The Social Life of Indian Generic Pharmaceuticals in Johannesburg THE SOCIAL LIFE OF INDIAN GENERICS Copyright Manaf Kottakkunnummal 2016 ii THE SOCIAL LIFE OF INDIAN GENERICS A thesis submitted in fulfilment of the requirement for the degree of Doctor of Philosophy of the Faculty of Humanities of the University of the Witwatersrand, Johannesburg. The Social Life of Indian Generic Pharmaceuticals in Johannesburg I declare that this thesis is my own unaided work. It has been submitted for the degree of Doctor of Philosophy of the University of the Witwatersrand, Johannesburg, South Africa. It has not been submitted before for any other degree or examination at any other university. ------------------ Manaf Kottakkunnummal, 12 February 2016 The University of the Witwatersrand, Johannesburg iii THE SOCIAL LIFE OF INDIAN GENERICS iv THE SOCIAL LIFE OF INDIAN GENERICS Acknowledgements I owe my entire dissertation to the CISA team. First of all, I thank Dilip M. Menon for giving me an opportunity to study in South Africa and extending guidance, support, and friendliness. Second, Sharad Chari instilled constant motivation in me and has been a mentor during the three years of research—thank you very much for supervising me! Julia Hornberger’s co- supervision, indeed, made my research project utterly enjoyable. Vinitha Jithoo also was very generous with me, devoting substantial time—I express my gratitude to her. I also remember the warm guidance of Catherine Burns, Christopher Lee, and Andrew Macdonald at crucial junctures of my work. Again, Catherine Burns, along with Anne Pollock, and an anonymous reviewer from South Africa laid out publication plans and gave major suggestions for revisions. Despite being so negligent about Anne Pollock’s minute corrections she continuously encouraged me to work hard from 2014 onward. My salutes to the threesome! The staff of Cullen and Wartenweiler Library (Wits) were really friendly. Those at the interlibrary loan division of the latter quickly delivered many valuable books that I had audaciously requested, and voraciously read too. Let me also thank the staff of Adler Museum, WHSL Library, WITS, and Pharmacy Museum, Rosebank. I am also grateful to the service of ISID (New Delhi), CSMCH, CHS, CSSS, EXIM Bank Library, and the Central Library (JNU, New Delhi), Ratan Tata Library (Delhi School of Economics), and NMML (New Delhi). v THE SOCIAL LIFE OF INDIAN GENERICS I acknowledge two anonymous reviewers of The Economic and Political Weekly, and The Journal of Southern African Studies who extensively reviewed major portions of Chapters 2 and 3, respectively. Chapter 2’s major portions were published by the former as a special article. I gained heavily from the comments of many anonymous interlocutors who commented on my drafts during the four paper presentations at Wits. I slightly struggled in conducting the fieldwork in Johannesburg. The assistance of various people from the pharmaceutical industry of Johannesburg during my ethnography is well appreciated. The IMS Health, Johannesburg happily shared the audit data on the ARVs. The branches of The HIV Clinicians Society, The Pharmaceutical Society of South Africa, Treatment Action Campaign, and Medecins Sans Frontieres at Johannesburg graciously received me as their cohort. The High Commissioner of India, Pretoria, and Consul General, Johannesburg also facilitated my research endeavours in many ways. I thank them all! My parents and brother have stood with me till now, enduring all the hardships: I love you for believing in me. Thanks to Amit Bhalla, Fatema Chandoo, Mukesh Kumar, Maryclare Gatome, Sarfraz Ali, Wilson, the jolly community of the Inter National Residence, Wits, and last, but not least, to Ajay K. Singh for longstanding support and friendship. In 2016, I have been so lucky to have lived amid the student community of JNU, my alma mater. I thank Sharon K.P.R, Prashant Upadhyay, Sourav Mahanta, Mujeeb Rahman, Saidalavi Panayathil, for their hospitality and support during my visit. Let me also spare warm thanks to Muqbil Ahmar for doing excellent copyediting of the entire thesis. vi THE SOCIAL LIFE OF INDIAN GENERICS I acknowledge three years of financial assistance from the Ministry of Overseas Affairs, Government of India, for my research. JNU, 13-10-2016 vii THE SOCIAL LIFE OF INDIAN GENERICS Abstract Thesis title: The social life of Indian generic pharmaceuticals in Johannesburg Supervisors: Drs. Sharad Chari and Julia Hornberger Department: Anthropology and Centre for Indian Studies in Africa Degree for which this thesis is submitted: Doctor of Philosophy Abstract This dissertation attempts to document the social life of Indian generic pharmaceuticals within the broader material culture of pharmaceuticals in