Beruflich Dokumente
Kultur Dokumente
In his recent essay in The Nation [Le Carre (2001)], John Le Carre offers
the brief but useful suggestion that the military industrial complex
spawned by the last stages of decolonization1 is being replaced by a new
politico-industrial complex equally authorized by the vast perception of its
ability to do humanitarian good (that is, protecting lives) and by huge
wealth, pathological secrecy, corruption and greed. Big Pharma the
multibillion-dollar multinational pharmaceutical companies Le Carre
argues, might be recognized as the replacement for nations at a time when
geopolitical relations between countries are no longer based on cold war
antagonisms and military posturing, but on such things as the messy yet
profitable business of ensuring patent protections, and winning debates
over not only who owns the knowledge used in the manufacture and sale of
sometimes life-saving drugs, but also who determines objective truths about
efficacy, medical benefit, and medical harm in these debates. The debates
highlight the critical yet highly contested role played by scientific medical
inquiry in postcolonial times.
I focus on a nation Tibet that many argue is still colonized,2 yet also
participant in the apparatuses of opportunity, economy, domination, reg-
ulation, and what I will call legal theft that were in some cases spawned
by, and in other cases merely sustained after, decolonization in the larger
global context.3 These apparatuses are supported by economics, biology,
ecology and health sciences (to name only a few of the scholarly fields) that
were deployed (post Bretton Woods) to promote development through
multilateral and bilateral aid programmes [Ferguson (1994); Escobar
(1995)]. They are accompanied by the sustained investments of multi-
national corporate firms that operated prior to and during colonialism but,
as Le Carre suggests, have come to depend even more in the postcolonial
era on the sciences of industry, economy and health (and, in the case of
multinational pharmaceutical firms, on practices of scientific truth-making
and patent-generating), to ensure a corner on the market of profitability.
Globally, Le Carre notes, these apparatuses of science and industry have
frequently served as substitutes for and, in all cases, influences upon
geopolitical diplomacy, displacing the nation itself. But I show here that
their operational effects are neither benign nor balanced between nations
or cultures in the debates that such suggested erasure portends.
Within China, development was mobilized as part of socialist nation-
making (often glossed as modernization), particularly in the regions it
considers remote and backward, where sciences of economy, industry and
health have often been tied to repressive forms of social control.4 The shift
to a post-socialist free-market system has ensured a rising presence of
multinational pharmaceutical investments in China, even in remote re-
gions like Tibet a fact that marks, in some cases, a shift to productive (in
the Foucauldian sense) forms of power and discipline.5 It is in part the
increasing desire and enthusiasm among Tibetan doctors, pharmacists and
bureaucrats to participate in global pharmaceutical capitalism that have
spawned tensions around the meanings of science when it comes to
matters like measuring the efficacy of Tibetan medicines, in contrast with
that of western or biomedicine.
In this paper, I explore some of the outcomes of transnational medical
encounters spawned by the circulation of Tibetan medicine inside and
outside of the Tibetan Autonomous Region (TAR), in domains already
colonized by multinational pharmaceutical interests and state regulatory
processes. I ask: what sorts of imbalanced outcomes have been produced
by the transnational circulation of Tibetan medicine, and do these in-
stantiate the features of postcolonial science? Several contested sites are
made visible herein: as debates over what constitutes magic versus sci-
ence; in the relative force of markets versus state regulations in negotiating
medical truth; and, finally in the effects of decolonization in relation to the
rise of new carceral regimes that are articulated in and around scientific
truth claims, protection of consumers, and medical opportunism.
