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Although for over a century Ayurvedic and Unani manufacturers have played a crucial
role in the modernization of Indian medicine and influenced the way Indians look upon
their medical traditions, this fact has been largely ignored by social scientists and
historians working on Indian medicine. By looking through the lens of the industry and
focusing on medicines, this study questions the notion that traditional medicine is largely
beyond commerce and is highly sensitive to patients as individual subjects. The paper
asks how the logic of the market has shaped, constrained and transformed two
Indian medical traditions: Ayurvedic and Unani Tibb. What kind of indigenous
medicines dominate the Indian market? To whom are these marketed and what are the
images used by the industry to promote their products? How do large manufacturers
construct the ‘Indianness’ of their commodities? Based on ethnographic research among
large Ayurvedic and Unani manufacturers in India during the period 1996–2002,
data for this paper was generated from open-ended interviews, conversations,
observations, and company publications such as popular and semi-popular periodicals.
Promotional materials and research reports were also used, as well as popular
writings on Indian medicine such as articles in general newspapers and magazines.
The paper concludes with a discussion of the effects of commoditization of Ayurvedic and
Unani medicines for clinical practice and the consequences of this development for
the poorer sections of Indian society. The paper highlights Indian medicine as a
commercial activity.
The stall outside was the domain of Peerbhoy Paanwalla . . . Like an artisan of antiquity,
Peerboy took great pride in the products. Besides the notorious bed-breaker paan [betel
leaf with many combinations of ingredients], he sold various others: to ward off sleep,
to promote rest, to create appetites, to rein in an excess of lust, to help digestion, to
Correspondence to: Maarten Bode, Vespuccistraat 82-II, 1056SP Amsterdam, the Netherlands. Tel.: 0032 20
4898146; Email: m.bode@uva.nl
ISSN 1364–8470 (print)/ISSN 1469–2910 (online) ß 2006 Taylor & Francis
DOI: 10.1080/13648470600863555
226 M. Bode
assist bowel movements, to purify the kidneys, to nullify flatulence, to cure bad breath,
to fight falling eyesight, to make well the deaf ear, to encourage lucidity of thought, to
improve speech, to alleviate the stiffness of joints, to induce longevity, to reduce life
expectancy, to mitigate the labour of birthing, to ease the pain of dying—in short he
had paan for all seasons. (Rohinton Mistry 1991, pp. 157–158)
About 7500 factories produce thousands of Ayurvedic and Unani formulas (Ministry
of Health and Welfare 2001).1 Most of these firms are small enterprises with an
annual turnover that does not exceed US $500,000. The 10 largest firms are
responsible for approximately 60% of the total sales of Ayurvedic and Unani
medicines. The author estimates that in 2000 the sale of Ayurvedic products
amounted to about US $800 million and that approximately US $40 million was
spent on Unani commodities.2 The industry is expanding fast and four years later the
turnover of the Ayurvedic industry was about US $1000 million. This is significantly
high when compared to a turnover of US $6 million in 1980 (Leslie 1989, p. 27).
Ayurvedic and Unani products are marketed as natural remedies against common
discomforts such as indigestion, cough, muscle pain, headache, pimples and rashes,
menstrual irregularities, whitish discharge, post-partum and menopausal ailments.
Increasingly, Ayurvedic and Unani medicines have been propagated as remedies
against ‘modern’ chronic diseases like diabetes, arthritis, Alzheimer’s and Parkinson’s
disease. A variety of tonics, ‘to boost the immune system’ is yet another important
class of Indian health products. There are ‘sexual’ tonics, ‘brain’ tonics, ‘liver’ tonics
and tonics against jet-leg, to mention just a few. Other products are marketed as
adjuvant for fighting the iatrogenic effects of biomedical treatment and as
preventive and curative substances for the treatment of ‘ailments of affluence’ such
as high blood pressure, obesity and high cholesterol levels. Ayurvedic and Unani
cosmetics promising all-in-one health and beauty are another large segment of the
market of Ayurvedic and Unani commodities. Soaps, creams, toothpastes, hair
oils and shampoos make up a substantial amount of the annual turnover of
the industry.
