further, Ayurveda claims the knowledge
of the exact medicinal properties of a large
number of plants, but in order to create
new drugs from them, the clinical evalu-
ation of their claimed properties of medici-
nal 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 govern-
ment has two kinds of institutions involved
in this activity – the Central Councils for
Research in Ayurveda and Siddha (insti-
tuted by the health minister Raj Narain
of the Janata government of 1977-79) and
the other, special scientific committees in
1139
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 depart-
ments of Ayurvedic colleges and univer-
sities 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
pharmacological or 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
research efforts 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 dis-
cussed in this paper and so one that needs
to be urgently addressed by the govern-
ment.
What is important to clarify is that
standardising the quality of the manufac-
tured 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 standards of 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 of its
medicines. In a country like India, the
knowledge question is important, in the
rapidly ‘modernising’ society where edu-
cation, professional and lifestyle changes
of a certain class has meant that all things
based on traditional knowledge 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 medi-
cines are not able to demonstrate the ef-
ficacy 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
Central Council for Research in Ayurveda
and Siddha, New Delhi revealed that the
current policy emphasis is on the working
1140
out of TLC profiles of most drugs. Now
that the export market is definitely open-
ing 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
research councils and any initiatives by the
government have to be based on them.
This is echoed by the statement of the
Indian Ayurveda Congress about the focus
of its most recent conference:
A very clear emphasis has been placed to
draft a strategy for evolution of inter-
nationally acceptable standards for con-
ducting research in alternative systems of
medicine... During the Congress, it is hoped
that progress would be made towards
evolution of methods, which will be accept-
able to ‘Drug Regulatory’ authorities of
various countries. How this would be
achieved is a task, which requires close
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 creden-
tials and acceptability of the Indian Sys-
tems of medicine, referred to in the open-
ing paragraphs of 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 hege-
monic knowledge system, as in the pro-
duction 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 integra-
tion 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 integration are
new. There are two beacon lights available
for this. The first is the critical revaluation
of the parameters of the controlled clinical
trials conducted by the scientists of the
Economic and Political Weekly
ICMR. More than 20 years ago, Chaudhury
argued that
The controversies, challenges and prob-
lems that arise when carrying out clinical
trials of plants with anti-fertility properties
can be appreciated better if viewed against,
(a) a background of the historical use of
medicinal plants, (b) the past experience
in screening such plants for pharmacologi-
cal activity, and (c) an understanding of
some of the relevant concepts of the in-
digenous systems of medicine where plants
have been traditionally utilised (1980:474).
His insistence on this position, as also that
the pattern/protocol of clinical trials should
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
motivate allopathic hospitals to undertake
trials to establish the benefits likely to
follow using traditional approach whether
directly or as an adjunct therapy. Research
methodologies have to be designed keeping
in mind the individualistic nature of the tradi-
tional diagnosis and the holistic aspect of
traditional drugs [MOHFW 2001:17].
What is significant about this is the parity
that is accorded to the biomedical and tradi-
tional knowledge systems, by an eminent
mainstream scientist. This would certainly
be one of the most obvious ways in which
some communication would be restored
between the hitherto antagonistic systems.
The second beacon light is from a num-
ber of experiments in ‘integration’ of
different medical traditions, already being
carried out by non-governmental organisa-
tions in many parts of 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 nec-
essary participants identified in order to
bring them together. This will be better
understood once some of these organisa-
tions have been discussed later in 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
March 23, 2002
had Ayurvedic physicians associated with
them. These have grown with time, though
not always proportionate to the demands
made on them. The latest information availa-
ble on the number of licensed pharmacies
is as of April 1998. The centrally-assisted
pharmacies and the statewise number of
pharmacies are shown in Table 1 [MOHFW
1998:316]. The associated institution that
was set up in 1978 was the Indian Medi-
cines Pharmaceutical Corporation, in Ram-
nagar, UP, with a view to meet the demand
of units under central and state govern-
ments, which the latter could not fulfil.
In the Drugs and Cosmetics Act (1940),
the definition of a ‘drug’ excluded “medi-
cines and substances exclusively used for
or prepared for use in accordance with the
Ayurvedic or Unani systems of Medicine”.
When it was amended in 1964, it ensured a
limited control over the production and sale
of these medicines, in the following ways:
(1) The manufacture should be carried out
under hygienic conditions, under the su-
pervision of a person having prescribed
qualifications;
(2) the raw materials used in the prepa-
ration of drugs should be genuine and
properly identified; and
(3) the formula or the true list of all the
ingredients contained in the drug, should be
displayed on the label of every container.
All manufacturers now follow the above
provisions. However, many users, particu-
larly vaidyas, do not feel that it serves any
particular purpose.
