By Gaston Fulquet*

Dr. Sujatha Venkatesh from the Jawaharlal Nehru University (JNU) of India visited FLACSO-Argentina. Invited by the Global Studies Programme she lectured a masters seminar and a conference entitled “Cultural assimilation and cultural exchange: Civilisational interaction in the era or markets” as a way to celebrate an agreement of academic cooperation recently signed between both universities.

Dra. Sujatha Venkatesh is associate professor at the Center for the Study of Social Systems in JNU New Delhi, India. She obtained her PhD in sociology and specialized in the fields of sociology of health and philosophy. She has participated of and coordinated various research projects in these thematic areas both in India and in Europe.

 

In general terms, your academic path has been associated to the field of sociology of knowledge and health but I was wondering when and under what motivations you began to focus your research more on the topic of traditional systems of medicine?

 

SV: My interest in traditional medicine was not that direct but it was more the outcome of a path of search. My PhD focused on knowledge of health and medicine, and one of the things that called my attention was whether ordinary people had knowledge of body and health. At that moment, available social sciences literature suggested that masses were ignorant in the way that they would not know how to take care of their own health because of a lack of knowledge. In that context, experts would be the authorized voice who would come and give them trainings and teach them how to live in a healthy manner. This is the kind of literature that dominated the field of sociology and development: poor people were culturally and intellectually poor.

 

So my interest was to identify how ordinary people think about health, medicine and sanitation. I chose a geographical area in India designated by development authorities as “backward” because of the low level of income, high rate of illiteracy, etc. My research focused on recovering through long narratives the voice of these people and what they knew and thought about various aspects of their body, health, medicine, environment, what doctors were saying about their problems and what they think their health problems were and what were their possible solutions. I realized that people actually had a very coherent idea of what was happening to them and that despite the backwardness of their region their health parameters did not completely correlate to that adverse context.

 

I would discover later on that despite their low income these people had their own food grains, they had herbs from the forest that they consumed periodically and I noticed that their knowledge of nature and their traditional practices around health were helping them stay in good health.

 

So one my findings proved how  wrong was the idea that people who are not formally literate are ignorant, that they do not have a coherent body of knowledge. Mainstream social sciences had associated variables such as high income and education with development without realizing how traditional medicine was a tool used by people for overcoming adverse contextual situations.

 

What are the predominant systems of traditional medicine that stand out in India and that you are analyzing in your studies?

 

SV: When we talk about traditional systems of medicine at an Indian level we refer to Ayurveda. This system has a textual corpus coming from 1500 B.C. There are 3 main texts that are used in the ayurveda curriculum and thousands of regional versions. So this shows a constant engagement with the original texts but also the chance for reinterpretation and new pharmacological formulations that have been included in later texts. This also shows that the development of ayurveda has been accumulative.

 

Ayurveda has also progressed and changed over these 3 millenniums. Earlier in time, it focused on a minimal drug intervention and health should be achieved by preventive actions, so it operated on the principle that food is medicine and medicine is food. But this philosophy had to change as society and lifestyles became more complex and ayurveda developed a significant pharmacopoeia after the 10th century.  It also incorporated practices similar to the principles present in acupressure and acupuncture. These developments were guided by medicals and martial arts specialists. So ayurveda has evolved and now there is the classic ayurveda more severe in terms of food restrictions and a modern ayurveda that is laxer.

 

But then there are other regional traditional systems. For example Siddha medicine is a system coming from Southern India that differs to Ayurveda in that medications have more minerals and metallics. This system was initiated by a group of mendicants and tantrics, the Sadhus, who were not medical people as such but instead they were trying to experiment with the body. By consuming metals in small proportions they could make the body free of diseases. This is combined with breathing practices such as Pranayam and Yoga. This is very spread out in south India among the ordinary people because Siddha were wondering mendicants who moved from place to place spreading their practices, creating and transferring knowledge from one place to another.

 

Unani medicine is another system that comes from Greco-arabic tradition and that in India has developed an elaborated pharmacopoeia which differs from Unani outside of India which did not developed on this direction and it stayed as a philosophical system. But in India due to cultural assimilation it has become a system.

 

Then there is a whole spread of regional traditional medicine associated to traditional regions and language, thousands of them. Imagine that only in south India we found 2 million medical manuscripts written in palm leaf. Apart from that there are oral traditions of tribe groups not find in ayurvedic texts but that are found in practice. These systems adapts their medications and treatments to their ecology, region, etc. What I want to say is that these variety can not be reduced to Ayurveda only. Even the government department for all alternative systems use  AYUSH, an acronym for ayurveda, yunani, siddha and yoga.

