Pervious Drugs - Brill

asian medicine 9 (2014) 49–76

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© koninklijke brill nv, leiden, 2�15 | doi 10.1163/15734218-12341292

Pervious DrugsMaking the Pharmaceutical Object in Techno-Ayurveda

Laurent PordiéNational Center for Scientific Research (CNRS)Research Unit on Science, Medicine, Health & Society (Cermes3), Paris

[email protected]

Abstract

What makes it possible for ayurvedic pharmaceutical objects to come into being? To answer this question, this paper takes an ontological route in line with local epistemolo-gies, in which the objectness of the thing is itself taken as quite porous and susceptible to circumstances. This approach has much in common with science and technology studies: objects acquire meaning in a specific context, itself embedded in a relational network at a specific point in time and space. Here too, objects are unstable, tran-sient and circumstantial. This has serious consequences since the connections around objects question, even destabilise, the very idea of objectivity. This article examines what is omitted in the discussions and practices on objectivity in technologically driven ayurvedic drug discovery and manufacturing. It discusses innovation processes within and beyond the lab and the way in which pharmaceutical objects absorb ideas, episte-mologies, materials, or even policies. These considerations will provide a useful meth-odological framework to appreciate the kind of uncertainties and heterodoxies that characterise these therapeutic products.

Keywords

objects – innovation – absorption – pharmaceuticals – ayurvedic industry

Introduction

Social sciences studies on the encounters between biomedical science and healing traditions find it hard to escape the rhetoric of scientific hegemony and

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resistance,1 adaptation2 and, consequently, the analysis of these encounters in terms of domination or subordination.3 The fact that science, knowledge, and (political) power are deeply intertwined in practice has led to a remark-able number of works from both historians and anthropologists that highlight these asymmetries from colonial times to the present4 and the way that domi-nant expressions of power in the medical field have been vernacularised5 or domesticated.6 In most cases, local epistemologies and practices are seen to be suffering from a kind of violence that takes place when a domain of knowl-edge such as Ayurveda is recast or redefined in biomedical terms. Indeed, the categories of biomedicine tend to be imposed on other forms of knowledge.

Postcolonial and subaltern studies have played a significant role in framing such ‘epistemic violence’,7 while at the same time freezing unequal relations of power over time. However, as the sites of political and economic power are historically rearranged, the dynamic nature of global asymmetries must be acknowledged. The rise of today’s ‘transition economies’, such as China, has dramatically modified the world scenario. To a certain extent, a reshuffling of asymmetries is also noticeable in the health field. Indian national policies, for that matter, are geared towards turning the country into a global healthcare destination by fostering the medical travel industry,8 by encouraging the devel-opment of biotechnologies9 and pharmaceutical production.10 Some Indian companies involved in the international wellness industry challenge taken-for-granted economic assumptions, and go as far as delocalising medicinal oil and cosmetic production from India to Australia or the UK.11 Contrary to the widespread use of asymmetry in postcolonial studies to describe relatively sta-ble inequalities of power, asymmetry in this paper will instead be viewed as an important driving force behind human agency. In this way, the contemporary reordering of global asymmetries is a transformative agent in healthcare.

As a reaction to the fact that Science and Technology Studies (STS) have until now focused on the ways in which cultural values, everyday practices, and

1 Bala (ed.) 2001; Pannikar 2002.2 Landy 1974; McMillen 2004.3 Arnold 1993; Khan 2006.4 Adams 2002; Cleetus 2012; Halliburton 2011; Sujatha and Abraham 2009.5 Mukharji 2011.6 Pordié 2008a.7 Spivak 1998. See also Nandy (ed.) 1988.8 Crooks et al. 2011; Pordié 2013; Turner 2007.9 Bharadwaj and Glasner 2009.10 Lögfren 2012.11 Pordié 2011.


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forms of subjectivity in the West have been transformed by scientific and tech-nological developments over the past few centuries, a recent body of literature has situated STS in different social and cultural environments and in this light examines the relationship between techno-scientific knowledge and postco-lonial orders.12 Known as postcolonial science studies, this endeavour clearly shows that the material discussed in STS is relevant to other contexts, such as Asia. However, this subgenre remains largely embedded in issues of hegemony, power, and domination. This is a welcome addition to the study of science and technology which has never really been driven by such issues, nor does it take much interest in ‘dispossession’,13 but there are options for the practice of STS in non-Western countries other than those inspired by postcolonial studies. By examining the advent of science and technology in ayurvedic pharmacy, this paper takes such a route. It is centred on what makes it possible for global pharmaceutical objects to come into being.

I shall start with a provocative reconciliation: science and technology studies and Asian worldviews, as found in Buddhist scholasticism and vari-ous branches of Hinduism, share a similar stance on objects. ‘All objects are without self-substance’, writes Daisetz Teitarō Suzuki,14 underscoring the illu-sionary nature of the phenomenal reality that was significantly developed in Buddhism. The objectness of the thing (la choséité) is itself always in question and always ephemeral. A beginner’s version of an otherwise highly elaborate and complex subject in both Buddhist and Hindu traditions would qualify this absence of self-substance as emptiness (śūnyatā in Sanskrit)—the object is ‘empty’ in itself and, concomitantly, only exists through an array of relation-ships to other things. STS scholars, on the other hand, have insisted on the fact that objects acquire meaning in a specific context, itself embedded in a relational network at a specific point in space and time.15 These objects are bounded to their environment because it is this environment and the practices that take place within it that ultimately define the object.16 This assertion sug-gests that objects-by-themselves can also be seen as ‘empty’. They are context-specific; the qualities, the usages, the functions, the relations/associations, the locations, and of course the perception of a particular object, are unstable and

12 Anderson 2002; Harding 1998; Philip et al. 2012; Seth 2009.13 Law 1991.14 Suzuki 1998, p. 168.15 Latour 2005; Law 2002; Law and Hassard (eds) 1999.16 For other examples on the context-specificity of objects stemming from social anthropol-

ogy, see Appadurai 1986, as well as classical studies on gift exchanges, e.g. Godelier 1996 and Mauss 1950.