Two consequences have resulted from
this instead. One, that often the ingredients
listed on the label, are those required by
the quoted formulation, but are no longer
actually available in the market. The buyer
of these medicines is not aware of such
changes and so, may be paying for only
a substitute after all. Since that cannot be
openly demonstrated, it is possible that
non-standard substitutes are being used,
which may at best be ineffectual and at
worst be harmful to the patient. In fact, a
young and committed vaidya told me that
the biggest companies in the market, used
the most shocking natural plant material
for these purposes, but there was no agency
or institution which was available, to ei-
ther check or apprehend this practice.
Good manufacturing practices for
Ayurvedic medicines: These are included
in the latest Rules of the Drugs and
Cosmetics Act and are supposedly a re-
sponse to the ‘conscious’ new consumer
of Ayurvedic products, who would like to
be assured of the best conditions in which
Economic and Political Weekly March 23, 2002
these medicines are being made. So in two
parts, this new set of rules delineates both
the actual requirements of premises, pol-
lution control and other facilities as also the
kinds of machinery that are now manda-
tory for the manufacture of broad classi-
fications of medicines. The latter particu-
larly seems to be carefully done because
the lists for Ayurveda/Siddha are separate
from that of Unani, given that the types
of medicines are not exactly the same. The
‘hygienic conditions’ just mentioned in
the earlier amendment are here spelt out
clearly in terms of the factory premises,
location and surroundings, buildings, water
supply, disposal of waste, storage of raw
materials, packaging materials and fin-
ished goods and the working space. For
the first time, there are specifications of
the health clothing and the health condi-
tions/hygiene of workers. Besides, there
are a clear set of instructions about keeping
distribution records, those of market com-
plaints and quality control procedures fol-
lowed. It is interesting that for the last,
which, it has been repeatedly stressed in
this article, is such a major area of concern
both for government and big industry, the
standard requirement is that of following
the specifications of the Ayurvedic For-
mulary. But a most interesting exception
has been made in the case of “teaching
institutions and registered qualified
Vaidyas, Siddhas and Hakeems who pre-
pare medicines on their own to dispense
to their patients and not selling such drugs
in the market are exempt from the purview
of the GM” [MOHFW 2001:342].
Role of Indigenous Practitioners
The country has a large stock of health
manpower comprising of private practitio-
ners in various systems, for example,
Ayurveda, Unani, Siddha, Homeopathy,
Yoga, Naturopathy, etc. This resource has
not so for been adequately utilised. The
practitioners of these various systems enjoy
high local acceptance and respect and
consequently exert considerable influence
on health beliefs and practice. It is, there-
fore, necessary to initiate organised mea-
sures to enable each of these various
systems of medicine and health care to
develop in accordance with its genius.
Simultaneously, planned efforts should be
made to dovetail the functioning of the
practitioners of these various systems and
integrate their service, at the appropriate
levels, within specified areas of responsi-
bility and functioning, in the over-all health
care delivery system, specially in regard
to the preventive, primitive and public
health objectives. Well considered steps
would also require to be launched to move
towards a meaningful phased integration
of the indigenous and the modern systems.
In accordance with the structures agreed
upon in the early planning years, the struc-
ture of the central health service was such
that the dominant position was attributed
to biomedicine and the indigenous sys-
tems of medicine, Ayurveda, Unani and
Siddha were incorporated into the regular
structure. Later, Homeopathy, Yoga and
Naturopathy were also included, and the
terms and arguments on which this was
done is a fascinating story. But clearly, the
option that was being favoured and propa-
gated by the government was the allo-
pathic system, with its biggest outlays for
hospitals, dispensaries, doctors nurses,
other paramedical staff. This meant prima-
rily that the emphasis remained on the
elaborate and expensive infrastructure, on
big hospitals in metropolises and central
towns, combined with a disregard for
primary health centres and provision of
basic amenities which would help in the
maintenance of health. Thus, even the
epidemiological aspect of biomedicine,
which would have focused on these as-
pects, was ignored.
The policies that emerged with respect
to the Indian Systems of Medicine re-
flected the lop-sided understanding of the
desirable nature of the health-service sec-
tor in general and the relative significance
of the systems of medicine in particular.
