Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine by Kaushik Sunder Rajan

Abstract

Reviewed by: Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine by Kaushik Sunder Rajan Kalman Applbaum Kaushik Sunder Rajan. Pharmocracy: Value, Politics, and Knowledge in Global Biomedicine. Durham, N.C.: Duke University Press, 2017. xiv + 328 pp. $27.95 (978-0-8223-6327-9). The relentless pursuit of “wealth in health” in the pharmaceutical sector has long been the subject of critical inquiry. Pharmocracy adds to this catalog. As the purported existence and analytical concept of “pharmocracy” form the central argument of the book, I begin with how Kaushik Sunder Rajan defines the term: Pharmocracy, he says, is “the global regime of hegemony of the multinational pharmaceutical industry” (p. 6). [End Page 142] The book argues for the adoption of the neologism, “pharmocracy” (though the term itself is not new1) by primarily examining two cases of foreign companies seeking to establish a beachhead for their pharmaceutical products in the Indian market. In the first, a clinical trial for Merck’s HPV vaccination Gardasil may have caused the death of seven participants (the investigation remained inconclusive). The second concerns a lawsuit brought by Novartis against the Indian government, alleging its failure to uphold international patent law with respect to the company’s anti-cancer drug Gleevec, as warranted under the provisions of Trade-Related Intellectual Property Rights (TRIPS). Sunder Rajan selected these cases because they illustrate, in terms of the pharmocracy argument, the ways in which India has yielded, against its national interests and the well-being of its citizens, to international agreements concerning pharmaceuticals. Such agreements concern aligning with mandates put forth by the International Conference on Harmonization (ICH), the stated purpose of which is to standardize quality, safety, and efficacy measures in clinical trials worldwide, and the changeover to product rather than process patents on new drugs under TRIPS. Sunder Rajan is not the first to insinuate that these mechanisms were engineered by the pharmaceutical industry to serve its interests. Ultimately, the book’s main argument is not wholly convincing. Facts on the ground are too splintered and inconsistent to fit inside the restrictive sleeve of pharmocracy. Sunder Rajan does not shrink from presenting this complexity but never acknowledges the way in which it undermines his argument. In chap. 3 and 4, for instance, he argues that Novartis’s Gleevec giveaway program merely “provides the justification for monopoly” (p. 172). At one point, he epitomizes Novartis’s crusade for monopoly with their threat to discontinue their donation program if Indian companies commenced selling generic versions of Gleevec. An Indian physician involved with the program tells Sunder Rajan, “Yeah, yeah, but that never happened” (p. 177). It’s not to say that the threat was therefore meaningless, but its nonexecution and perceived insignificance by program participants does not back up the hegemony argument. It is awkward but I believe proper to point out that some of this story—the patent battle and the Gleevec donation program—was analyzed first (and far more effectively, in my opinion) by Stefan Ecks in 2008.2 Sunder Rajan’s version overlaps quite a bit with his predecessor’s, though he does not acknowledge any debt. Sunder Rajan proposes an opposition between monopoly and free market capitalism (also “democratic capitalism” [p. 228]). To represent the latter, he offers the example of Cipla, the large Indian generics manufacturer sometimes referred to as the Robin Hood of pharmaceutical companies because it copies [End Page 143] best-selling patented drugs and sells the generic versions inexpensively around the developing world. There is a certain nostalgic poetry to the idea that Indian nationalist health industries were engaged in a more equitable capitalism before Euro-America, with its unrelenting “genocidal monopoly” (Cipla CEO Yusuf Hamied’s term, p. 200), came along and compelled local companies to adopt its a/immoral design. However, many Indian pharmaceutical companies are also multinationals and behave accordingly. Reverse engineering drugs and then lobbying the government to reject the inventor’s product patent could, without too much cynicism, be seen as rent-seeking behavior, even if it has the agreeable overtones of serving the poor and doing battle against former colonial masters. Several Indian pharmaceutical companies have partnered with or allowed themselves, without dragging their...