The sad part about the research is that they would never have even
considered HP an important measure if I had not done this research and
introduced the idea of HP to them in the first place.
the United States and European nations [Berg & Mol (1998)], bio-
medicine in Tibet is often presumed to constitute a uniform package of
knowledge and techniques that can be compared, contrasted, and also
integrated with Tibetan medicine.14 One detects an echo of Indian and
Chinese medical scholars of earlier generations who sat on the edges of, or
in the full throes of, Euro-American colonialism, and who responded by
proposing alternative sciences based on their own traditions, all the while
internalizing biomedical professional forms and epistemology [Nandy &
Visvanathan (1990); Leslie (1976a); Prakash (1999)].15 The form of this
debate in Tibet produces enormous tensions around ideas about what
constitutes sacred knowledge and how it should or should not be shared,
what accommodations are required of this knowledge in view of political
demands, and assumptions about the uniformity of Western scientific
claims [Adams (2001b)]. What is missing from an inquiry focused on
epistemology alone, however, is the question of how such medical knowl-
edge has become intertwined with markets and, with an eye on profit, the
politico-legal systems that serve such market interests.16 Given the contem-
porary forms of such encounters, we might ask: what is the role, if any, of
contested medical truths in the pharmaceutical corporate pursuit of mar-
ketable Tibetan drugs? When and how do legal systems become invoked to
legitimize scientific claims, and what are the politics of cultural knowledge
that underlie both the criminalization and profitability of some forms of
medicine within the United States?
had applied for FDA approval for testing Tibetan medicines in clinical
trials, and that these researches had not yet been completed, therefore they
couldnt be marketing them as medical products. He was disappointed. He
went on to tell me that they were excited about the prospect of getting
scientists of Western medicine to validate the efficacy of Tibetan treat-
ments.29 He wondered if I could make sure to send him the results of those
studies when they came out. I did not tell him, at that time, that studies
showing that Tibetan medicines did not work would likely jeopardize their
legal marketability on both the medical and health food market. Neither
study had thus far shown clinical benefits.
Good scientists in the United States and Europe know very well that
the strategies of research deployed by NCCAM and its satellite clinical test
operations in medical institutions around the country, and around the
world, need to sustain a consensual conversation about scientific stan-
dards. Tibetan doctors know this as well, although the temptation is to
note that perhaps the better term for both groups of medical researchers is
that they believe in the necessity of consensual standards. In the case of
NCCAMs director, Dr Steven Strauss, who spoke to a captivated audi-
ence of complementary and alternative medicine researchers in Londons
Wellcome Institute in 2000, there is little room for negotiation about the
gold standard: the randomized controlled clinical trial (RCT), preferably
double blind.30 There, and at a similar conference held in San Francisco in
2001,31 Strauss offered what he called the NIH game plan: exploratory
things are tolerated so long as they have a scientific basis . . . Placebo
controls and the simplest designs are the best.32
In Strauss vision of the game, all contenders can step up to the table
of clinical research where all potential treatments have an equal chance to
play: funding is allocated through stochastic review processes, called
grantsmanship, and with funding secured, the RCT suggests an even
playing field where the best players (treatments) win. Outcomes are
allegedly all that count; the winner cures the most. Inclusion here is an act
of the modern globalized state-defining participants by their ability to
become subjects of a shared medico-clinical gaze. But, in this model,
underlying theories of humours, winds, karma, and elements that explain
diagnoses, treatments, or outcomes from the Tibetan perspective are
considered largely irrelevant to research. They constitute the magical
thinking that needs to be shed for medical legitimacy. But if this magical
excess constitutes what cannot be included, as an expression of the states
presence in the clinical laboratory, it is also in part what attracts many
American consumers to things like Tibetan medicine. Even if the stochastic
processes of testing via the NIH and FDA consider these unimportant for
the ante-up, they become at least superficially visible in the profit margins
for those who win property ownership of the medicines, at least according
to marketers in the industry.33
From the perspective of practitioners of Tibetan medicine, the stand-
ard of the randomized controlled trial is both seductive and problematic.
Seductive, because desires for approval by Western medical scientists
sometimes belie the ability for these practitioners to see how uneven the
epistemological playing field really is. Problematic, because placing a bet
that their treatments will win in this game and submitting to the logic
that unbiased science will offer definitive truths about treatment efficacy
also renders them vulnerable in two ways. First, by entering into the
market, they are potentially criminalized by transporting into the market
both their drugs and their magical thinking. Second, entering the research
field exposes them to the theft of their intellectual property.