The general view is manifest in the fact
that outlays to the Indian Systems of
Medicine duplicated the exact pattern as
for the biomedical services, rather than
creating an alternative structure for it
altogether, in keeping with their method
of treatment and perspective of health. The
allocation for Indian Systems of Medicine
in the Five Year Plans has grown from
Rs 0.40 crore in the First Plan to Rs 85.39
crore in the Seventh Plan. Not only is this
a small figure in absolute terms, but also
particularly eloquent when compared to
the outlay on the rest of the health sector
(refer Tables 3-6). The most eloquent,
however, is the classification of entries in
the Annual Reports of the ministry of health
and family welfare (which have not changed
pattern for many years). There are separate
entries on health, hospitals, dispensaries,
etc, with central and statewise figures. But
on close examination it becomes evident
that these are made in such a way that they
1141
include only the allopathic system. For
information relating to any of these aspects
of the ISM, an altogether separate entry
on them needs to be located. It indicates
from this that the ISM is in a position akin
to that of an oddity in the ministry’s
activities and seems almost peripheral to
it. This was also in evidence in the colleges
and examination boards and other such
educational infrastructure that were pro-
vided from the very beginning by the
government far outstripping similar pro-
visions in the indigenous systems.
II
Developments of Last Decade
The limited focus of the post-colonial
state with respect to the Indian Systems
of Medicine, was reflected amply in the
position it occupied in the large ministry
of health in the centre. In the 1970s, when
population became a major issue within
and outside of developing countries, it was
expanded to include family planning, later
improved to family welfare. ISM was even
then a small section, the charge of no more
than a joint secretary. But it was only in
the 1995, with an increasing recognition
of the significance of this area and its
potential in the new markets, both domes-
tic and international, that it was given the
status of a third new department within the
ministry, with a full-fledged secretary in
charge. This development, in terms of the
meanings of changing hierarchies in pub-
lic administrative institutions, has meant
basically much more autonomy to conduct
its affairs. One of the most positive out-
comes of this autonomy is its changing
relationship with industry.
In March 2001, this was in evidence at
a conference organised jointly by the
Confederation of Indian Industry (CII) and
the Department of ISM, called ‘Good
Health in the New Millennium’. The
conference interestingly was organised at
the initiative of the CII and given the new
tenor of the government’s activities and
orientation, it was possible to build some
linkages with industry and further, some
actors in the civil society. This was quite
a milestone event and for the first time it
is perhaps possible to envisage partner-
ships in progress between the different
actors that have played significant roles in
the development/modernisation of
Ayurveda. But what the outcome for this
partnership turns out to be, particularly in
the face of the rapidly changing interna-
tional economic and trading environment,
1142
is not entirely clear yet. There are a number
of arenas where this is possible to envisage,
though. One such is that of medicinal plants.
Even at this conference the CII presi-
dent, in his speech referred to the possi-
bilities that the traditional medicine indus-
try and those of its raw materials, particu-
larly medicinal plants, could mean for India
in the world market. He offered that an
expansion in the usage of the former could
well be encouraged by apprising different
industries (affiliated to the CII) about their
continuing significance and providing
incentives to their workers and
organisations, like reimbursements, etc, so
they would use them. About medicinal
plants and India’s possible gains in the
world market, he was aware of the con-
tradictions. While there was enormous
demand on the one hand, there was great
concern for the depletion of biodiversity
as a result of over harvesting on the other.
He suggested that in this context, the input
of companies to cultivate these plants and
to create herbal gardens would be a worth-
while activity both in terms of intent and
profit. As it happens, the prime minister,
who graced this historic occasion, an-
nounced with great flourish the creation
of a Medicinal Plants Board, that would
look at all these questions closely and
advise the government on making policies
on this important new area. While this
announcement had been made before, this
time round it did result in the creation of
this board and the first committee meeting
was held in September 2001.
This board is a national level body of
the government of India, “constituted to
look after formulation, coordination with
ministries/departments, ensuring sustain-
able availability of medicinal plans and to
coordinate all matters relating to their de-
velopment and sustainable use” [MOHFW
2000:2]. It includes a number of bodies
and groups, within government – across
ministries and outside of it and certain
major players from the civil society – both
companies and non-governmental
organisations. It has designated several
committees, to focus on the different
aspects, the cultivation, including conser-
vation of rare and endangered species,
research, demand and supply, on patents
and intellectual property rights and on
exports and imports. Thus, it is designated
a number of functions, relating to each of
these activities and could well be a very
important institution in one of the most
significant new arenas of governmental
activity in the years to come.
Economic and Political Weekly
The policy that set this board in place
is very conscious of the national and inter-
national pressures now at work. While the
demand for medicinal plants grows be-
cause of the increasing market for herbal
products, there is a very real awareness of
over harvesting and depletion of irreplace-
able natural resources. So both the produc-
ers and the sustainable development lobby
are concerned. Given that so much of the
negotiations in the future are going to be
around these natural resources, such a board
could well play a very important role in
projecting the best Indian interests in the
international arena. It remains to be seen
as to whether it exercises it potential and
to how the hierarchies of power within the
different organisations and institutions
involved, respond to these questions.
