Publications and presentations

The BHESA team presented at Lisbon University at the Biannual South Asia conference titled European Conference on South Asian Studies in 25-28 July 2012. We gave four papers on a panel called Knowledge, Power and Health in South Asia  that was convened by Cristiana Bastos, Sanjoy Bhattacharya and Salla Sariola.


Janus in the mediscape? The Indian pharmaceuticals industry (and its global ambitions)


Roger Jeffery (University of Edinburgh) 

The trajectories of pharmaceuticals in India's urban centres have been transformed since Indira Gandhi unleashed the generics industry by removing product patents. In 2005, product patents returned to an Indian pharmaceuticals industry that was not only dominating the Indian market but also exporting its products to the global heartland, taking over European and US companies in the process. Big Indian Pharma - like Ranbaxy, Dr Reddy's and Cipla - display Janus-faced characteristics. On the one hand, they are providing employment for millions and ensuring that essential drugs at affordable prices are available to the vast population of the sub-continent. On the other, as exemplars of the world of the Indian corporates, they want to join the rich man's club. Their successes are trumpeted by the Indian government, and are part of the imagined goal of a hi-tech knowledge-based economy. Their factories and corporate headquarters appear as futuristic mediscapes, peopled by global citizens.

Here I draw on material collected in the project 'Tracing Pharmaceuticals in South Asia', which followed three drugs from their urban roots to their urban and rural consumers. I focus on the similarities and contrasts between two iconic companies: Ranbaxy and Cipla. Ranbaxy is the archetypal, no-nonsense, go-getting business where dynastic squabbles led to a division of the company and the creation of a corporate hospital chain. Cipla is a quintessentially Nehruvian company which has challenged patent-holders and supplied generic medicines to sufferers from AIDS in sub-Saharan Africa. It remains under the control of the son of its founder. The paper explores the significance of the contrasts between these business models.

 

From being a care-giver to becoming a researcher - clinical research in India


Deapica Ravindran (Center for Studies in Ethics and Rights, Mumbai ) 

Salla Sariola (Durham University)

Following a legal change in 2005 that provided stronger patent protection in India, multi-national pharmaceutical companies have been increasingly out-sourcing their clinical trials to the country. As on August 2011, there are approximately 1900 trials registered in the official Clinical Trials Registry of India (CTR-I). Since then, there have been both international as well as national criticisms suggesting that this shift is a form of exploitation of poor patients without any real benefits to the country, science community or local health needs. However, what actually happens on the ground and why trials are welcomed has not been thoroughly documented to date. As part of a research project entitled Biomedical and Health Experimentation in South Asia, in 2011 we conducted around 40 in-depth interviews in three tertiary care hospitals in India with medical doctors and junior research assistants who are the local mediators of these trials, about the conduct of experimental research. The principal investigators we interviewed were busy doctors, often heads of departments. These doctors are crucial to the implementation of a trial but their views on clinical research activities have not been analyzed. This study illuminates why busy, practicing, doctors agree to become investigators in clinical research despite their demanding schedules particularly when research is not an common part of medical practice in India. In this paper we describe the benefits that the doctors expect from clinical trials and how they manage to maneuver their schedules to accommodate the time consuming research activity.

 

Evolution and growth of health research and experimentation in Nepal: emerging trends, actors and modalities


Jeevan Sharma (University of Edinburgh) 

Ian Harper (University of Edinburgh)

Rekha Khatri (Social Science Baha) 

There has been a steady increase in research activities within the health sector in Nepal. With the growing emphasis on 'evidence' in policy and programming and the growth of scientific publications within academia, there is an increasing emphasis on scientific research. One aspect of this is the question of 'rigor' as an important element in the debate within the scientific and policy community. This paper traces the evolution and the development of health sector research in the context of Nepal. We chart the actors, sponsors and modalities of conducting public health research and experimentation within the health sector in Nepal. In particular it examines the growing culture of contract research in the health sector. Based on the mapping of key research activities, actors, journals, investigators and research focused NGOs as well as key informant interviews, this paper begins to attempt to reconstruct a social history of health research in Nepal. The paper concludes with a number of propositions based on our ongoing fieldwork in Nepal and the broader analytical questions and the issues they raise.

 

Situating ‘evidence’ in public health interventions and policy making in Sri Lanka


Tharindi Udalagama (University of Colombo) 

Salla Sariola (Durham University) 

Bob Simpson (Durham University) 

The ethnographic material on which this paper is based on is drawn from a project titled 'Biomedical and Health Experimentation in South Asia'. This project undertakes a comparative examination of experimental research taking place in India, Nepal and Sri Lanka. Here we report specifically on a public health intervention project and a randomized control trial in Sri Lanka that was followed during the year 2011-2012. The paper explores the methodological and analytical consequences of undertaking ethnographic research among groups who are themselves undertaking research. It focuses on the relationships between ethnographers, researchers, public health practitioners and other stakeholders and highlights the different approaches to strategies for implementing research design, policy engagement, extent of local capacity, securing of funding and the ways in which collaborations are managed. The evidence assembled enables us to comment on the extent to which the methodology of RCTs contributes to the emergence of public health research in Sri Lanka and how the differences of the two projects inform research practice and its outcomes.