To see how this works, we must turn to the house rules of this
medical research that both distinguishes itself from the magical so force-
fully, yet also looks to the magical in order to redefine and domesticate it
for sale. Who benefits from this domestication, and in the process, how
might we, in sympathy with foreign alternative practitioners, read it as a
kind of crime?
reproductive tract infections, but can develop over many years into growths
in the uterus.
Tibetan medicine looks for underlying patterns of imbalance that may
have systemic symptoms in the body emerging in different places at
different points in time. In contrast, biomedicine tends to focus on the
disease as an isolated phenomenon that can be targeted for intervention as
if it were free-standing in the body and frozen in time (or over time),
preferably as an acute disorder (though not always).34 Tibetan medicine
classifies diseases according to the humoral constitution of the patient and
its relationship to other simultaneous disorders, not on the basis of disease
resemblances between patients only. For example, a person with a blood
growth in the uterus may be diagnosed as having the growth because of
weak downward expelling winds accompanied by strong bile energy.
Another patient with a growth in the uterus that looks just like the first
patient in an ultrasound diagnosis, will be diagnosed as having a flesh
growth from an overly strong phlegm presence accompanied by strong
winds. Thus, two patients with the same biomedical disease can be seen as
having different Tibetan diseases.35 But, even if the patients are identified
with the same Tibetan disease, they may be diagnosed with different
etiological pathways, and so needing different treatments.36
Finally, Tibetan medical techniques of diagnosis (tongue, urine, pulse,
interrogation) and its explanations for diagnoses including such things as
spirit causation, karma from actions in past lives, or even perceptions of
political repression/social conflict that are mediated by inner winds are
taken to be largely non- (or even pre-)scientific, and therefore not legit-
imate bases for making claims about valid diagnostic categories. The idea
that winds circulating within the body (responsible for movement of all
substances, for instance) might be affected by things like meditation and
belief in Buddha beings, by immoral behaviour in past lives, or by the
perception of nefarious spiritual entities wreaking havoc in ones home or
in ones heart (seat of the mind for Tibetans) is simply, at this point by and
large, beyond the purview of a scientific approach to alternative medical
efficacy.
One consequence of the complexity raised by such questions is that
outcomes in randomized controlled clinical trials are almost always based
on disorders named by biomedicine. Because it is assumed that disease
labels may change but diseases themselves are universal, few question whose
diagnostic instruments or labels should be valorized in clinical research
protocols. Yet, starting with biomedical diseases results in a disorganization
of the Tibetan approach, undermining the logic of its etiology and treat-
ment resources, and making it most likely that it will not produce statis-
tically successful outcomes. In the end, medicines that cant show effective-
ness in treating biomedical diseases are considered a failure. Practitioners
who use them are at risk of accusations of medical fraud.
In this domain, the spiritual aspects of Tibetan medicine that enable it
to make sense of its failures and successes are excluded as rationale or
object for research design and analysis,37 but they are the points of entry
Second Rule
The second rule at the casino of clinical trials is that evidence is incon-
trovertible; a well-designed RCT study will produce reliable evidence. One
finds that in the global arena of RCT research it is assumed that empirical
data produced in a well-designed randomized clinical trial will be reliable
and incontrovertible. What is wrong with this assumption? Both Tibetan
medicine and biomedicine make use of empirical evidence to make claims
about efficacy, but even when the same diagnostic instruments are used by
biomedical and Tibetan doctors, as is usually the case in outcomes re-
search, each tradition may read empirical data differently. For example,
during field research on Tibetan treatment of growths in the ovaries in
Lhasas Mentsikhang, my American MD collaborator would frequently
interpret ultrasound evidence differently than our Tibetan physician col-
laborators.39 Ultrasound evidence, for example, would show persistence of
growths in the uterus, and to my American MD collaborator, this would be
taken as evidence that the Tibetan treatments had not been effective. But
the Tibetan doctors would frequently note that the ultrasound evidence
was not necessarily able to provide the most accurate measures of effective-
ness of their treatments. The ultrasound evidence was not necessarily a sign
that the patient had not been cured, since the growths were understood
sometimes as symptoms of humoral imbalance, but not as diseases them-
selves [Adams (2002)]. If other diagnostic signs (urine, pulse, tongue)
suggested that the treatments had cured the patient, Tibetan doctors often
explained the ultrasound evidence by noting that residual evidence of
things like growths might be seen for a disorder that was already cured at
the root. Because Tibetan medicine takes a long time to show its effects,
they said, such residual evidence of former humoral imbalance is not
uncommon. Such disagreement over how to read physical evidence was
not uncommon. Similar questions were raised by the work of Fei Fei Li, in
my second introductory snapshot.