The traditional medicine knowledge
digital library, conceptualised and devel-
oped by the government research and
development institutions including CSIR
laboratories in the country, will go online
on December 15, 2001 enabling accessi-
bility to it for patent examiners worldwide.
About 3,500 formulations in Ayurveda,
followed by Siddha and Unani with details
about the plants and their combinations
will be put up on the web site. The secretary
of ISM and Homeopathy, government of
India told Pharmabiz.com that one of the
major objectives to have a digital library
in place was to ensure that the patent drama
played with regard to turmeric is not re-
peated. She argued that at a time when the
west is clamouring for plant-based health
care products, the Indian Institute of
Medicine (IIM) and its practitioners need
to be more organised, quality conscious
and proactive. “We now need to streamline
the standardisation of drugs, spruce up
R&D and manufacturing facilities”.
Draft National Policy
As is evident then, a number of develop-
ments have made it possible for govern-
ment policy to gravitate toward a national
policy exclusively oriented toward the ISM.
There are major points of departure dem-
onstrated by this policy. First, there is an
overt support for the ISM yet significantly,
it is not argued for on the basis of their
lineage or innate superiority. With the clear
statement that they have not been appre-
ciated enough for the role they play in the
health of the country, there is instead a
conscious positing of the pragmatic use
of these systems. The policy states that
given the huge government – funded
March 23, 2002
infrastructure facilities that an effective
utilisation of these would serve to augment
the public health programme. At the same
time, it addresses issues of access and
equity, system neutrality in offering ser-
vices and expanding choice. Most impor-
tantly however, it clearly takes the position
of promoting medical pluralism and
introduce strategies to mainstream the
indigenous systems of medicine. This
way it marks a radical departure from the
Chopra Committee position quoted
earlier in the paper and that which pro-
vided the subtext of all subsequent policy
interventions.
Second, the policy states envisages a
change in the orientation of research and
output of the ISM developed by the ICMR
and the research councils. This document
reflects the benefits of many years of
questioning and rethinking on these
knowledge systems, both by those within
them and those without. This will have
far-reaching implicaitons for the questions
of standrdisation and vlidation that have
dominated the government discourse on
this issue for so long. This will be discussed
in more detail in the next section analysing
influence of the international organisations.
Third, this policy is a first in recognising
identifying different ‘stakeholders’ in the
policies on ISM. This implies that the role
of the civil society, i e, both the companies
manufacturing medicines and the non-
governmental organisations engaged in
issues around Ayurveda, is seen to be
important to include and involve in any
government initiative. It further recognises
that this step could help actualise some
questions that seem to remain at the aca-
demic level simply because there is a lack
of political will and institutional infra-
strucures to implement them. A very
important issue in this context is that of
sustainable development. The increasing
market for medicinal plants, whether for
direct export or for the growing manufac-
turing sector of Ayurvedic medicines,
implies a depletion of biodiversity and
so there has to be a concerted attempt by
industry government and non-government
organisations to tackle the problem. This
can be seen as one of the more substantial
and positive policies of liberalisation,
claims of which are being made by
government for so long. Howevver, most
uncharacteristically, the will has come from
an institutional intervention and that can
be cause for concern as well as celebration.
Concern, because the political climate in
which this sector is being projected is not
Economic and Political Weekly March 23, 2002
best known for its critical approach to
traditional knowledge – the issue of astro-
logy being fresh in everyone’s mind. Cel-
ebration, because political agendas often
get waylaid by bureaucratic delays or
hostility and in this instance, quite the
opposite is evidently the case.
III
Influence of International
Organisations
The World Health Organisation (WHO)
has defined herbal medicines as “Finished
labelled medicinal products that contain as
active ingredients aerial or underground
parts of plants, or other plant material or
combinations thereof, whether in the
crude state or as plant preparations” [WHO
1996:178-83]. The same WHO document
adds that medicines containing plant
material combined with chemically de-
fined active substances, including chemi-
cally defined, isolated constituents of
plants, are not considered to be herbal
medicines.
In 1978 the WHO and the United Nations
Children Fund (UNICEF) came out with
the Alma Ata Declaration with the goal of
providing health care for everyone in the
world by the year 2000. In support of that
goal, WHO, UNICEF and the World Com-
munity endorsed traditional medicines
programmes worldwide and underscored
the important role of traditional medical
systems in providing primary health care
to 80 per cent of the world’s population
(WHO 1978). In the 1980s, there was a
continuous, if marginal support for re-
search on issues of traditional medicine.