 

In India, is there a pacific coexistence between traditional forms of knowledge and modern medicine more associated to technological progress? Or is the relationship conflictive?

 

SV: After several years of promoting and recognizing only biomedicine the government has allowed ayurveda to be located along with allopaths, so since less than a decade biomedicine and traditional medicine coexist under the same roof in India. This is not just because of the benefits of ayurveda but also because there are not enough allopathic doctors to sit in public hospitals. However the cost of the treatment, in terms of medicine supply, has to be beard by the patient. This is somehow an impediment for accessing this type of treatment.

 

Still it is important to highlight that in regions like South India and West India, ayurveda is a top priority. There are very good hospitals that treat cancel, liver disease, I mean they treat hardcore diseases as well as the allopaths. This has to do with history, in regions of India were colonialism did not hit so hard ayurveda had a good background for continuing to develop and ayurveda education stayed strong. So there are some regions with medical centers of excellence.

 

Coming back to something we talked about before, you were mentioning how in the old times mendicants were responsible for communicating traditional knowledge from region to region. But how is the communication and use of this type of traditional knowledge being affected by market forces? And, how is the intellectual property regime affecting this sector?

 

SV: Well, in the old times the medical would have the ingredients and the knowledge to prepare the medicines. This type of traditional set up still exists and there are people who still do that.

However the organized industrial production of traditional medicines started quiet early in India even prior to the chemical industry. Already in 1891 when health was identified as a key issue, all medicines were being imported by the British government from Britain so this brought huge protests because medicines were very costly. So ayurvedic companies started to emerge and manufacture ayurvedic medicines and since then there has been a lot of innovation as they are presented in the forms of paste, oil, tablets easier to be marketed. So scholars do believe that this initial shift was necessary for ayurveda to enter the 20th and 21st century because household production of ayurveda could not compete with biomedicine. This was reinforced by introducing ayurvedic education also in the early 1900 in modern colleges being then recognize as formal education.

 

Companies born by the end of the19th were started by families of the traditional practitioners themselves combining their knowledge in the large scale production process. Most of them did not allow their medicine to be exported, instead they were to be dispensed only along with consultation. Nonetheless in the past 2 or 3 decades pharmaceutical multinationals have entered the market wanting to trade herbal products and nutraceuticals for the global market. Many of these are also Indian companies that started at the end of the 19th century but they have also shifted their production profile. The difference is in the kind of drugs that they produce: while earlier the classical drugs mentioned in the ayurveda texts were made following medical expertise of traditional medicine, now they have research teams that pick up some formulations from the text and modify it though RNA taking only the active ingredient and prepare the medicine in a very different form.

 

So these are all drugs that under ayurveda are being marketed everywhere despite there is very little ayurveda on them and more chemicals. Proprietary drugs have a huge market around the world, particularly in Europe. This transition from classical to proprietary drugs is creating this gray area marketing populations who are looking for natural substances although they are not fully getting that. They market them as food supplies or neutroceuticals as there are restrictions in the main markets for importing drugs coming from other systems of medicine.

 

This reality coexists with smaller household production that follow the classical way of producing the drugs. The panorama is very complex and mixed since there are over 9.000 companies in India and only 25% represent those big multinationals. While large ones export their production to the international market and are subject to “good manufacture practices” enforced by the government of India, small scale production is not regulated at all so there is no way to test if the ingredients used are the original. So my critic is that the government of India is more interested in exporting ayurveda and earning foreign exchange rather than promoting it for public health.

 

As regards to property rights, the bigger firms that developed proprietary drugs have already got their own patents. But I think the problem starts before because many things affecting agriculture may also affect ayurveda, for instance patents on genetically modified seeds and more and more food-crops and substances get patented by multinationals and that is affecting at a grass-root level because these substances are used by ordinary people but gradually they are becoming someone else’s property. On the other hand, the Indian government has digitalized all the ayurvedic formulations on an effort to try to maintain traditional knowledge protected (so they can fight cases regarding intellectual property opposing patents).

 

But on the other hand, a disturbing trend is that the government of India has passed a law for exporting raw herbs as an export oriented activity in order for these herbs to be processed elsewhere. So the huge demand for exports will affect the sustainability of herb production in India and drugs that where available will not be anymore for local use by local populations. So this is other dangerous side effects of the commercialization and “commodification” of ayurveda.

 

 For more information on traditional systems of medicine in India see:

 

*Global Studies Programme, FLACSO-Argentina.

V.Sujatha & Leena Abraham (2012) “Medical Pluralism in Contemporary India”. Orient Black Swan. New Delhi.