Here the question that is seldom asked is: whose outcomes count?
Culturally contested medical claims are arbitrated according to maps that
oppose magical or non-scientific methods to empirical methods that
are familiar enough to substantiate other biomedical models of the body
and health. Herein, theories of humoral roots of disease and cures without
ultrasound evidence are treated as non-scientific as based on belief and
even magical thinking. The exclusion of the former determines whose
outcomes count as winners, and whose claims get to be legalized. Herein,
legal claims are inserted as place-holders for medical truth, confusing the
terrain of a natural fact with political and economic priorities. If the
language of science is enlisted to establish exclusion of certain magical
claims about outcomes (when they are seen as failures), then when the
public persists in treating others of these medicines as if they are not
failures (by continued consumption), then medical research is once again
enlisted to explain the mechanisms of effect, leading to an interesting
inversion. The magical must suddenly be seen as in need of being ex-
plained biologically, molecularly, cellularly, biochemically. This, I sug-
gest, enables a shift of ownership of valid outcomes, a shift that becomes
most visible in the case of pharmaceutical products, which I turn to
now.40
Third Rule
The third rule adopted by clinical researchers in the alternative medicine
field is that treatments can be reduced to discrete lists of isolable active
ingredients. In fact, it is generally assumed that reliable remedies can be
reduced to a few basic active ingredients that can be evaluated singularly
for their effectiveness. This assumption ultimately opens up space for both
crimes and profits.
The RCT method advocated by NCCAM allows for Investigational
New Drug (IND) status for Tibetan medicines, but it also limits the
number of drugs and ingredients that can be tested in clinical trials. Here,
the question of to what extent Tibetan medical treatments can be modified
and still show positive benefits is raised. The model of singular magic bullet
drugs or treatments that can eliminate identifiable acute diseases runs
counter to the model of treatment for diseases that are humorally-based
and change as treatments progress, requiring subtle re-combinations of
sometimes over 60 ingredients and, for many patients, constantly shifting
combinations of different medicines.
Despite claims that outcomes are all that counts, NCCAMs Dr
Steven Strauss advocates identifying the active curative components by
use of the simplest study designs. This means using the same set of
treatments for each patient and limiting the ingredients in each medicine in
the study. In recent breast cancer trials for Tibetan medicine,41 efforts were
made to allow different types of treatment for each stage IV breast cancer
No doubt, trademarking and patenting are also much easier that way.
Tapping into the public desire for Tibetan and Chinese herbals, though,
also requires in the case of Tibetan medicine that Johnson & Johnson figure
out how to pack the magic and spiritual into the pills. In doing so, it
must speak to both a reductionistic language of active ingredients and a
holistic language that imputes spiritual potency to products.