But these were mostly on the pharmaco-
logical and toxicity aspects, in tune with
the requirement of ‘validation’ of herbal
medicines of any kind, put forward by
hegemonic scientific institutions. Given
that mainstream scientists dominate the
scientific committees of the WHO, that is
not surprising. In that sense, the analysis
of the “WHO, while being a technical
agency of the United Nations, is also a
political agency which reproduces and
distributes political positions through its
technological discourse and practices”
[Navarro 1984:165], continued to be valid.
In 1987, the 40th World Health Assem-
bly adopted a resolution reaffirming the
Alma Ata Declaration and gave two fur-
ther mandates to the WHO:
(i) Initiate comprehensive programmes
for the identification, evaluation, prepara-
tion, cultivation and conservation of
medicinal plants used in traditional
medicine. (ii) Ensure quality control of
drugs derived from traditional plant rem-
edies by using modern techniques and
applying suitable standards and good manu-
facturing practices. Following this, came
the Chiang Mai Declaration of 1988 en-
titled, ‘Saving Lives by Sharing Plants’.
It recognised that medicinal plants are es-
sential in primary health care, both in self-
medication and in national health services,
viewing with grave concern the fact that
many of the plants that provide traditional
and modern drugs are threatened. This
then focused attention on the issues threat-
ening medicinal plants, including those of
habitat destruction and unsustainable
harvesting practices, and the continuing
disruption and loss of indigenous cultures. It
would seem though, from the subsequent
focus provided by both the WHO and the
national governments, that the most im-
portant was the significant economic value
of the medicinal plants used today and the
great potential of the plant kingdom to
provide new drugs. What is relevant for
this discussion is that given the change
of emphasis in the international market
with the new possibilities of the herbal
medicine sector, that the focus of the
WHO seems ot have moved away from
traditional medicine to that of herbal medi-
cine. The latter is more inclusive than the
former, and allows for the entry of the
biomedical pharmaceutical sector. The
implications of this, for both policy and
politics, are very significant and will be
discussed later.
The influence of these developments on
the decision-making of the Indian govern-
ment in this sphere, has an interesting
trajectory. With the Alma Ata (1977)
Declaration’s emphasis on the primary
health care system, a greater role for
Traditional Medicine and Health for All,
the focus had to be shifted somewhat from
the biomedical, large hospital and urban-
centred approach of our health service.
With the Chiang Mai Declaration of 1988
and a series of meetings and conferences
later, these two policy imperatives, of
primary health service and traditional
medicine, seem to have been married. So
now traditional medicine systems are being
posited as the main instruments of realising
the objective of providing holistic and
cheaper health alternatives at the primary
health care level.
But an interesting shift can be observed
through stray publications like that authored
by Ranjit Roy Chaudhury, entitled Herbal
1143
Medicine for Human Health (1992). It
contains the most searing criticism of
mainstream scientific research, “There is
this continued refrain that medicinal
plants being used for the alleviation of
symptoms and of illnesses at the primary
health care leve should be evaluated for
efficacy. This insistence on testing by
western-trained scientists, moulded in the
allopathic mode of thinking,...could be
dangerous” [ibid: 77]. Again, “One impor-
tant step in any new approach is to wipe
away the attitudes developed over years in
the training provided by the western sys-
tem of medicine” (ibid:79); and a similar
critique of the international organisations,
“there is no sign of any international
consortium or a joint programme involv-
ing WHO. The United Nations and the
World Bank, for example, like the Tropi-
cal Diseases Programme, in the field of
medicinal plants research” [ibid:77]. Then
he goes on to offer the most radical of
alternatives, a fragmentary example of
which is as follows. “It would be ideal if
an innovative and imaginative research
programme aimed at the development of
a few selected herbal drugs is set up between
an interested and leading University de-
partment, a pharmaceutical house and
WHO and, if necessary, other United
Nations organisations such as the United
Nations Development Programme”
(1992:80).
While none of these ‘ideal’ solutions
find actual expression in later WHO poli-
cies, the force of the argument is reflected
in some recognition and accommodation
of clearly conflicting interests. The latest
in this sequence is the WHO Guidelines
for Quality Control of Medicinal Plant
Materials. This is a set of guidelines laying
down very detailed instructions that could
be used to set standards for international
markets. But the usage of words in the title
is most striking. Not medicinal plant
medicines, even products (as have been in
vogue for some time now in the market),
but simply materials. It is possible of course
that brevity is the reason for this usage,
given that medicinal plants are processed
into a wide range of things – like inter-
mediate products, raw materials, as well
as medicines and other products. So the
only inclusive term could have possibly
been ‘materials’. However, given the trend
of the slow erosion of legitimacy to the
medicines of ‘traditional’ systems in the
international market, this word does not
seem innocent of reducing traditional
medical systems to simply plant materials.