Johannesburg. Foregrounding the question of value created in circulation, the study explores how conduits of generic pharmaceutical flow are saturated with the global politics of humanitarianism, locally embedded profitmaking efforts by businesspersons based on risk, cultural moorings of pharmaceutical relations, and historical specificities of locations in which pharmaceuticals have been mobilized for consumption. The central method is the ethnography of circulation. By documenting the ‘moral claims’ of Indian pharma capital as manifested in the public culture of pharmaceutical business, the discussion places the intersectionality of moral and material transactions at the centrestage of pharmaceutical sales and the creation of value. Keywords: social life of Indian generic pharmaceuticals; Indian capital in Johannesburg; humanitarian goods; pharmaceutical territory; pharmaceutical relations; pharmaceutical entrepreneurship; circulation and value of generic pharmaceuticals viii THE SOCIAL LIFE OF INDIAN GENERICS ix THE SOCIAL LIFE OF INDIAN GENERICS x THE SOCIAL LIFE OF INDIAN GENERICS Contents Introduction: The social life of Indian generic 1 pharmaceuticals in Johannesburg 1. The social history of generic pharmaceuticals in India 67 2. Seeing like a generic pharmaceutical company: Are generics humanitarian goods in Africa? 100 3. Pharmaceutical territory: Entanglement and dispensing in pharmacies 133 4. Of sales representatives and tenderpreneurs: Traffic in 182 Generic Pharmaceuticals Conclusion 236 Bibliography 246 xi THE SOCIAL LIFE OF INDIAN GENERICS xii THE SOCIAL LIFE OF INDIAN GENERICS Abbreviations AICC All India Congress Committee API Active pharmaceutical ingredient ARV Antiretroviral medicine ART Antiretroviral therapy BB-BEE Broad-Based Black Economic Empowerment CII Confederation of Indian Industries CME Continuing medical education CPD Continuing professional development CBD Central Business District, Johannesburg DLF Delhi Land and Finance DRC Democratic Republic of Congo EML Essential Medicines List EMR Exclusive marketing rights FDC Fixed dose combination of ARV FERA Foreign Exchange Regulation Act GEAR Growth, Employment, and Redistribution Programme GMP Good manufacturing practices GORD/PUD Gastro-oesophageal reflux disease /peptic ulcer disease GAA Group Areas Act 1950 HCR Hathi Committee Report IDPL Indian Drugs and Pharmaceuticals Limited, Hyderabad. IPA Indian Patents Act, 1970 KSSP Kerala Sastra Sahitya Parishat, Trissur LSM Living standard measures MCC Medicine Control Council xiii THE SOCIAL LIFE OF INDIAN GENERICS MEC Mineral energy complex MMV Medicines for Malaria Venture MSF Medecins Sans Frontieres, Johannesburg NAPM National Association of Pharmaceutical Manufacturers NAM Non-Aligned Movement NRTI Nucleotide reverse transcriptase inhibitors NNRTI Non-nucleoside reverse transcriptase inhibitors NDH National Department of Health, Pretoria NDP National Drug Policy, 1978 NSIC National Small Industries Corporation Ltd., India PEPFAR US President’s Emergency Plan for AIDS relief PCMA Pharmaceutical Care Management Association of South Africa PLHIV People Living with HIV SME Small, medium, and micro enterprises TAC Treatment Action Campaign, Johannesburg TRIPS Trade Related Intellectual Property Rights SAARF South African Advertising Research Foundation SEP Single Exit Price WITS University of the Witwatersrand UAA Urban Areas Act 1923 USFDA US Food and Drug Administration xiv THE SOCIAL LIFE OF INDIAN GENERICS xv THE SOCIAL LIFE OF INDIAN GENERICS xvi THE SOCIAL LIFE OF INDIAN GENERICS xvii THE SOCIAL LIFE OF INDIAN GENERICS List of Figures 1. Sulfapyridine antibiotics, Carboy museum 5 2. Major legislations that determined the circulation of 20 Materia Medica, 1830–2013 (pg missing) 3. Shitala’s advertisement for a cardiovascular medicine 31 4. Indian generic companies and related firms in and around Johannesburg 34 5. Top pharma companies in South Africa 40 6. Top generic companies in South Africa 41 7. Share of different pharma companies in the private sector ARV market 45 8. Sigma’s ARV sale in quantity 46 9. Sigma’s revenue from ARV sale 46 10. Ujamaa’s ARV sale, quantity 49 11. Ujamaa’s revenue from ARV sale 49 12. An advertisement of Sigma’s Odimune 128 13. A leaflet of Ujamaa’s ARVs 130 14. A testimonial advertisement of Gemini’s Demelan cream 164 15. Phamacies in the backgroung of the map of Johannesburg 166 xviii THE SOCIAL LIFE OF INDIAN GENERICS xix Introduction The Social Life of Indian Generic Pharmaceuticals in Johannesburg Arguments This dissertation explores how Indian generic pharmaceutical companies which I call Shitala, Sphynx, Eureka, Sigma, and Gemini engage in the circulation of generic pharmaceuticals in the highly competitive and complicated realm of pharmaceuticals’ market