The theoretical perspective of this paper draws on work of Arjun Appadurai in
which he makes us aware that meanings attached to material objects depend upon the
social-cultural context in which we find them (Appadurai 1986, pp. 3–63). According
to Appadurai social-cultural contexts—called ‘arenas’ or ‘sites’—are marked by their
transactions and meanings. For example, different values are attached to the same
object when it is sold at an auction, worshipped in a temple or cherished in a home as
a relic of the forefathers. A range of scholars have applied and extended Appadurai’s
view to medical substances (van der Geest, Whyte & Hardon 1996; Whyte, van der
Geest & Hardon 2002). These authors draw our attention to the different ‘life phases’
modern pharmaceuticals go through when they are manufactured, traded, prescribed
and consumed. These high tech products are subsequently tokens of modern
technology, merchandize, facilitators of clinical encounters and symbols of hope
for the ill. Medicines, the authors tell us—apart from offering strategies for dealing
with non-wellbeing in a somatic, psychological and social sense—represent cultural
ideas about health, illness and therapy. The different life phases of pharmaceuticals
have transactions and meanings of their own. Just like modern pharmaceuticals,
Anthropology & Medicine 227
Ayurvedic and Unani medicines are framed by a variety of arenas. For example, in the
context of the family these substances are tokens of nurturance; in the national arena
they are proof of Indian spirituality vis-à-vis Western materiality; and in the social
context the consumption of Ayurvedic and Unani medicines testifies to a wholesome
lifestyle and ecological awareness. And as prescriptions of traditional physicians of
high repute and moral status, Ayurvedic and Unani medicines become signals of
wisdom and are conceptualized as gifts to ailing humanity of Hindu rishis (seers) and
Muslim tabibs (wise men). However, when Ayurvedic and Unani medicines feature
on the price lists of manufacturers they are merchandize. This paper focuses on
Indian indigenous medicines as commodities in the market. Here Ayurvedic and
Unani formulas turn into mass-produced goods that are distributed, traded and
consumed. In the arena of the market place Indian medical traditions have become
commodified and its healing substances have been commoditized.3
This paper discusses the way the market shapes, constrains and transforms
Ayurveda and Unani Tibb, India’s largest medical traditions.4 It starts with setting
apart three categories of Ayurvedic and Unani formula and shows that branded
products sold as over-the-counter consumer goods dominate the market. How are
these commodities defined and to whom are they marketed? Following an analysis of
the brand construction, the second part of the paper deals with their sale. What
media and which messages do Ayurvedic and Unani manufacturers use to ‘convince’
the Indian consumer to buy their products? How do they adapt their medicines to
urban middle-class buyers? In their marketing discourse, manufacturers emphasize
the Indian character of Ayurvedic and Unani products. What kind of Indianness
do they project? What notions of Indian identity do Ayurvedic and Unani
manufacturers capitalize on? Finally, the paper discusses the consequences of
the commoditization of Ayurvedic and Unani formulas for the nature of these
substances, Ayurvedic and Unani clinical practice and the accessibility of
these traditions for the less well off in Indian society. Research done in the period
1996–2002 among large Ayurvedic and Unani manufacturers provides most of the
empirical data on which the paper draws.
the author revisited the firm in 2002. This radical change in policy illustrates the
dominance of the over-the-counter market for Ayurvedic and Unani formulas.
How can we explain the fact that in the 1990s branded Ayurvedic and Unani
formulas dominated the market? There are at least three reasons that explain this: the
rise of a rather wealthy urban consumer class; the wish of manufacturers to
protect investments in marketing; and favourable government policies towards
Indian indigenous medicines are all responsible for the profusion of brands in that
period. A change in Indian economic policies in the form of liberalization benefited
urban professionals such as professors, physicians, lawyers, business executives and
higher government employees. Together with urban business people these groups
formed an affluent consumer class that could afford to pay much more for Ayurvedic
and Unani medicines than they could 10 years before. This created a market for
Ayurvedic and Unani branded products, which are approximately five times as
expensive as similar traditional medicines (Bode 2004, pp. 45–46). A lot of money
goes into marketing these brands. Manufacturers only want to invest in products they
can call their own. Therefore the productions of branded products increased at the
expense of traditional formulas that could be obtained from several firms.
Economic factors explain the profusion of brands but regulatory policies are also
responsible for this state of affairs. The Indian government has created a category of
Ayurvedic and Unani medicines called ‘Patent & Proprietary Medicines’. In contrast
to traditional medicines, of which both composition and manufacturing process are
mentioned in pre-selected Ayurvedic and Unani canons, manufacturers of Ayurvedic
and Unani brands just have to convince local food controllers that the ingredients
they use in their products are mentioned in one of these texts. In other words: to get
your product included in the category Ayurvedic or Unani ‘Patent & Proprietary
Medicines’ it does not matter that its ingredients are scattered over different texts.