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circumstantial. The materiality of an object is imperative and crucial but it does not suffice in making the object what it is. Of course, a medicine is a concrete, palpable thing with real material effects, and there is no point ques-tioning this. This paper does not intend to overemphasise fluidity to the point where any tangible thing would disappear, but rather to highlight pharmaceu-tical objects as variable entities.

This has serious consequences. The fluidity of the object challenges the very idea of objectivity. Because objectivity is of paramount importance in all attempts at understanding in the medical/pharmaceutical realm, it may be appropriate to examine what is meant by objectivity in situations that con-verge in material formations—from the body structure to its physiological functioning or from individual medicinal substances to industrial pharma-ceutical compounds. No room remains to account for subjectivity or ‘non- measurable stuff ’, and even less the idea that the material formation under scrutiny is fluid, changing and, ultimately, ‘empty’. Take, for example, clinical research in pharmaceutical research and development (R&D). Not only is the production of scientific facts based on material assemblages, measurements, dosages, and observations, it also ‘literally “screams” the conclusion to which they lead with undisputed authority’.17 Thus trying to reach some form of objective truth naturally fails to draw attention to whatever is omitted in the discussion—notably, the importance of the unplanned, the unthought-of, or the hidden. Attempts at objectivity are therefore as much an ethos— bringing in its wake habits, choices, modes of decision-making, and the like—as an epistemology.18 And when this applies to objects such as drugs—considering their context-specificity, their instability, and their transient character—the situation is rendered all the more complex.

This situation is not avoided in the contemporary invention of drugs in Ayurveda. The aim of this paper is to examine what is overlooked in the dis-cussions and practices concerning objectivity in the ayurvedic pharmaceutical industry. My case study is The Himalaya Drug Company, one of the leading ayurvedic industries in India and globally.19 Here as well, the context cer-tainly changes the quality of things—and this is well described in the classical

17 Stengers 2013, p. 8, my translation.18 Datson and Galison 2007.19 This research was funded by the French National Research Agency from 2010 to 2013.

My work took place in Southern India mainly, in the cities of Chennai and Bangalore, as well as in the State of Kerala. I would like to express my gratitude to The Himalaya Drug Company for allowing me to conduct repeated ethnographic fieldwork in their premises (Drug Discovery, Manufacturing, International Regulatory Affairs and Business


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ayurvedic treatises dealing with the location of plants, the period of collection, or the seasonality of treatment—but I would like to suggest a more ontologi-cal argument in line with local epistemologies, in which the choséité is itself already taken as quite porous and susceptible to circumstances. To under-stand the extent to which drug discovery in this context is ‘objective’, I will consider the object’s emptiness—a pharmaceutical drug in this case—as the condition of possibility for the absorption of ideas, epistemologies, materials, or even policies. In this paper, emptiness works as a locale in which material and immaterial attributes can be ‘placed’ to make the object. I will show that filling these empty spaces within or around the object’s materiality confers attributes, dynamism, and ultimately identity to this object. Considering phar-maceuticals as pervious or spongeous in nature thus raises the question of absorption in a technologically driven ayurvedic industry.

Plasticity and Exchange in Asian Medicine

Ayurveda, the ‘science’ (Skt. veda) of ‘longevity’ (Skt. āyus), is a branch of medi-cine stemming from the Brahmanic tradition, the doctrine of which was estab-lished in three founding collections (Skt. saṃhitā), which are called The Great Triad (Skt. Bṛhattrayī), composed in Sanskrit and attributed to Caraka, Suśruta (c. first and third century CE, respectively) and Vāgbhaṭa (sixth to seventh cen-turies CE). In spite of the stability of its doctrine, this medicine has always been fed by surrounding therapeutic practices (as much as it has fed them). Mutual borrowing and exchanges in the areas of theory, medicinal materials, or medi-cal practice characterise the historical construction of Asian medicines gen-erally, brought into contact by trade routes, military and political conquests, colonialism, or religious proselytism. The history of Middle-Eastern and Asian learned traditions, albeit still fragmentary yet relatively better documented than other regions of the world, clearly shows instances of knowledge transfer and the way in which various forms of therapeutic knowledge have influenced each other. Ayurveda shares some theoretical concepts with Hippocratic medicine, such as the pneumatist doctrine, which suggests that exchanges have been forged between these practices since ancient times.20 Greco-Arabic medicine, introduced into the Indian subcontinent with the Muslim conquest and developed especially during the Mogul period (1526–1858), derives its

Departments), as well as in their retail shops and with their medical representatives. I alone remain responsible for what is written in this paper.

20 Filliozat 1949.


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doctrinal principles from the medical traditions of Hippocrates and Avicenna. In South Asia, this practice became known as Unani ( yūnanī), which means ‘Greek’ (i.e., Ionian) in Arabic. This designation, generalised in India since the nineteenth century, indicates the desire of certain practitioners to secularise their medicine and incorporate new ideas through their dialogue with colo-nial medicine.21 Ayurvedic texts, such as the Aṣṭāṅgahṛdayasaṃhitā (c. early seventh century CE), circulated as far as Tibet to become a dominant influ-ence on Tibetan medicine; and other influences also include Greek medi-cine, Indian tantrism, Chinese medicine, and Buddhism.22 The centuries-old coexistence of ayurvedic and Unani medicines has also generated a host of exchanges, including the writing of erudite texts in Persian, Urdu, or Sanskrit, but also in the domains of clinical practice, surgery, pharmacopoeias, and in the fields of health administration and development. Unani medicine forms an integral part of the Indian Islamic culture, but that has not precluded the historical and contemporary existence of Hindu practitioners, including some scholars who produced numerous texts of Greco-Arabic medicine in Persian. Writings inspired from this medicine have also been drawn up in Sanskrit and in a variety of vernacular languages such as Telugu and Tamil. In these seem-ingly traditional contexts, therapists may be innovative and integrate some therapeutic materials and theoretical elements while rejecting others, often leading to unique combinations.23 Examples also abound from scholarly med-icines and their relations to non-codified local practices.24 The trajectory of therapeutic knowledge and medicinal materials in the historical development of Asian forms of medicines along with the porosity of these practices altered established traditions and opened up spaces favourable to innovation.25 They account for the ‘paradigmatic plasticity of traditional medicine’.26

Therapeutic substances and medicinal formulations are also subject to transformation. Substances follow multidimensional itineraries across space and time, and as they go through epistemological frameworks and local envi-ronments of use and practice, their attributes and their place in medicinal for-mulae are modified.27 Recipes and their domains of use, in turn, gain or lose constituents, which themselves have agency in the production of therapeutic

21 Attewell 2007.22 Beckwith 1979; Meyer 1995.23 See Pordié 2014.24 Sujatha 2007.25 Hsu (ed.) 2001.26 Meyer 1987.27 Attewell 2010.


