Keeping the doctor in the loop: Ayurvedic pharmaceuticals in Kerala

Abstract

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

Doktor Kot, Doktor Sla – book doctors, plant doctors and the segmentation of the medical market place in Meghalaya, northeast India

“…The specific mix and availability of practitioners varies considerably across the different regions of the county (Lambert 2012; Prasad 2007; Payyappallimana and Hariramamurthi 2012), and the relative legitimacy of different practices has varied historically in response to the professionalising strategies, shifting state support and alignments of particular political and medical projects (Broom, Doron, and Tovey 2009; Khan 2006; Hardiman 2009). Biomedical practices do not necessarily enjoy hegemonic dominance: Kudlu (2016), for instance, has recently documented the processes of commodification and ‘pharmaceuticalisation’ of Keralan Ayurveda as in part a crafting of legitimate alternatives to biomedicine. Indeed, the codified traditions outside the allopathic sector, now known as AYUSH (Ayurveda, Yoga, Unnai, Siddha and Homeopathy), are being increasingly mainstreamed through national health policy (Albert and Porter 2015).…”

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“…For instance,Kudlu (2016) discusses dominance of the classical medicine market and an attempt to preserve the traditional Ayurvedic non-commercial practices in Kerala.6 Ongoing trials for COVID-19 with existing combinations of drugs which include anti-viral and anti-inflammatory medicines to treat severe cases, is an example of the nature of radical experimentation in bio-medicine(Stebbing et al 2020). 4 Efrat (2014) define power distance as "the distribution of power within a society in terms of the degree to which its members expect and accept inequality".3 Masculinity refers to the dominant male gender role in society reflected by "ego, performance, money and achievement"(Efrat 2014).…”

“… 5 For instance, Kudlu ( 2016 ) discusses dominance of the classical medicine market and an attempt to preserve the traditional Ayurvedic non-commercial practices in Kerala. …”