This also gives ample room for manipulation because the identity of Ayurvedic and
Unani ingredients is widely disputed. This ambiguity has led to the hilarious
situation that a health product like Vick’s Vapo-Rub, a nose decongestant made by
a foreign firm, carries ‘Ayurvedic Proprietary Medicine’ on its label (Cohen 1995,
pp. 336–337). When a product is officially recognized as an ‘Ayurvedic Proprietary
Medicine’ or ‘Unani Proprietary Medicine’ the commodity falls into a lower tax
tariff. For similar products that have not obtained this qualification levies amount to
20% or more, but the owners of Ayurvedic and Unani brands only have to pay 8%.7
This lenient attitude of the government has its roots in India’s recent history when
indigenous medicines were seen as an affordable alternative for western drugs. Before
independence and in the first two decades after 1947 Ayurvedic and Unani medicines
were a matter of national pride (Anil Kumar 2001; Bode 2004, pp. 18–22). Apart
from financial dispensations the favourable treatment of Ayurvedic and Unani
medicines also finds its expression in the fact that a manufacturer of a Ayurvedic and
Unani product can itself decide how the product will be marketed: as a prescription
medicine to modern and traditional physicians or as an over-the-counter product
directly to consumers.
230 M. Bode
Selling Brands: Urban Middle-class Consumers and the Making of Indianness
In earlier publications the author has argued that in the last two decades of the
twentieth century urban middle-class consumers such as professionals, business
executives and senior civil servants with a monthly income of more than US $500
have become important customers of over-the-counter Ayurvedic and Unani brands
(Bode 2001, pp. 449–557; Bode 2002, p. 187). The following quotation illustrates that
to attract and serve these new consumers, dosage forms and indications of use had to
be adapted:
My daughter of eighteen does not want to swallow bitter potions when she has a
common cold or a headache, or when she does not feel well because of her menses. She
wants to get rid of her problems the easy way. On television she sees that popping pills is
the solution when you do not feel well. She does not want to swallow large quantities of
traditional powders or use bitter potions and she asks why bother about food and life-
style changes which often come along with a traditional Ayurvedic approach. A nice
pack, a modern name that hints a medicine’s usage, and dosage forms that are easy to
take such as coated tablets are part and parcel of the Ayurvedic over-the-counter brands
of today. Indications of use have become disease specific, because classical humoral
ideas about which medicines to take for which symptom complexes in what kind of
circumstances are too complex to communicate to lay people. (R&D Manager of the
Arya Vaidya Sala, interview, Kottakkal, February 2000)
breast milk and prevents it from any infection’ (product brochure named Post
Delivery Restorative Tonic for Women 1997, p. 4). In contrast, smaller firms market
their version of dashmularistha as a traditional product within a humoral discourse.
In this case the indications for use are quite different and dashmularistha is sold as
remedy against ‘wind-diseases’ such as cough, asthma (svas), tissue-wasting (dhatu-
kshinta), involuntary semen loss (prameha), diabetes (madhuprameha), nausea,
vomiting, jaundice and stomach disease. The formula is traditionally also
recommended as a ‘stimulator of the digestive fire’ (agnivardhak) and general
fortifier.
Over-the-counter brands are advertised in public media such as television, radio,
cinemas, newspapers and magazines. Signboards and sales exhibitions are also
popular ways of drawing the attention of the consumer to Indian indigenous medical
products. Attractive packaging, catchy slogans and gift-with-purchase deals are used
to compete with other similar products available in the market. Companies do their
best to create brand loyalty and try to establish a positive product image in the
consumers’ minds. Because of expenses involved only large Ayurvedic and Unani
manufacturers such as Dabur, Hamdard, Zandu, Himalaya Drug Company, Carak,
Medimix, Aimil, Vicco and Baidyanath can advertise on the national television
Doordarshan and in prominent magazines such as India Today and Grih Lakshmi.8
These manufacturers also buy printing space in periodicals. In so-called ‘Special
Advertising Supplements’ and ‘Advertising Specials’ soliciting and informing go hand
in hand. General information on Ayurveda and Unani Tibb is intertwined with
material on the firm and its products. By the end of the 1990s large manufacturers
established their own websites to sell their products. To attract consumers,
manufacturers use the rhetoric and images of tradition, nature and modernity
(Bode 2002). They link their products to common substances and notions as well as
to ‘a golden past’ such as that of the Gupta dynasty (320–550 AD) or the Islamic
Moghul empire (1555–1857). At the same time they boast their modern production
facilities and laboratories, and emphasize modern pharmaceutical studies that frame
their products (Bode 2004, pp. 84–104). Ayurvedic and Unani brands are traditional
and modern at the same time.