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knowledge and practice. Although the formulations are laid out in the texts, in practice they are open to novelty. This openness reflects the ephemeral charac-ter of their objectness and their susceptibility to circumstances.

Ironically, a number of recent works discussing the transformation of Ayurveda, or more precisely, its current globalised forms with strong commer-cial potential, often disparagingly present these therapeutic forms as diluted or corrupted versions of a greater tradition.28 The speed of the change witnessed today may have led some observers to suffer from chronocentric illusion, as if the many centuries of transformation of Asian medicine did not affect or design what we perceive to be traditional and authentic today. The contem-porary situation exemplified in this paper in the case of The Himalaya Drug Company in India in fact demonstrates the emergence of a new configuration of Ayurveda.29 This new branch of Ayurveda maintains a clear lineage with the classical formulations. The source of the knowledge deployed in the making of these new products largely stems from ancient ayurvedic texts and may in some instances respect the cognitive logics of substance association and therapeutic indication of Ayurveda or, in contradistinction, simply involve the assembling of ingredients by following their individual indication as single drugs, much as European phytotherapy would have it. Therefore, the fact that the new ayur-vedic pharmaceuticals stem from classical formulations does not imply that substances association strictly follows ayurvedic epistemic logics (yogam).

These products are of ayurvedic descent but they include other forms of knowledge. Ayurvedic knowledge is cumulative in practice and open to all sorts of additions, as long as they are perceived to be beneficial. Distant para-digms, such as those of experimental science and biomedicine, may be par-tially absorbed without however leading to rupture or substitution. A sense of complementarity characterises the encounters between ayurvedic knowledge and other knowledge forms, and the historical construction and trajectory of Ayurveda is defined by variability. This disposition differentiates Ayurveda from the type of science described in Thomas Kuhn’s classic book,30 where radical change and discontinuity are presented as two fundamental pillars of scientific revolutions. To summarise, the new replaces the old and, when

28 See, for salient examples, Reddy 2002 and Zysk 2001 on ‘New Age Ayurveda’, Islam 2010 and Selby 2005 on the commoditisation of ‘Indian medicine’, or again Banerjee 2008, pp. 201–2, on ayurvedic pharmaceuticals.

29 In the same way, Smith and Wujastyk 2008, pp. 2–4, write about the emergence of various lineages in global Ayurveda, and Pordié 2008b, pp. 4–5, underscores the plurality of forms in contemporary Tibetan medicine.

30 Kuhn 1970.


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the scientific community is won over, a new paradigm is born. In this case, paradigmatic contradiction and exclusion allow science to move on. As the remainder of this paper will show, Ayurveda is also moving on but on a differ-ent basis—that of selective absorption as a means of innovation.

Practicing Fluidity: Industrial Reformulation in Ayurveda

The Himalaya Drug Company, established in 1930, is no doubt a leading actor in fostering change and innovation in Ayurveda. The company’s foray into herbal medicine began when its founder, M. Manal, saw a villager in Burma pacify-ing a restless elephant by feeding it the root of the plant Rauwolfia serpentina. Fascinated by the plant’s effect on the animal, he had the root scientifically tested. After researching the herb, the drug Serpina® was launched in 1934; it is presented in the corporate documents as the world’s first herbal antihyperten-sive pharmaceutical. The company objective has always been to ‘contempo-rise Ayurveda by validating it through modern scientific research’, as the CEO puts it today. This was a radical position at a time—both pre- and post-1947 (the date of the Independence of India)—where ideological conflicts were prominent between the ‘purists’, who did not want Ayurveda to interact with Western science, and the ‘modernisers’, who were keen to facilitate dialogue and integration between Ayurveda and ‘modern science’.31 From its incep-tion, The Himalaya Drug Company developed its own innovation model, with increasing levels of conceptual and technological sophistication over time, based on the creation of new medicinal formulae stemming from classical rec-ipes established in ancient texts (śāstra). In doing so, the modernisers at The Himalaya Drug Company have reinvented, and are still reinventing, ayurvedic remedies by borrowing from various and distant medical schools of thought and technologies, including modern galenics, biomedicine, experimental sci-ence, and traditional medicine. Staff at the firm openly acknowledge the fluid-ity and relative malleability of ayurvedic products, as explained mid-March 2013 by a member of the Drug Discovery Department:

Our approach takes Ayurveda as both the foundation for innovative cre-ation and as a constantly evolving medical system. New products have

31 On the debates and its implications, see the seminal works by Brass 1972 and Leslie 1976. On the modernisation of traditional medicine in India, including the manufacture of drugs, see the work by Habib and Raina 2005, on three important figures from the late nineteenth and early twentieth centuries.


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always been created in Ayurveda, and there is no chance this will stop. This is the nature of things, everything changes, evolves, get transformed. Do you know anything permanent?. . . . What we do is make the best of this potential to offer well-researched, efficacious and cost-efficient drugs.