Many Americans have ideas about authentic spiritual potencies in-
vested in Tibetan medicines, and some of these are close to Tibetan views
on the sources of potency of Tibetan medical products. In Tibet, these
medicines are often rendered potent by tantric empowerments (carried out
by highly educated lamas who know these esoteric rituals). Much of the
Tibetan public believes that without these empowerments the pills are not
as potent as they would be, as just a compounded set of ingredients alone
[Adams (2001b)]. Americans pursuing cures through Tibetan medicines
often note that it is the spiritual component of Tibetan medicines that
gives them their potency as well. At the same time, many consuming
Americans also want to know if these medicines offer a magical combina-
tion of ingredients that will surpass conventional biomedical/medical in-
gredients in providing cures. Thus pharmaceutical companies who wish to
truths and facts. Herein the desire for marketable end-products leads to
inclusive practices of research (and desires to have the outcomes positive).
At the same time, desires for the potential profits generated therefrom also
lead to practices of exclusion, authorized in the United States by scientific
processes of renaming and the legal regulations tied to them that ultimately
enable a transfer of ownership of the intellectual property in countries like
this.
The process of converting medicinal substances that are in some sense
owned as the intellectual property of Tibetans into medicines that can be
patented and marketed by pharmaceutical firms is sometimes direct.
Johnson & Johnson hopes to enter into deals with the Tibetan institutions
that manufacture these medicines and indirectly assures them a percentage
of any profits. In the end, however, these arrangements enable the pharma-
ceutical firm to gain ownership of the medicines, because the Tibetans
involved do not know how to negotiate these business deals, nor how to
contest the research processes. The more indirect route for this conversion
is by way of biomedical research, RCTs, and the subtle unravelling of those
things called Tibetan medical techniques into chemical substances, statis-
tical effects, and investment-return obligations. Again, the story of Taxol
is another exemplary case here in that it marks the conversion of a natural
product to a publicly-owned resource (by way of government-funded
research mechanisms) and eventually to a privately-trademarked product
owned by Bristol-Myers [Goodman & Walsh (2001)].
Even when pharmaceutical companies do not get involved in market-
ing Tibetan medicines, direct marketing of Tibetan herbal products also
poses risks that involve a return to the scientific methods now used in RCT
research. Increasingly, biomedical research groups are being funded (by
NCCAM among others) to evaluate the nutritional supplement market in
order, potentially, to weed out any products that contain suspicious in-
gredients. This includes any potentially toxic substances (or at least sub-
stances that are identified as such by RCT methods) being sold as non-
therapeutic resources but being used as precisely therapeutic alternatives.
Often this research does not involve human subjects, but simply a screen-
ing of ingredients against known substances that have been established as
potentially harmful, by some measure.47 Despite the fact that Tibetans
have been taking these medicines in large quantities for many generations
without fatal outcomes, the presence of processed and decanted heavy
metals in many of these medicines poses the risk that without support and
political backing by pharmaceutical firms that convince the US govern-
ment of the safety of these products (with metals removed), Tibetan
distributors of these medicines will be targeted for exclusion and criminal-
ization, even before they are offered a place on storefront shelves.
The fancy games of language and risk-taking that make it possible to
decipher active ingredients and clinical effects, then, are also games that
ensure certain winners and certain losers, much of the time, and this has as
much to do with large-scale investment potential (and the ability to fund
Controlled Crime
Nor, within this Enlightenment framework, may the aspirations of indige-
nous peoples to protect the cultural indicia of their heritage . . . be
adequately acknowledged. . . . The nexus of these difficulties may be
located at the heart of liberal legal discourse itself, its contradictions,
instabilities, and ambiguities aporias ever more apparent in late-twen-
tieth-century conditions. [Coombe (1998): 248]
criminal by way of testing regimes and criminal sanctions because the state
needs to protect unwitting customers from harm, and possible death. But
another crime might be thought of as a crime committed by the state: by
including Tibetan medicine in its legal purview, Tibetan medical practi-
tioners become the means by which the state articulates its exceptional
privilege of deeming what is criminal while also, by that means, enabling
theft of the intellectual property from Tibetan doctors.
