Introduction [5]
he dies.”4 The image of that scene has stayed with me, of a man whose only
chance of living was to be on experimental medi cation. But what I remember
most is not the man himself, but rather the pointing fin ger of the doctor—
directed at a dying man sitting in front of him, as he talked about that man to
a stranger in En glish, a language he could not understand. He was pointing
not just to a dying man, but to the situation of treating gas victims as their
tissues turned malignant, in a context that has been marked by a failure of
both health care and the law for over three de cades. The doctor was engag-
ing si multaneously in experimentation, therapeutic intervention, and repre-
sen tation, even as he was involved in a deeply politicized situation that had
already been rendered scandalous.
How do we think about value that emerges here, in such spaces and
through such relationships? How do we think about the politics that emerges
here? How do we think about the health that emerges here? How do we
think about the democracy that emerges here? I ask such questions by fol-
lowing ways in which health, value, and politics are constituted globally, in
and through speculative metrics of value established on Wall Street, or phar-
ma ceu tical corporate lobbies in Washington, DC, or through local, national,
and global civil society advocacy around health issues as they play out in
high courts in India, in the calculations of brokers in clinical research located
in Seattle and Hyderabad, North Carolina, and Northern Andhra Pradesh, in
the investments of Indian cap i talists with nationalist inheritances attempting
to be global health players, in trade negotiations happening behind closed
doors within bilateral and multilateral forums, in the pages of public health
journals, or in legislative debates in the Indian Parliament. These are ques-
tions of pharmocracy.
In early 2005, the Indian government passed two consequential pieces of
legislation for the phar maceutical sector. Both involved bringing national laws
in line with global regulatory frameworks, a pro cess referred to as harmo-
nization. One involved an amendment to Schedule Y of India’s Drugs and
Cosmetics Rules of 1945, in order to harmonize guidelines for the conduct of
clinical trials with those mandated by the International Conference on Har-
monisation of Technical Requirements for Registration of Phar maceuticals
for Human Use (ich), the purpose being safe, efficient, and ethical pro cesses
for the testing, approval, and registration of drugs for market. The second
change was to India’s patent laws to make them compliant with the mandates
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