structures of global phar maceutical po litical economy. What interests me is
precisely the fact that in the same place (India), at the same time (the 2000s),
in the same industrial sector (concerning phar maceuticals and health), one
can have such diﬀ er ent trajectories of po litical contestation, which intersect
and interact with globally hegemonic movements in po litical economy.
This is the empirical conundrum that allows me to enter into a further
discussion of how I conceptualize the emergent phenomenon of pharmocracy.
This is a complex phenomenon, operating across scales, locales, histories, and
events. I do not wish to pres ent a simpliﬁed picture of this phenomenon for
the sake of analytical clarity; but I also do not want to allude to the massive
complexity of this phenomenon without a concerted attempt to unpack it.13
This will necessarily be partial, following certain threads that I feel are signif-
icant, and focusing largely on Indian events and circumstances. But through
a multiplicity of such partial perspectives, juxtaposed and set in historical,
geo graphical, epistemic, and sectoral relationship to one another, I hope to
generate ele ments of a broader and more comprehensive structural eluci-
dation of con temporary biomedicine, con temporary capital, con temporary
globalization, and con temporary Indian politics.
I enter into an empirically grounded analy sis of pharmocracy through the
case: signiﬁcant events in India that have structured terrains of global bio-
medicine even as they highlight ele ments of that terrain. The two cases that
are central to this book concern clinical studies of vaccines against human
papilloma virus (hpv) infection conducted in the Indian states of Andhra
Pradesh and Gujarat (the focus of chapter 2), and patent disputes in India
around an anticancer drug, Gleevec, developed by the Swiss phar maceutical
com pany Novartis for the treatment of chronic myelogenous leukemia (the
focus of chapter 3). Alongside that, I unpack the critical concepts of value,
politics, and knowledge, to show how complex and multifaceted each one is.
I next elaborate these two parallel routes through which I elucidate ele ments
of pharmocracy as they have materialized in con temporary India.
Ele ments of Pharmocracy (1): A Tale of Two Trials
The year 2005 saw the coincidence of critical pieces of legislation being
passed in India in the domains of clinical trials and intellectual property
rights respectively. These changes must be located within larger trajectories
and contexts of global harmonization/hegemony that facilitate capital flows.
How does one think of the relationship between these longue durée institu-
tional reconﬁgurations and the particularity of a legislative event? Or more