The Himalaya Drug Company sees no inherent conflict in the existence of innovative ayurvedic products. Well before the ground-breaking collection put together by Charles Leslie in 1976, which irrevocably rejected the stasis hitherto attributed to medical traditions, the founders of The Himalaya Drug Company knew that these traditions were dynamic and changed under the influence of local and national policies, or following contact with modernity, science, and technology. Their experience of the political turmoil surrounding Indian Independence and its effect on Ayurveda gave them first-hand knowl-edge on the matter. They were also aware of this dynamism when they chose pharmaceutical innovation as one of their primary objectives. A very success-ful enterprise, the firm has managed to put a number of innovative formula-tions on the market, to export to over 90 countries,32 and to obtain approval and certifications from the stringent regulatory environments of Europe and North America (such as ISO 9001:2000 in 2003). Their flagship product, Liv.52®, was invented in 1955 to treat liver disorders and probably is one of the most enduring phytomedicines. As we will see in greater detail later, the firm’s approach has also magnified the absorption qualities of its products by allow-ing multiple flexibilities in its innovation programmes and in its business and marketing strategies. While they are rooted in ancient knowledge, the pharma-ceutical objects created by the firm are both vehicles of novelties and enact-ments of strategic logics.

The firm aims to reformulate and simplify ayurvedic medicinal composi-tions in order to create new ‘traditional’ drugs. This model exemplifies what we have termed as the reformulation regime33 in drug discovery to qualify the technological, social, and cognitive dimensions of contemporary manufactur-ing and production practices in the industrialisation of Asian medicine, as well as their central role in reshaping the way traditional knowledge-based phar-maceutical innovations are appropriated and protected by law. The reformu-lation regime therefore profoundly questions the economic, epistemological, and regulatory contexts of pharmaceutical innovation. By making use of plant

32 The company’s global turn took place in 1975, much before economic liberalisation, when India’s regulatory environment did not support global expansion.

33 Pordié and Gaudillière 2014.


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compounds and/or phytochemical fractions,34 this regime also offers new avenues in pharmaceutical innovation as it constitutes an alternative to the molecular paradigm that has dominated the pharmaceutical milieu since the mid-twentieth century. It stands at odds with the biomedical world of phar-macy, which—when it comes to the uses of plants—remains centred on the bioprospection model, i.e., mining local resources in order to select research materials, to identify and purify active molecules, and to make them available through chemical synthesis. Taking the shastric formulations and descriptions of plant properties as its basis, innovation at The Himalaya Drug Company therefore consists of reformulating remedies through multiple translations in the lab in order to create new ayurvedic medicines for biomedically defined ailments. These drugs account for heterodox and creative epistemologies that overlap nosological categories and pharmacological universes.

In terms of human resources, such industrial reformulation also means that a fair proportion of the research and engineering staff needs to be specialised in pharmacy, pharmacology, chemistry, or allied biomedical sciences. In fact, the vaidyas (a term used to designate the practitioners of Ayurveda) are a minor-ity in the firm, but they nevertheless play a leading role as they put together new formulations or revise existing ones. Many of the R&D staff—and this also applies to business and management—come from biopharmaceutical companies in India, such as Pfizer and the like. Specialists in industrial phar-macy circulate in a specialised milieu which, in India, also includes ayurvedic manufacturing firms. This is the case for many people in the firm, including virtually all the heads of departments, from quality assurance to international regulatory affairs, or from formulation development to medical services and clinical trials. This workforce allows for the kind of ‘modernisation’ the lead-ers of the firm have sought from the very beginning. On the other hand, such a configuration could only take place because of the fluidity and tolerance to change of the ayurvedic object.

To a great extent, The Himalaya Drug Company shares its administrative, operational, and infrastructural profiles with those found in mainstream global pharmaceutical firms. The manufacturing and production department is a state-of-the-art unit that complies with ‘good manufacturing practices’ (GMP) and ‘good laboratory practice’ (GLP). Antimicrobial flooring is proudly imported from Germany; microbiological air filters are to be found alongside the latest manufacturing equipment. While this type of unit is not uncommon

34 Chemical fractionation is a separation process used in chemistry, including phytochem-istry, in which a certain quantity of a given mixture is divided into a number of smaller quantities (the fractions) according to chemical groups.


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among ayurvedic industries in India,35 the material organisation, manage-ment, and personnel profile at the firm together with the reformulation, busi-ness, and marketing practices have brought the pharmaceuticalisation of Ayurveda to its climax.

However, a pharmaceutical is not a given; it needs to be made. This first requires transforming plants (or sometimes minerals) into medicine, and in most cases this entails transforming individual medicinal substances into com-pound medicines. It is in the industrial context that the compound in question becomes a pharmaceutical. At The Himalaya Drug Company, the raw medici-nal ingredients are gathered through multiple and complex supply channels across the country, and are processed in Lucknow in North India. They are then sent as granules to the main campus in Bangalore, identified by numbers that guarantee quality assurance, traceability, purity, etc. Once on campus, where around 600 people work, these plants are transformed into medicine, either as polyherbals or single plants—I will return to that latter point later. A stan-dardised pharmaceutical is then produced; it takes a certain galenic form and is kept in a package which is manufactured according to product lines, target markets, and languages. This circuit represents one possibility among others, since the firm now produces in various locations, including as of 2013, Dubai for the company’s Middle East operations.

Following individual ingredients until they are made into a compound pharmaceutical would certainly provide a rich terrain for the biographical approach to drugs.36 The trajectories of the plants shed light on the social, cultural, and epistemological contexts in which they circulate before being assembled as a medicine, and each step or context in the trajectory has its own particular actors, relations, and transactions,37 all of them characterised by different sets of ideas and regimes of values.38 This approach in the anthro-pology of pharmaceuticals can of course be taken for the entire ‘life cycle’ of a drug, from its conception and birth to its production, marketing, ingestion, and metabolism. It also offers important insights into studies in material cul-ture, which too often privilege the materiality of the object itself rather than its material components and their own individual trails.39 However, what may be

35 Bode 2008, pp. 133–8.36 Van der Geest et al. 1996.37 See, for example, the work by Dejouhanet 2012 on the supply channels of medicinal

plants in South India.38 Appadurai 1986.39 Ingold 2007.


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missed there is the fact that all circuits ultimately show the practice of refor-mulation as a creative process that highlights the transformative abilities of the pharmaceutical object. The following section will delve into further stages of ontological enquiry to demonstrate that the pharmaceutical object is pervi-ous in both senses of the term: it is at the same time open to passage, perme-able to materials, and open to ideas, arguments, and change.