1144
Apart from this, the details of the guide-
lines continue to emphasise the clinical
and pharmacological aspects, of the kind
that Roy Chaudhury so passionately ar-
gued against not 10 years ago.
It is interesting however, that the latest
policy of the national government does ref-
lect some of the sentiments of Roy Chaud-
hury’s crusade, when it identifies the dif-
ferent stakeholders and common program-
mes and interests to be pursued in conso-
nance with each other. “An environment
for collaborative research is sought to be
created, by establishing integrative struc-
tures for research, bringing together the
various stakeholders and assigning funds
to support these activities” [MOHFW
2001:16].
Globalisation and Ayurveda
In the global economy, wherein herbal
products has already been identified as a
profitable enterprise, the support-struc-
tures, resourcewise as well as in legal terms,
are already being created. With the drastic
changes in the patent laws imminent in
India, two forces will play an important
role. One, the processes of manufacture
will become patentable, a facility which
transnational companies will be able to
avail of before any of the Indian compa-
nies, because of the sheer size of their
research and development divisions. Two,
the already initiated process of the creation
of gene banks in the industrialised coun-
tries, will give them rights also to geneti-
cally engineer plant varieties for medicinal
purposes, now in accordance with the
requirements they identify in the market.
This will, in fact, completely stand on its
head the conception of man and nature in
Ayurveda, that is, that they belong to the
same cosmology from whence the source
of sustenance as well as succour comes.
Having systematically abdicated its cos-
mology as well as form to these larger
ideological-political forces, Ayurveda
cannot combat these forces within the
parameters of production and the market.
When these structures actually begin to
function in the way they are meant to, then
it is likely that the host of small manufac-
turers of Ayurvedic medicines in the market,
will be effectively competed out of the
market. So a combination of new patent
laws and the creation of gene-banks, will
wrest the control and capacity of local
entrepreneurs over their own resources and
markets. Thus, in the sphere of mass
production, Ayurvedic medicines will pass
Economic and Political Weekly
on to the control of the new trading re-
gimes. But that is not all.
It is important to see that the ‘herbal’/
the ‘natural’ are as much concepts, as the
label for a certain variety of products.
Also, that this concept is actually more
important in preparing a space and mindset
for the market, already created in the
industrialised countries. There, it had
stemmed from the dissatisfaction with
modern biochemical products, both me-
dicinal and cosmetic. Over time though,
these products had come to slowly occupy
the entire space for ‘alternatives’. Thereby
they have sought to substitute commodi-
ties for what was being increasingly
recognised by those societies as a concrete
and comprehensive political need. I be-
lieve that this trend, more than the products
themselves, that is being transposed to the
developing countries. That it can be pos-
sible to provide a salve of the ‘natural’ by
marketing certain products claiming those
properties, rather than leave it open for
contestation in political terms. So, together
with all the other identified concerns, as
those of the taking over of the natural
resources of the developing world by the
new trading regimes and the knowledge
of their process and use by the new patent
regime, this is in fact a more deeply political
take over, not yet being fully appreciated.
In the scramble for protecting the markets
and knowledge regimes, each a very laud-
able and necessary political agenda, a
deeper colonisation is not yet understood.
That it is being played out in terms of the
alternate world views (inherent in these
medical systems) being edged out, that the
reason for this lies not only in the over-
whelming hegemonic forces of dominant
science technology and trade, but the very
policies of ‘standardisation and scienti-
sation’ undertaken by the south Asian
regimes in the last 50 years, these are issues
that need urgent recognition. As has been
consistently argued so far, this is the process
whereby the real process of exploring
multiple/alternate/ diverse modernities was
quelled. It could not be squashed though,
because political movements, albeit on the
fringe, kept this political project alive in
some way.
This is where one of the significant
flaws of the current policy lies. It
emphasises too much the requirements of
the international market, in terms of the
agenda it is setting for itself. Its self-con-
fessed priorities are the standardisation of
requirements for the export market and
the good manufacturing practices for the
March 23, 2002
local, as also the long-awaited regulation
and coordination of the medicinal plants
market. All of these policies are in re-
sponse to the pressure of the international
market and the industrial groups that
stand to benefit from these develop-
ments. Hence the active interest taken in
this respect by the CII and the support
provided to its moves by the different
associations of manufacturers. It cannot be
reiterated enough that while it is wise to
make these moves, because they are
worthwhile and relevant anyway, there
is another side to this. It is countries such
as India, with textual medical traditions
like Ayurveda already geared with the
research institutions and the governments
behind them, that can lend some measure
of challenge and new directions to the
issues of standardisation and regulation
being demanded by the different facets of
the international arena. So can China, given
their experience, but it looks like the forces
of globalisation are going to prove to be
far too powerful for such challenges to be
made concrete.
