1. Conversation with the author, Qazi Camp, Bhopal, November 23, 2011 (translated
2. Satinath Sarangi, conversation with the author, October 31, 2012. See also Hanna
3. Yusuf Hamied, interview with the author, August 28, 2008.
4. Interview with the author, November 2, 2012.
5. Current industry estimates put the cost of developing a new drug molecule in ex-
cess of $2 billion, with a failure rate of nearly 80 percent. While such ﬁgures have been
disputed in some corners, they are widely accepted and form a basis for the justiﬁca-
tion of patent monopolies and high drug prices in the United States. I discuss this
in greater detail in chapter 1, and unpack the ideology of innovation that underlies
assumptions such as these through the course of this book.
6. Gramsci developed the notion of hegemony through a series of observations,
many of which were recorded when he was imprisoned by the Italian Fascist govern-
ment in the late 1920s and 1930s, and subsequently compiled into his famous Prison
Notebooks (Hoare and Nowell- Smith 1971). Therefore this is not a term that he de-
scribes with a single deﬁnition, but is rather a problematic that he developed through
fragmentary writings on a range of con temporary po litical issues over a number of
7. Even though I am uncomfortable with the term harmonization, I use it here as an
actor’s category that describes the pro cesses I am in teresting in unpacking.
8. I am referring here to phar maceutical clinical trials, that is, the conduct of clinical
trials to approve new drugs for market. There are many other forms of clinical research
that may not be about drug approval: for example, epidemiological, outcomes- based
public health research. While it is impor tant to distinguish between the two, it is not
always easy to make clean- cut distinctions (see chapter 2).
9. Im portant ethnographic work describing the rise of the cro industry in the
United States and globally includes Adriana Petryna’s (2009) When Experiments
Travel and Jill Fisher’s (2008) Medical Research for Hire. Petryna is especially con-
cerned with the globalization of clinical trials, a pro cess that started in earnest in the
mid-1990s, and the consequent “ethical variability” that has emerged in the conduct