Pervious Drugs: On the Absorption of Concepts and Substances

Classical, textual formulations fall under the public domain. On the contrary, new ayurvedic formulations belong to the category of ‘proprietary medicines’ which are owned exclusively by licensed manufacturers and usually marketed under a name registered as a trademark.40 Innovation is of course tied to mar-ket construction. But this also means that the dynamics of compound formu-lations are officially recognised in India or, in other words, that therapeutic objects such as ayurvedic drugs are seen as flexible since new compositions are not simply considered valid but are actively encouraged. As in many coun-tries today, innovation is considered to be an economic asset in India.41 The pharmaceutical milieu has been especially concerned since the establishment of the national Drug and Pharmaceutical Research Programme in 1994 which aimed to boost innovation by focusing on both biomedicine and the tradi-tional medicines industry.

This provision opens up an infinite range of options for The Himalaya Drug Company in the creation of formulations, the ingredients of which (their quality and quantity) may be arranged and rearranged according to numer-ous conditions, such as the therapeutic targets set by the firm, the availabil-ity of plants, the production costs, etc. Basically, this situation means that any formulation produced by an Indian ayurvedic manufacturer, once it contains plant (and sometimes mineral) compounds, can be registered as an Ayurvedic Proprietary Medicine. The ayurvedic pharmaceutical object is open, to say the least. This openness makes it all the more difficult to grasp the essence of such an object, other than it comprises a number of empty spaces waiting to be filled by specific materials and conceptions at a particular point in space and time.

40 Proprietary medicines are governed by the rules and regulations of the Drugs and Cosmetic Rules 1945, of the Drugs and Cosmetics Act 1940 (amended up to 30 June 2005).

41 Viswanathan et al. 2012.


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Here, we shall start with the concepts. Filling the object with concepts may sound a bit out of line for the casual reader but it is nevertheless what The Himalaya Drug Company does in practice. In 1999, the firm launched a range of personal care products under the brand ‘Ayurvedic Concepts’. These products, although they were not therapeutics, signalled better than anything the fact that they were objects instilled with ideas (and ingredients) stemming from Ayurveda. In fact, they were both objects and ideas and both of these at the same time.42 Additionally, the brand was promoted by a series of TV adver-tisements featuring the actress Ava Mukherjee as the iconic dadima (a Hindi word for grandmother), which was conceptualised as an elderly lady with a degree in molecular biology. In an interview for Express Pharma, Ravi Prasad, the company’s former CEO, today turned Chairman, explained:

The English speaking, trendy grandmother aptly merged Himalaya’s brand promise of the richness of traditional Ayurveda with the moder-nity of science. By conveying her knowledge of age-old health tips and Himalaya products in a language used by the youngsters, she connected with the youth and presented Ayurveda in a contemporary light. Unlike typical grandmothers, she was aware of latest trends around her; be it in technology or fashion.43

In what the press described as a ‘roaring success story as far as advertisements go’,44 the grandmother aptly symbolised the synthesis of age-old wisdom and modern trends. It showed that Ayurvedic Concepts were not only limited to Ayurveda.

This is true for all products at The Himalaya Drug Company. The question therefore is: how do we place various and sometimes diverging concepts into a single object? Finding an answer to this question first involves an examina-tion of the knowledge-prospection mechanisms, in which authoritative texts in classical ayurvedic literature as well as biomedical, ethnopharmacological, and phytochemical publications are screened, studied, and used. Plants and their effect on the body, diseases and their treatment, epidemiological trends, etc. are carefully examined from many disciplinary angles, which reflect var-ious conceptions of the body and its dysfunctions. While in most cases the

42 This means that the concept does not refer to the object but rather to the pharmaceutical product, itself as much a concept as a material entity. For theoretical development in this vein, see Henare et al. (eds) 2007.

43 Patwardhan 2007.44 The Hindu 2002.


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ayurvedic literature takes precedence over the rest in establishing pilot formu-lations, especially a selected number of reference works, scientific publications are a very helpful tool to frame research (and later, or perhaps concomitantly, findings) on these formulations in biomedical and/or chemical terms. A senior member in the firm said that in some instances, phytochemical publications serve as direct leads for ayurvedic discovery. These botanical, physiological, or therapeutic conceptions stemming from distant domains of knowledge (mod-ern taxonomy vs. Sanskrit denomination, tridośa theory vs. biomedical physi-ology, etc.) are taken on-board, compared and equated, to reach a (generally hybrid) point of consensus within a given team on the way the pharmaceutical object is perceived and presented. In the Drug Discovery Department of The Himalaya Drug Company, the drugs may be understood and explained accord-ing to hybrid pharmacological models, including, for example, ayurvedic post-digestive tastes (vipāka) and substance potency (vīrya) together with bio-medical understanding of enzymatic activities.

In using various disciplines and paradigms, in-house research also contrib-utes to diffusing concepts into the object-to-be. They use biomedical sciences, such as pharmacology or chemistry, on a daily basis. Toxicity studies, among others, also take place. This practice is closely associated with pharmaceuti-cal research and, as mentioned above, the firm had to hire a number of spe-cialised scientists, many of whom show no theoretical or factual knowledge of Ayurveda. However, hiring such specialists appears to be central to the cre-ation of ayurvedic products that merge and mix paradigms and categories.

This work is rendered possible through lengthy and complex processes of reverse engineering, which involve multiple translations. A typical sequence consists of identifying symptoms (and biomarkers) associated in the biomedi-cal literature with the targeted indication (or disease), seeking an equivalence in ayurvedic medicine entities, listing all the formulations mentioning these entities in the śāstra, defining a simplified consensus formula (containing half a dozen ingredients at most), and selecting a protocol to produce and test (possibly biologically) this formulation. Such was the case for the drug named Diabecon®. As the name suggests, this medicine is indicated for biomedically-defined diabetes (insulin-dependent or not), the symptoms of which find their equivalent in an ayurvedic-defined disease called prameha (or meha), which translates as ‘urinary disorders’.45 The ayurvedic physician leading the Drug Discovery Department said that this ayurvedic disorder would correspond to polyuria, which includes diabetes (or, according to biomedical nosology,

45 I refer to Zimmermann 2012 and this volume, as well as to the many personal communica-tions we had during informal and formal meetings in Paris and elsewhere.