IV
Civil Society and Ayurveda
As indicated earlier, two parts of the
civil society have been important for
Ayurveda: industrial-manufacturing units
of Ayurvedic medicines and non-govern-
mental organisations. Each of these has
been active in modernising and
foregrounding Ayurveda in the public
domain, particularly in the face of its
decreasing credibility in the dominant urban
market. It is interesting to note that for this
mandate, they have followed the same
trajectories for a long time – highlighting
Ayurveda’s credibility based on historical
experience, trying to demonstrate its
innate ‘scientific’ value and also showing
its relative value counter to those of bio-
medicine. Increasingly however, there
seems to be a significant divergence in
their paths taken by these two parts of the
civil society. While industry and market
are following a series of trends guided by
the potential international market and its
influence on the urban consumer, some
non governmental organisations are delib-
erately charting out a different course of
action. They are concentrating on Ayurveda
as a knowledge system of medicine that
offers not only different kinds of medi-
cines for illnesses, but also a holistic
perspective on health. The latter has been
pointed out as one of the major casualties
of the modernist perspective of health care
along with those on development, like the
policies with respect to agriculture and
industry vis-a-vis the environment. Much
of the response of these non-governmental
organisations is to this critique of develop-
ment offered both by academics and
activists in the last 20 or 30 years. Given
how powerfully they are now lobbying
with both government and industry on the
basis of their solid work on the ground,
this is bound to have very important
implications for the future developments
in/of Ayurveda. We will look at each of
these in turn.
The market for Ayurvedic medicines in
India today displays great variety and
complexity. India Today once reported,
“Take an ancient prescription, add a dash
of essence, enclose it in attractive pack-
aging and back it up with high decibel
marketing methods. What you get is bur-
geoning business and hefty returns in one
of the country’s oldest industries”
(1989:109). This actually indicates the
precise manner in which more and more
manufacturers are worming their way
into what has been an already established
industry and is actually good business sense
now. There are a myriad new companies
everyday, and the market is expanding at
a fast pace. Broadly though, if we examine
the kinds of manufacturers, we find they
are of three types. There are ones that
manufacture Ayurvedic medicines proper,
ones that make mostly cosmetics and
personal care products and those that
make what are known as patent medicines
(new formulations made on the basis of
established Ayurvedic knowledge). Of
these, the ones that are growing the fastest
are the second variety: those of cosmetics
and personal care products, so much so
that well-established companies of
Ayurvedic medicines are strengthening this
part of their operations, Dabur and
Himalaya Drug Company being signifi-
cant cases in point. There is another dimen-
sion to the market, however, which is
the burgeoning of health resorts and
rejuvenation retreats. Again, this aspect
has a fairly wide range from those that are
serious alternate therapy centres to those
that provide a package deal of therapy, diet
and quiet to the harried upper class con-
sumer of today and are thereby part of the
accepted world of health or eco tourism.
This development is so significant that the
Indian government has taken serious note
of it and included it in the new policy
discussed above.
An important element in the market and
the shifts in its priorities, are the ways in
which international capital is moving and
the kind of priorities it is setting for itself.
At the conference I referred to earlier,
Mashelkar pointed out that as the world is
going digital herbal, India should not
find it hard to find itself a place in the sun.
It seems though, that our markets
have already figured which way the wind
is blowing since the early 1990s at least
and for them, they go the way the world
goes. As in so many examples of the last
hundred years or so, the capitalist appro-
priation of the critical and challenging
ideas posited by Ayurveda is slowly taking
place, but what is even more interesting
is that the state is endorsing this shift.
Locating Ayurveda successfully in this
arena of the civil society is circumscribed
therefore in two ways. On the one hand
by the manufacturers’ ability to construct
it in a way that makes it seem accessible
to a particular kind of consumer, and on
the other, to construct the drugs and cos-
metics market such that it can position
‘tradition’ in a form that sells.
The most recent entrant in this market
are ‘Nutraceuticals’ – basically meaning
food supplements and complements to
regular medicines. This is one of the fastest
growing industries these days and is likely
to draw many players – both already ex-
isting firms and new ones, precisely be-
cause of their liminal positioning in the
market. They have neither medicinal nor
cosmetic value, but are increasingly con-
sidered important for two reasons. One,
because the urban middle class in India is
conscious of food not having enough
nutrient value because of adulteration and
that dietary regulation alongwith medica-
tion is becoming increasingly important
even with biomedicine. But what is im-
portant to point out is that this trend also
clearly shows the way forward for bio-
medicine, wherein the necessity for in-
cluding a diet and therefore recognising
the need for dietician, is now seen as a
scientific requirement, which the Indian
physician seems to be unable to do. But
herbal practitioners of all kinds, definitely
the Ayurvedic cannot prescribe without
‘parhez’ (regulation/abstinence)! So this
should be seen as strengthening the direc-
tion of the new ‘integrated science’ – this
is very important to delineate the way
toward the new agenda for alternatives.
