Review of Bhattacharya’s, Disparate Remedies | Asmita Sarkar

BOOK REVIEW

Disparate Remedies: Making Medicines in Modern India
by Nandini Bhattacharya

McGill-Queen’s University Press
Intoxicating Histories Series
2023. xii + 257 pp.
(paper), ISBN 978-0-228-01753-0

Reviewed by Asmita Sarkar (University of Oxford)

In Disparate Remedies: Making Medicines in Modern India, Nandini Bhattacharya investigates the historical roots of the contemporary pharmaceutical industry in India. Bhattacharya’s central concern is investigating why and how “disparate remedies,” that is, remedies from different systems of medicine and of varying quality, coexist in the Indian medical market and are often marketed by the same institutions. This concern is then situated within the larger backdrop of the many contradictions of the pharmaceutical industry in India, which is characterized by spectacular success in the manufacture and export of medicines as well as the saturation of the local medical market with counterfeit drugs. The presence of disparate remedies and the contradictions inherent in the pharmaceutical industry, Disparate Remedies argues, are not simply the product of twenty-first-century globalization but have their roots in the policies of the colonial state from the late nineteenth century onward.

Disparate Remedies covers the period between the late nineteenth century and the mid-twentieth century. The book moves away from the general historiographical trend of analyzing the proliferation of therapeutic goods in colonial India through the lens of consumption and instead focuses on the networks of distribution of such commodities. It is organized thematically. In the first two chapters, Bhattacharya introduces two major actors in the medical market in colonial India: European drug houses and “bazaar” firms, that is, the Indian manufacturers, wholesalers, and distributors who constituted what Bhattacharya terms the “baazar market” in colonial India. While Bhattacharya does not explicitly define the term “bazaar market,” it can be gleaned that she uses the term not just to signify that the firms and sellers who constituted it were often based in the native bazaars but also to signify the section of the medical market that was served by Indian manufacturers and distributors, which catered to large numbers of middle- and lower-class Indians, as opposed to Europeans and elite Indians, and which sold hybrid, and not just Western, therapies. In these two chapters, the author introduces several important themes that run through the course of the monograph. These include the expansion of the domestic medical market in India in the aftermath of the Revolt of 1857, the increased British presence in India and the expansion of the hospital system that it engendered, the porous boundaries between the sections of the medical market catered to by European drug houses and the firms that constituted the bazaar market, the intense competition that characterized the medical market in India where the importance of cheapness and affordability of drugs was paramount, the critical role played by state support in ensuring the success of pharmaceutical firms, and the importance of the First World War in facilitating indigenous production of drugs.

Bhattacharya also demonstrates that while the bazaar market was heterogenous and incorporated a range of producers and distributors of drugs, including large-scale importers and distributors of pharmaceutical products from Europe, it continued to be associated with cheapness and unhealthiness and remained “racially marked with Indianness as well as moral dubiety” (p. 54). While new-age laboratory-based indigenous pharmaceutical firms established from the late nineteenth century onward sought to distinguish themselves from the bazaar market and the stigma associated with it, these firms, Bhattacharya argues, marketed commodities similar to the bazaar firms and did not produce any exceptionally novel drugs.

In the next three chapters, Bhattacharya explores three issues that dominated the medical market in colonial India: the demand for an official Indian pharmacopeia; the demand for import substitution, or the substitution of imported Western drugs with local ones; and debates around adulteration and the demand for its regulation. The author demonstrates that these three demands involved issues that would have benefited the indigenous drug industry, by standardizing, legitimizing, and bolstering it, and were often demanded by nationalist leaders. However, Bhattacharya shows that these three demands were either not realized during colonial rule or only met in its very last years. Disparate Remedies illustrates that while the disparate nature of the Indian medical market, which defied standardization and legislation, was blamed by the colonial government for its inability to establish an Indian pharmacopeia and to regulate the presence of adulterated drugs in the market, it was the association of imported British drugs with quality by the doctors of the Indian Medical Service that thwarted import substitution. In these three chapters, Bhattacharya demonstrates effectively how colonial policies allowed the disparate nature of the Indian medical market to persist and thrive and how a confluence of economic interests, of the colonial state, of British pharmaceutical firms, and of Indian Medical Service officers who had ties with such firms was responsible for the non-realization of the three demands discussed in these chapters.

Moving away from the producers, importers, and distributors of medicine, in the penultimate chapter, Bhattacharya explores the impact of the eclectic and heterogenous colonial Indian medical market on dispensing practices. Bhattacharya centers her analysis on the role played by a hybrid class of dispensers, understudied in historical scholarship, known as compounders. In colonial India’s fluid medical market and unregulated medical profession, these compounders did not just dispense medicine but often also practiced it, leading to tensions between them and medically qualified Indian doctors who practiced independently. Compounders were both a part of the disparate Indian medical market and a product of it, and they continued to persist even after the beginnings of the professionalization of pharmacy in the final years of colonial rule and into the postcolonial period.

In the final chapter of the monograph, Bhattacharya extends her analysis to the postcolonial period and shows that, much like the colonial period, the question of import substitution and self-sufficiency remained the primary concern of the Nehruvian state. Unlike the colonial period, however, in the Nehruvian state, with its policies of scientific industrialism, this self-sufficiency was to be achieved in the production of synthetic drugs and not indigenous ones. Despite these developments, however, much like in the colonial period, Bhattacharya argues, disparate cultures of medicine continued to persist, of which the state remained the chief arbitrator. The state thus looms large in Bhattacharya’s analysis throughout the monograph.

Disparate Remedies paints a vivid picture of the variegated medical market in colonial and postcolonial India and the historical processes that shaped it. It integrates historical scholarship on medical cultures in India and on drug policy. Since the monograph addresses a contemporary concern, its analysis will be of interest to social scientists and historians working on postcolonial India. It also contributes to several different strands of the historiography of medicine in colonial India. Its most extensive engagement has been with the historiography on the vernacularization of Western medicine in colonial India.[1] While much of the focus of this extant historiography has been on the processes of the incorporation of Western diagnostic and therapeutic technologies by Indian medical practitioners, Bhattacharya shows that the vernacularization of Western medicine also involved the quest for the incorporation of indigenous drugs within Western pharmacopeia and the rise of hybrid practitioners and dispensers of Western medicine, such as the compounders.

Apart from some repetition across chapters, a result of the thematic organization, the monograph is rich in historical detail; uses a range of sources, such as government records, official reports, and periodicals; and is an important scholarly contribution. Disparate Remedies will be of interest to both historians and social scientists working on South Asia and on other colonial contexts.

Note

[1]. Shinjini Das, Vernacular Medicine in Colonial India: Family, Market and Homeopathy (Cambridge: Cambridge University Press, 2019); Projit Bihari Mukharji, Nationalizing the Body: The Medical Market, Print and Daktari Medicine (London: Anthem Press, 2009); and Projit Bihari Mukharji, Doctoring Traditions: Ayurveda, Small Technologies, and Braided Sciences (Chicago: Chicago University Press, 2016).

[This review from H-Net is reproduced here under a Creative Commons License]