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reveals the existence of diabetes). The classical formula used in the treat-ment of prameha stems from a Sanskrit textual source from the nineteenth century, namely Bhaiṣajyaratnāvalī, and comprises, among numerous other things, two important triads of plants: the three myrobolans (Terminalia che-bula, Terminalia belerica, and Embelica officinalis) and the three spices (Piper nigrum, Piper longum, and Zingiber officinale). These triads, as well as the main component in the classical formula (the plant guggulu, Commiphora sp.) and the paste Vidangādi lauham (in which the plant Embelia robusta is the main component) remain as such in the newly formulated Diabecon®, which con-tains a total of 33 ingredients although there is a higher number in the original formula from the śāstra. The new formulation has been chosen among vari-ous others, which were all subject to toxicity and efficacy essays (animals and in vivo). The selected formulation then went to the Department of Formulation Development, where it has been stabilised (through galenics) and rendered compatible to mass production. Because this drug is marketed, the mode of action of Diabecon® is not presented in ayurvedic language, but in exclusively biomedical terms. The company’s website reads:

The natural ingredients in Diabecon increase insulin secretion in the body. By reducing the glycated hemoglobin level (form of hemoglobin used to measure glucose content in the blood) level, normalizing micro-albuminuria (a condition which is an important prognostic market for kidney disease in diabetes mellitus) and modulating the lipid profile, Diabecon minimizes long-term diabetic complications. The drug also increases hepatic and muscle glycogen content, which enhances the peripheral utilization of glucose.46

To ensure their accessibility and credibility to both biomedical prescribers and global consumers, all therapeutic products at The Himalaya Drug Company are presented in ‘scientific language’. Biomedical physicians, for example, are given the products’ monographs which comprise of a collection of scientific papers or excerpts of publications written exclusively in the biomedical idiom. They are also regularly visited by medical representatives who introduce their range of products in the same manner.

It should be noted, however, that in the preceding paragraph, I passed rather quickly over an otherwise important choice the inventors of Diabecon® had to make. I wrote ‘the new formulation has been chosen among various others’.

46 See http://www.himalayahealthcare.com/products/pharmaceuticals/diabecon-tablet.htm, last consulted on 29 January 2013.


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How does this generally happen? What kinds of circumstances bring the object into being?

Objectivity and its Circumstances

New formulations are made in various batches, say six at a time. So there are six possible formulations for one or more therapeutic indications. These early formulations enter the Department of Formulation Development which is responsible for making a product suitable for mass production and the market. A circumstantial example of this follows. Global consumers, as well as some people in India, are reluctant to take ayurvedic products due to their pecu-liar taste. For some products, this step may therefore include the addition of chemical flavours, such as strawberry, to render their taste more agreeable to the consumers’ palates. In other instances, tablets may be coated with sugar according to the requirements of the country to which they are shipped. You may then find the therapeutic object A sugar-coated in Kazakhstan and raw in Hungary and Nigeria. In reality, this therapeutic object A becomes A1 here and A2 there. They are different objects, all of which are nevertheless produced, sold, and consumed as one and the same thing. What is more, the fact that these flavours or coatings may change therapeutic activity is out of the ques-tion, I have been told, because the quantity is ridiculously small.47 However, if we follow ayurvedic pharmacological principles, any ingredient in the formula-tion potentially affects therapeutic activity. But with the kind of hybrid objects produced by the firm, this is easily reconcilable: the essence is Ayurveda but the means of producing evidence is biomedical. In this case, flavour and coat-ing are considered to be inert excipients. These selective arrangements coin-cide perfectly with the needs of the market.

Each batch then reaches the Department of Medical Services and Clinical Trials for preliminary testing in vitro or on animals. These preliminary assays provide an idea of the toxicity and the efficacy of a formulation. Some formula-tions will be kept and others rejected, until new tests are made on a new batch, and so on, to eventually reach a stage where further research will be conducted on a selected number of formulations. The final candidate will then go through fully-fledged RCTs carried out in collaboration with research hospitals in the

47 The pharmaceuticals also comprised colouring substances, as such as carmoisine (CI 14 720) and preservatives as sodium methylparaben or sodium propylparaben—all of which are understood in biomedicine as having potential bodily actions.


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country. In order to be validated, the object needs to absorb biomedical ideas, either through in situ or ex situ clinical research. The final formulation will then be ready for regulatory submission, accompanied by a bulging file in which the results of the scientific research are presented in great detail. The itinerary of the formulation is of course more complex and complete in practice, but this brief sketch suffices for my purpose. Everything is made or presented to meet the standards of objective research.

But objectivity is as relative as the object itself. The work of the Department of International Regulatory Affairs clearly demonstrates this. Its role is well-defined. Specialised personnel check the constituents of all formulations and may discard or keep a formulation on this basis. If a formulation contains a plant which is banned in the UK, EU, or US, the formulation is simply thrown out of the window, irrespective of its efficacy. The formulation does not meet the target of ‘global compliance’ and this pitfall precludes any further devel-opment. A substitute for the plant will then be found. This does not pose any major problem to the eyes of the inventors as they say there are interchange-able plants in the texts that may enter a single formulation and which are con-sidered to have similar effects. The object always keeps an empty space for an addition or a modification. Conversely, if a formulation contains a plant which is part of an existing pharmacopoeia in these countries, its use is strongly encouraged and the formulation kept. Of course, in-depth research will follow this selection phase and the most active formula will be selected. But finally, the regulatory environment of Western countries, in other words the market, plays a very direct role in the innovation processes and the selection of for-mulations. Seen from this angle, scientific objectivity is compromised, if not annihilated.

Once it is on the market, the object is not, however, definitively fixed. Such was the case for a drug prescribed as a treatment for menopausal syndrome. The drug Menotab®, known as MenoCare® in the US, was replaced in the early 2000s by Menosan®. While the therapeutic indication is similar, table 1 shows profound modifications in the formulation.