By linking their goods to Indian culture, Ayurvedic and Unani firms claim desi-ness
(commonness, Indianness) for their products that they project as authentic, genuine
and safe remedies. Ayurvedic and Unani manufacturers state that their goods express,
maintain and advance Indian identity as illustrated by the following quotation:
Socially and culturally speaking Unani is well integrated because it is in India for almost
thousand years. Unlike Western medicine that uses mainly chemicals we only use
natural medicines and humane healing methods. Our medicines are part of nature,
well-balanced and wholesome to Indian bodies and minds. Unani does not give people
side effects but gives them what they are: their culture, their history and their health.
(Marketing Manager, Hamdard, interview, Delhi, February 1999)
Unani Tibb and Ayurveda are associated with Indian values such as naturalness,
wholesomeness and authenticity. Marketing rhetorics hold it that Ayurvedic and
Unani formulas lead people back to their ‘true’ natures. Ayurvedic and Unani
substances, notions and practices are said to ‘establish people in themselves’.
232 M. Bode
Table 1 Stereotypes of Western and Indian Medicine
Acknowledgements
I thank my friend Darshan Shankar for providing the title of the article. I have benefited
greatly from suggestions and corrections made by the editors, Sushrut Jadhav and Susie
Kilshaw as well as from the critical queries raised by the anonymous reviewers of
Anthropology & Medicine.
Notes
[1] The forms of contemporary Indian medicine have much in common. Ayurveda and Unani
Tibb, for example, use similar ingredients and preparation processes, and have similar ideas
and practices related to health, disease and well-being. Among Indian medical traditions
Ayurveda is structurally and functionally dominant. In number of colleges, physicians and
drug manufacturers, Ayurveda surpasses other Indian medical traditions.
[2] Figures are the result of a process of triangulation. Data come from personal communications
of managers, company publications and written enquiries with government agencies and
professional organizations.
[3] The term ‘market’ denotes ‘. . . any domain of economic interactions where prices exist
which are responsive to the supply and demand of the items exchanged’ (Plattner 1985,
p. viii). I distinguish between ‘commoditization’ and ‘commodification’. The former refers to
material objects that have become objects of trade, while ‘commodification’ is used when
a money tag has been put on non-material things such as health and labour.
The commodification and commoditization of Indian medicine is a fact when medical
Anthropology & Medicine 235
practice, training and the distribution of medicines have largely become commercial
undertakings.
[4] Ayurveda is endogenous to the subcontinent and Unani Tibb or Indian Greco-Islamic
medicine was introduced to India by Muslim conquerors in the twelfth century but became
indigenized in the centuries thereafter.
[5] What distinguishes brands from traditional formulas? In the case of Ayurveda, between 50
and 60 classical texts—the number varies because of negotiations in the boards and
committees—have been selected for this purpose. In the case of traditional medicines,
composition and preparation method must come from a single canon. In contrast, the
ingredients and preparation method of over-the-counter brands and ‘prescription’ brands
may be scattered over the selected canons. It would be incorrect to assume that this defines
Ayurvedic products unambiguously. In practice the boundaries between the three categories
are fluid and manufactures themselves decide into which category a product falls.
[6] See Kamat and Nichter (1998, 1997) for the common Indian practice of selling ‘prescription’
drugs over the counter.
[7] Percentages vary because the state governments determine the levies paid on Ayurvedic and
Unani products.
[8] Other examples are: The Times of India, the Hindu, the Pioneer, Frontline, maha-lakshmi
(a women’s weekly in Hindi) and the panjabi kesari (a Hindi newspaper from the north-west),
to name just a few.
[9] The Ayurvedic concept of prakriti and the Unani concept of tabiyat denote people’s individual
humoral balance, which is linked to their self-healing potential.
References
Anonymous (1997) ‘Dabur: introducing Ayurveda to the world’, Far East Focus, Oct., pp. 47–52.