I have titled this paper Randomized Controlled Crime because, from
the perspective of critical observers of research on Tibetan medicine in the
USA context, the idioms of randomization and control ensure the faade
of equal access and objective standards while also prioritizing a biomedical
model through exclusion of the so-called magical and spiritual aspects of
Tibetan medicine. The criminalization of practitioners of Tibetan medicine
is putatively both the cause and result of efforts to test the scientific validity
of Tibetan treatments, but the more compelling injustice is the way in
which the politics of knowledge that are deployed in and through govern-
ment and private sector research as the gold standard indirectly constitute
a form of crime that is built into postcolonial modern power. This
biopolitics conflates biological facts with legal privileges and ownership of
profits. It continually defines objects of scientific/legal concern by pushing
that which is deemed spiritual or magical either out of the picture or into a
form that is biological about life itself and therefore both patentable
(enabling a shift in ownership of the knowledge and product) or sanc-
tionable for posing threats to human health (in the case of the
practitioners).
The idea of a crime then might be understood broadly in this context
as tied to cultural sensibilities about scientific legitimacy and to state
instruments for regulating the market and the profits of alternative medi-
cine. When scientific claims are organized around profit margins masked in
a rhetoric of risk reduction to consumers, then the labels of criminality
and fraud can be easily deployed against those whose knowledge claims
differ or stand in the way of profits.48 If things like winds, karma,
elements or humours are also empirical, in RCT research they are less
so than things like placebos and molecular mechanisms. These are what
the NIH and AMA perceive as the audacious risk that mobilizes the
response of criminality, but since the market directs the terms and condi-
tions of legitimacy for medicine in the USA, another magical event has to
occur. Research techniques must either strip the magical qualities from
Tibetan medicines and find their scientific worthiness, while at the same
time stealing its profits for US/Western industries by deeming the scientifi-
ically-proven use of these medicines legal and legitimate, or, research
must appropriate the magical and spiritual qualities of Tibetan medicine
and shift their ownership to those agencies able to show, scientifically, that
they work. It does not always work this way, as surely Big Pharma is as
often embattled with the FDA over its rights to market drugs the govern-
ment considers dangerous as are practitioners of alternative medicines. At
the same time, from the perspective of Asian practitioners who are in the
various medical experts contend for profits and legal protections, suggest-
ing that certain scientific claims may work to benefit some persons (defined
by a national or sovereign terrain) more than others.
Notes
I gratefully acknowledge the generous support of funding from Princeton University, the
University of California San Francisco (REAC), the Wenner Gren Foundation for
Anthropological Research, and the National Science Foundation. Additional insights for
this paper were made possible under funding for a different project from the NICHD
(Network for Womens and Childrens Health). I also am grateful for the assistance of
Angela Ranzini, MD, Yangdron Kelzang, Fei Fei Li, the physicians and colleagues at
Lhasas Mentsikhang. I also want to thank the participants at the Postcolonial
Technoscience Workshop (May 2001) for their insightful comments and suggestions for
revisions, particularly Warwick Anderson, Donna Haraway, Anna Tsing, Paul Rabinow,
Stacy Pigg, Lawrence Cohen, Nicholas King, Helen Verran, Gabrielle Hecht, Philippe
Bourgois, Adele Clarke and Barry Barnes (and please forgive me if I miss others who
offered comments). Finally, thanks are owed to Kevin Ergil for his insights on similar and
other processes that occur with Traditional Chinese Medicine in the United States. Thanks
also to three of the four anonymous reviewers of this paper for their constructive
suggestions on how to improve it. That I received comments or research collaboration from
those named here in no way suggests that the ideas presented here represent their views.
7. That is, despite the many inequalities and exploitations found in colonial regimes, they
were also accountable for the welfare of subjected populations in ways that new
multinational firms are not.
8. This meeting was reported at the time in an article in The New York Times Magazine
[Cherry (1980); see also Benson et al. (1982)]. Elisabeth Stutchbury also offered a
brief account of the meeting in December 1996, in an unpublished paper delivered at
the Healing Powers and Modernity in Asian Societies Workshop (Newcastle, NSW,
Australia). She was present in India during Dr Bensons visit. I have myself been
following the research described in this paragraph since 1981.