The reformulation (Menosan®) of a reformulated drug (Menotab®) has been consubstantial with the partial disappearance of the object Menotab®. Its dis-appearance was only partial because parts of what made Menotab® still persist in Menosan®. The substitution is restricted: four plants remain, together with the therapeutic value and indications of a drug evolving in a sociotechnical network of relations and associations already in place. There is no revolution here but instead the material attributes of an already porous and ephemeral object are transformed.


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I am not in a position to explain why this reformulation occurred or why the drug Menotab® was withdrawn from the market, in spite of the claims made about its therapeutic efficacy.51 Allow me to make a guess about the number of ingredients. From 12 ingredients in the original formula, Menosan® today com-prises six plant extracts and two bhasmas. This type of formulation is more in line with the European (Traditional Herbal Medicinal Products Directive—EC Directive 2004/24/EC, as of 1 April 2011), American and WHO recommenda-tions or regulations regarding polyherbals. Manufacturers are encouraged to compose their formulations with up to six ingredients to facilitate controls and potential trials. This is also the reason why, in the typical sequence of

48 Source: Umadevi and Swarup 2000.49 Source: Gupta 2010.50 A bhasma is a substance obtained after long and complex processes of calcination.51 In the conclusion of their paper, Umadevi and Swarup 2000, p. 89, relayed by the press

in India and the US, wrote that ‘Menotab, with its herbomineral components gives 100% relief in vasomotor symptoms, viz. hot flushes thus comparing equally to medications.’

Table 1 Modifications of the formulae in two drugs indicated for menopausal syndrome

Menotab® formula48 Menosan® formula49

Withania somnifera Terminalia chebulaElletaria cardamomum Saraca indicaBombax malabaricum Centella asiaticaCentella asiatica Asparagus racemosusEmbelia ribes Glycyrrhiza glabraCanscora decussata Sida cordifoliaAsparagus racemosus Kukkutandatvak bhasma50 (processed in

Terminalia arjuna, Bombax malabaricum, and Chlorophytum arundinaceum)

Oyster shell extract Zaharmohara bhasma (processed in Terminalia arjuna, Bombax malabaricum, and Chlorophytum arundinaceum)

Glycyrrhiza glabraAdhatoda vasicaTinospora cordifoliaBoerhavia diffusa


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reverse engineering I presented above, I have indicated that the simplification of the classical formulae should ideally comprise half a dozen ingredients, as opposed to sometimes several dozen in the original recipes. This drastic reduc-tion facilitates market penetration. Again, the object appears fluid and contin-gent when we listen to the manufacturers who assure us that nothing really changes between formulation B and C, or rather nothing changes for the worse since the final product carries the same efficacy as the original, if not better. What counts here is the ‘ontological weight’52 of their claims and what this reveals about the way a pharmaceutical object ultimately absorbs the ideas of its creators.

The Himalaya Drug Company sometimes pushes the reformulation and simplification of classic formulae to its limits. This is the case with the range of products called Pure Herbs®, which rely on single plants—similar to European phytotherapy practice and perhaps more appropriate to reach the correspond-ing market. However, this is a complete novelty as far as classical Ayurveda is concerned because the use of single plants is generally proscribed. A plant is not a medicinal object per se, but needs to be associated with other sub-stances following predefined epistemic logics ( yogam, or union) to actually acquire the status of a medicine.53 The firm promotes 28 Pure Herbs® prod-ucts as antioxidant, cytoprotective, libido enhancer, anti-hypertensive, glucose control, or cardiovascular protector. The selection of plants is taken from the Bhāvaprakāśa nighaṇṭu, a dictionary dated around the mid-sixteenth century that describes a number of plants and their indications. Once the plant is cho-sen for a particular indication, a team of scientists standardises it, concentrates it, and enriches it with bioactive compounds. These scientists identify the herb active marker and isolate its chemical group through fractionation and dis-solution in different solvents, eliminating all other fractions of the plants. The final product is made of a 100% concentration of this fraction. The source of prospection—and not the mode of production—immediately confers identity to these objects which then acquire the legal status of Ayurvedic Proprietary Medicines.

This is true for India, but the status of the pharmaceutical object may change in a different national context. Spatial mobility involves a recontextu-alisation of the object which, in turn, transforms the object. In many countries,

52 Law 1991.53 I am not suggesting here that the polyherbals at this firm all follow the logics of the yogam

to the letter, although in many cases the cognitive patterns that govern plants association clearly stem from the ayurvedic doctrine. For a critical study of polyherbals, see Naraindas in this issue.


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the pharmaceuticals produced by The Himalaya Drug Company cannot enter the market as medicines. As Craig Janes notes for Tibetan medicine, ‘In defer-ence to laws governing definitions of what constitutes “medicine” and “medi-cal care” in the U.S., patients may not be offered Tibetan medicines as such, but are provided with elaborate and detailed prescriptions regarding management of diet and other particulars of behavior.’54 The new formulations may then be sold as food supplements, whether or not they contain the maximal number of plants prescribed by local regulations. The context in which the object is situated in this case brings about a shift in category: from being a pharmaceu-tical it becomes a food supplement or a lifestyle product, in a movement that signals the ‘fragility of objecthood itself ’.55 The firm is aware of this context-specificity and works hard to acquire the coveted identity of pharmaceuticals for these objects—from paperwork to clinical trials or formulation change—or prepare them to be recognised as such when the regulatory environment becomes favourable. This is true for the recent inventions of The Himalaya Drug Company, since they are all conceptualised in relation to international laws and global compliance, and this is understandable (why invent a new drug if there is no scope for sale?).

What falls under the radar is the fact that these very inventions operate within a space of possibility (number of plants, clinical targets, galenic forms), which guides and inevitably contains and restricts invention processes. Corporate discourses and published papers describing the pharmaceutical objects and claiming scientific objectivity fail to address the constraints of pharmaceutical innovation and the fact that objectivity is not simply a question of knowledge and epistemology. It is as much an ethos as it is inseparable from subjectivity.56 When manufacturers speak of objectivity—in their research protocols or the efficacy of their products—they usually leave aside from the discussion the plethora of factors that led to their decision and ultimately to their conclusion. Choices and decision-making, disciplinary selection, global regulatory envi-ronments and other policies, business strategies, and the market are some of the circumstances that influence the production of objectivity.