Much more confident position that can
show a way out by pointing to the way
forward, rather than back.

Economic and Political Weekly March 23, 2002 1145

look after formulation, coordination with
Given the recognition of the signifi-
cance of Ayurveda in the public domain,
its promotion has been the task of many
a civil society organisation in the last
hundred years or so. These include a large
number of small publishers engaged in the
production and distribution of popular
literature on the concepts, methods and
sources of Ayurveda, those that run
hospitals and dispensaries providing
Ayurvedic treatment and drugs, and in-
creasingly, those that are engaged in docu-
mentation and research on the sources,
local practices and the value of Ayurveda.
While there is a great diversity in these
organisations and their brief with respect
to Ayurveda, there is no doubt that they
have contributed significantly to keeping
the discourse and activity around Ayurveda
very much in currency. It must be pointed
out though, that here too, the influence of
international funding on non-governmen-
tal organisations is obvious. The inter-
national critique of development has paved
the way for a number of significant develop-
ments with respect to traditional knowl-
edge systems. It has fostered the idea that
greater respect for traditional knowledge
systems is crucial for sustainable develop-
ment practices. Further the concept of
rewarding indigenous communities for
the knowledge they share with scientists
and the market, which makes it possible
to preserve and access this knowledge for
posterity and access to larger numbers of
people. There have been organisations
in many developing countries, includ-
ing ours, that have been arguing similar
positions for years earlier, but the hege-
monic knowledge structures were able to
systematically confine them to the margins
for a very long time. The consolidation of
the challenges they face, particularly in the
international arena has helped consolidate
the voices of protest in the margins of our
countries as well.
This does not come without its fair
share of controversies however. The docu-
mentation of three types of knowledge –
about the actual medicinal properties of
plants, the procedures for medicines that
can be made from them and, health prac-
tices – are increasingly understood to
be a valuable resource that needs to be
urgently documented, else they would
be lost. Most of this knowledge is rich-
est in the ‘developing countries’, where
the recognition of such issues by local
governments and then the ability to finan-
cially support such tasks is not high on
their priority. But following from the
1146
international critique and recognition of
the urgency of this issue, financial and
ideological support for such activities is
available from international civil society
organisations. The controversy that arises
from such support is about knowledge
appropriation and its subsequent ‘propri-
etorship’. The worst case scenario envis-
aged in this is that this is simply a devious
method of stealing this knowledge now
and ultimately making it available to the
powerful markets abroad to exploit com-
mercially at a later point in time. Given
the deeply political nature of these posi-
tions, the differences over this issue are
likely to increasingly become an issue of
by now a classic stand off between differ-
ent kinds of civil society organisations –
‘social movements’ and ‘NGOs’. While it
is not possible to simply classify this in
such black and white terms, but in the field,
but it captures some of the essence of the
lay of the land.
The other important issue being ad-
dressed by some NGOs is that of bringing
different medical systems closer to each
other and to attempt to complement their
impact on one health problem. At one
level, this is similar to what has being talked
about by governments and corporations
around the world. At another, the manner
in which thse organisations are attempting
it are radically different. It is necessary to
do a full-fledged study to make any claims
on their behalf, but a general observation
is pertinent here. Given that groups of
well-trained doctors from different medi-
cal systems work together to solve local
health situations, they use the varied
resources of health systems knowledge
that they have at their disposal, to set up
a genuine communication among them. It
is possible then, that the scope of their
work could well be in terms of path-
breaking approaches to scientific inquiry
and not simply pragmatic programmes of
intervention.
V Comparative Study, Univeristy of California
Conclusion
The new policy therefore addresses is-
sues that are already at the cutting edge
of markets and international negotiations.
Standardisation and validation of tradi-
tional medical products and the issues of
integration of diverse medical systems into
the hegemonic medical one, such that there
may be order in the medical world are the
concerns articulated by the dominant
powers in science and the markets. Yet it
Economic and Political Weekly
seems to weigh the significance of the non-
market and smaller forces as far as possible
with those dominant. Whether it will be
successful in maintaining this balance from
the draft to the final policy stage, remains
to be seen. -29
Notes
[The author would like to specially thank the many
members of the department in the ministry and
the Central Council for Research in Ayurveda, for
their ready help and cooperation in making
information on government policy and initiative
available.]
1 Ayurveda, Unani and Siddha are 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).
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March 23, 2002