Between Health, Politics, And Democracy
Mahan Rao
PHARMOCRACY: VALUE, POLITICS AND KNOWLEDGE IN GLOBAL BIOMEDICINE by Kaushik Sunder Rajan Orient BlackSwan, Hyderabad, 2017, 328 pp., 1897
July 2019, volume 43, No 7

It is not easy to review a book that should be a classic in the field, or one that follows another book that is already, in my view, a classic. Kaushik Sunder Rajan’s earlier book Bio-Capital is indeed what I would describe as a classic: it is an exhaustive work, a final word if you want, that shows you what the structure of the global industry of drugs and pharmaceuticals is and how this global industry has moved away from chemical formulations to biological entities and products, and yet has not been able to discover any product that can rake in millions, despite all the money invested in it over the last three decades. This industry is always in crisis, because, as Sunder Rajan explains, it is entirely dependent on financial speculation, and the selling of hope and fantasy, to keep growing. Bio-Capital is thus a trenchant, fact-based critique of the transformations that have occurred in what we used to call the drugs and pharmaceuticals industry. This was a truly significant book. I have, and my students have, benefited enormously from this, particularly because it forms an enormous compliment to Foucault, whose ideas dominate studies on bio-politics. Sunder Rajan argues that political economy is key, while ideas of bio-politics are also extremely important, and indeed shaped by political economy.

You won’t get a PhD or a post-doc in health/ gender studies in the West if you do not do your salaams to Prophet Foucault. But as the late historian Biswamoy Pati argued, ‘A problem in scholarship to date seems to be the hegemonic hold of Michel Foucault, with undeclared assumptions about the relevance of his work when it comes to colonial India’ ( Pati and Harrison 2018: 198),  or indeed anywhere else.

What all of us forget is that Foucault was talking about the institution of medicine, not about health, which is of course much more than medicine. Health is primarily a reflection of the socioeconomic conditions in which people are born, live, work, age and die.  This has a long history that has been drowned with a shift in the concept of health itself, from one encompassing broadly social factors—availability of food, regularity and security of employment, wages, hours and conditions of work, the structure of the family and of work for women, leisure time and care of infants and children, a more nebulous sense of solidarity and community–to the absence of diseases (Hamlin 1992).

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