Conclusion

I started this article by opening a conversation between notions of scholastic theory as found in some Asian traditions and contemporary theory in science

54 Janes 2002, p. 268.55 Appadurai 2006.56 Datson and Galison 2007.


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and technology studies, where in both cases objects are understood as having no intrinsic permanence. For the learned vaidyas whom I met at The Himalaya Drug Company the object’s transience is in no doubt, and its non-phenome-nal reality can only be experienced through long and devoted contemplative and meditative practices. In this case, the object’s emptiness erases its very boundaries and its existence transcends materiality. However, my interlocu-tors recognised that this is an epistemological position—and for some, a philo-sophical position—that helps them to think through the mundane world. It does not mean that people in the laboratory see their pharmaceutical inven-tions in the making as ethereal or impossible to grasp as such, not at all. Some use these ideas to explain or justify the ineluctable transformation of things and phenomena, including ayurvedic products. In some cases, this scholarly knowledge was discursively used to legitimise the kind of profound change in Ayurveda that is fostered by the firm. But there is no point in stretching the comparison too far between these two very distant cognitive universes. It is enough for the purpose of this paper to note that by examining the pharma-ceutical object from the dual perspective of my analytical assumptions and the assumptions of the erudite people I work with and study in India, we come to similar conclusions: the object is fluid, transient, contextual and, as I like to say, ‘empty’. For these people, these conclusions are not mere intellectual excur-sions; they are also produced as a result of their daily pharmaceutical practice. In this way their knowledge is enacted in practice through the reformulation processes at play in the contemporary ayurvedic pharmaceutical industry.

My analytic stance is obviously that of science studies. Here, the overlap between both perspectives shows its limit, for the object tends to maintain its boundaries and be filled up by different ideas, concepts, material formations, or contents of a political, cultural, social, or epistemological nature. The pervi-ous quality of pharmaceuticals makes them conduits for all sort of social trans-actions and opportunities, and therefore offers a re-reading of classic works in pharmaceutical anthropology centred on the social (and not material) lives of medicines.57 So much happens and takes place in the materiality that forms medicinal substances and formulations. It is worth considering the material culture of the pharmaceutical object for these new ayurvedic products, as they are produced and transformed as much by their materiality as by the social and cultural world.58 The materiality is not full and inviolable; paradoxically, it contains spaces that need to be filled to allow the object to exist as such. In other words, the pharmaceutical object is a carrier of investments. This enables the object, for example, to both inhabit and absorb various epistemological or

57 Cf. Reynolds Whyte et al. 2002.58 Pordié 2012.


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legal environments, each of which produce therapeutic knowledge and ascribe meaning, value, power, and identity to a medicinal compound in a particular spatial and temporal context. By understanding the absorption qualities of the object in this way and reflecting on its status, this paper provides a method-ological frame to study the kind of uncertainties and heterodoxies, epistemo-logical and otherwise, that characterise these new therapeutic products.

Susceptible to circumstances and always fragmentary, the ayurvedic phar-maceutical is also a transient object par excellence. After all, pharmaceutical substances are made to be dismantled, disaggregated, dissolved, digested, or metabolised. It is perhaps at the moment that the object is consumed and dis-integrates that its boundaries disappear for the STS scholar, at least in part. These substances ultimately become part of the body; their materiality is in this way closely intertwined with body materials.59 The pervious object is itself absorbed, extending the chain of absorption from empty objects to empty bodies, and between objects and bodies, and providing a useful means to dis-cuss both continuity and transformation. This is the idea that I wish to convey when I speak of innovation through absorption.

These observations do not mean that the object is passive and inert. Studies in material culture in fact show the contrary, they underscore the recipro-cal shaping of inanimate things and people, essentially for social purposes.60 Indeed, the object may well exert some form of influence on the people at the origin of the creation of the object itself, revealing a transfer of forces between the object and the creator as described by Bruno Latour in the case of reli-gious sculptures and effigies.61 People at The Himalaya Drug Company create a pharmaceutical object, which in the course of its life finds itself endowed with meaning, value, and therapeutic power. The bestselling range of prod-ucts Pure Herbs® presented above is a case in point. They are produced and consumed as single plants according to a reductionist equation in which one plant equals one therapeutic indication. These phytomedicines embody the most advanced technological processes at the firm and are positioned as direct rivals to phytotherapy products in the West. Their attributes, in return, might have exerted their influence on their creators, as suggested by my dis-cussions with the Chairman of the company in March 2013. He said that The Himalaya Drug Company was no longer doing Ayurveda but producing phyto- pharmaceuticals. Although this type of discourse is still unquestionably mar-ginal among the personnel in the firm, it is perhaps more in tune with the

59 Sanabria 2009.60 Woodward 2007.61 Latour 1996.


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reality of the newest products. These products, through their presence and success, influenced the way the Chairman himself thinks about his company’s own creations. Once again bearing witness to fluidity and transience, the ayurvedic object becomes a phytotherapeutic item.

This paper also accounts for an era in which medicines displace other medical concerns, in a way that reduces most things medical to their phar-maceutical form. The reformulation regime is a testimony to this, as it feeds the emergence of an autonomous ayurvedic pharmacy that breaks with ayurvedic clinical practice both from a sociological point of view (prepara-tions are no longer made by doctors but by people specialising in medicinal plants and their manipulation) and an epistemic point of view (formulations are ready-to-use mixes for specific indications, no longer ad hoc mixes that are part of an individualised treatment regime).62 By largely overlooking individual humoral variability, the mass production of uniform medicines tends to simplify and depersonalise the act of healing—a trait which is even more pronounced when these medicines are sold on the Internet. This pro-cess objectifies medicine by placing the drug at the centre of the clinical relationship in an equation that once again both constructs and answers to market needs. There is an increasing transfer of power from the doctor to the medicine. Therapeutic power is thus inscribed in new values that are closer to the materiality of a fluid pharmaceutical product than to the practitio-ner’s knowledge.

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