Appadurai, A. (1986) ‘Introduction: commodities and the politics of value’ in The Social Life of
Things. Commodities in Cultural Perspective, ed. A Appadurai, Cambridge University Press,
Cambridge, pp. 3–63.
Banerjee, M. (2002) ‘Power, culture and medicines: Ayurvedic pharmaceuticals in the modern
market’, Contributions to Indian Sociology, vol. 36, no. 3, pp. 435–467.
Bode, M. (1997) ‘Integrated Asian medicine and the loss of individuality’, Journal of the European
Ayurvedic Society, vol. 5, pp. 180–195.
Bode, M. (1998) ‘On the consumption of Ayurvedic pharmaceuticals in India: extracting the
poison of modernisation’ in Uit de Zevende. Vijftig jaar Politieke en Sociaal–Culturele
Wetenschappen aan de Universiteit van Amsterdam [From the Seventh Faculty: Fifty Years of
Political and Social–Cultural Sciences in Amsterdam], ed. A. Gevers, Het Spinhuis,
Amsterdam, pp. 361–371.
Bode, M. (2001) ‘Indian indigenous pharmaceuticals: the articulation of modernization and Indian
modes of thought’ in History of Science, Philosophy and Culture in Indian Civilization: Volume
IV, Part 2, Medicine and Life Sciences in India, ed. B. V. Subbarayappa, Centre for Studies in
Civilizations, New Delhi, pp. 549–573.
Bode, M. (2002) ‘Indian indigenous pharmaceuticals: tradition, modernity and nature’ in Plural
Medicine, Tradition and Modernity, 1800–2000, ed. W. Ernst, Routledge, London &
New York, pp. 184–203.
Bode, M. (2004) Ayurvedic and Unani Health and Beauty Products: Reworking India’s Medical
Traditions. PhD thesis, Faculty of Social Sciences, University of Amsterdam.
Cohen, L. (1995) ‘The epistemological carnival: meditations on disciplinary intentionality and
Ayurveda’ in Knowledge and the Scholarly Medical Tradition, ed. Don Bates, Cambridge
University Press, Cambridge, pp. 320–343.
Kamat, V. & Nichter, M. (1997) ‘Monitoring product movement: an ethnographic study of
pharmaceutical sales representatives in Bombay, India’ in Private Health Providers in
236 M. Bode
Developing Countries: Serving the Public Interest?, eds S. Bennet, B. McPake & A. Mills, Zed
Books, London, pp. 124–139.
Kamat, V. & Nichter, M. (1998) ‘Pharmacies, self-medication and pharmaceutical marketing in
Bombay, India’, Social Science & Medicine, vol. 47, no. 6, pp. 779–794.
Kakar, S. (1982) Shamans, Mystics and Doctors: Psychological Enquiry into India and its Healing
Traditions, Oxford University Press, Delhi.
Katiyar, C. K. et al. (1999) ‘Spices: the traditional wealth for health’, Ayurved–Vikas,
November–December, pp. 25–36.
Kumar, A. (2001) ‘The Indian drug industry and the Raj’ in Health, Medicine and Empire:
Perspectives on Colonial India, eds B. Pati & M. Harrison, Orient Longman Ltd., Hyderabad,
pp. 356–385.
Leslie, C. (1989) ‘Indigenous pharmaceuticals, the capitalist world system, and civilization’, Kroeber
Anthropology Society Papers, pp. 23–31.
Ministry of Health and Family Welfare (2001) Draft National Policy on Indian Systems of Medicine
2001, Central Council of Indian Medicine, New Delhi.
Mistry, R. (1991) Such a Long Journey, Faber & Faber, London.
Plattner, S. (1985) ‘Introduction’ in Markets and Marketing, ed. S. Plattner, University Press of
America, Lanham, pp. vii–xx.
Singh, R. H. (1999) ‘Needs of Ayurvedic profession and expectations from the industry’
in Ayurvedic Drug Industry: Challenges of Today and Tomorrow. Proceedings of the First
National Symposium of the Ayurvedic Drug Manufacturers Association, ed. N. S. Bhatt,
Ayurvedic Drug Manufacturers Association, Bombay, pp. 41–48.
Van der Geest, S., Whyte, S. & Hardon, A. (1996) ‘The anthropology of pharmaceuticals:
a biographical approach’, Annual Review of Anthropology, vol. 25, pp. 153–178.
Whyte, S. R., van der Geest, S. & Hardon, A. (2002) Social Lives of Medicines, Cambridge University
Press, Cambridge.