9. Charles Raison (then at the Neuropsychiatric Institute at UCLA, now at Emory
University) presented this work at the First International Congress on Tibetan
Medicine, in Washington, DC (79 November 1998). His analysis focuses on the
relationship between thermoregulation and the biochemistry that underpins both
depression and euphoria in relation to possible adaptive mechanisms in human and
animal physiology.
10. I take this information from my own participation as a colleague, teacher and informal
consultant in her research.
11. Dharamsala is the exile home for the first wave of Tibetans who fled Tibet with His
Holiness the Dalai Lama in 1959. These Tibetans fled after about eight years of life
under the communist government of China (PRC) and increased presence of the
Peoples Liberation Army on the plateau. Tibetan exiles live in many different countries
today. This paper includes information collected among exiles as well as among
Tibetans still in the Tibetan Autonomous Region of China (which, in this paper, I refer
to as Tibet).
12. I was told this story by one of his students, who had witnessed the recounting of events
(Eliot Tokar, New York City, Chagpori Institute). This Tibetan doctor had established
American contacts of his own, and was now attempting to put together a lecture tour
on the relationship between Tibetan astrology and medicine.
13. Tibetan doctors travelled to India and throughout the Himalayas during the era of the
Raj, and were exposed to Western medical ideas and practices: see Adams & Dovchin
(2000) and Adams (2001b).
14. Also, Adams & Li (forthcoming) discusses at greater length how the category of
biomedicine is problematic both in terms of its name and its practices in this context
of China. Although many of the textbooks used to teach biomedicine in Tibet contain
information that is similar to that found in textbooks in the United States, the practices
of biomedicine (or what Tibetans call, interchangeably, western medicine, outside
medicine and Chinese medicine) in Tibet is often unrecognizable as such when
compared with similarly identified procedures within the United States. I do not take
biomedicine to be a uniform or essential set of practices, although that is often how it
is regarded among some of my Tibetan colleagues.
15. For more on this encounter in Chinese medicine, see Farquhar (1994); and on the
political implications of this in other contexts in the world, see Harding (1998).
16. Coombe (1998) asks how legal infrastructures make it possible to arbitrate cultural
differences to the advantage of some and not others. Her work on copyrights usefully
expands this inquiry in relation to the role of patenting, which I turn to later in this
paper.
17. Exploring these politics is not a project I undertake in order to establish the legitimacy
of alternative medicine, but rather in order to explore the ways in which legality versus
criminality, authenticity versus fraud, magical thinking versus scientific method,
serve to delimit privilege and denial in the playing fields of a postcolonial world and a
globalized economy. Rabinows (1996) description of this as a form of biosociality is
suitable here, in the sense that our institutions of sociality are increasingly organized,
made liveable, and mapped, by way of our readings/makings of biological life, and
death. The other influence on this work is Agamben (1998), who (if I read him
correctly) has suggested a way to connect biopolitics to the ambiguities of sovereign
law. The rule of the exception on which sovereignty is built is also a basis for a
political, social (and economic, I would add) infrastructure that is built around the
exceptional sacredness of life itself; thus arbitrations over life and death are not
extraordinary, but are built into the ordinary domains of sociality.
18. See, for another example, the DateLine television presentation of the UCSF-based
breast cancer research clinical trial of Tibetan medicine (the Principal Investigator was
Debu Tripathy, MD), in which patients selected for the study described their hope that
Tibetan medicines attentiveness to holism and spirituality will give them an advantage
that they cannot find in biomedical responses to their disease.
19. This information comes from field research among Tibetan doctors that I have been
conducting since 1993, at the Tibetan College of Medicine and Astrology (Hospital
and College) in Lhasa.
20. One could read this as an internal colonial resistance of sorts.
21. For a more complete exegesis of this argument, see Root (1995).
22. A case in point for this is the study of the positive effect that distant prayer is shown to
have on patients. This study is both applauded by many in the alternative medicine
community for its ability to confirm the need to expand scientific explorations into this
area, and largely vilified among those who oppose the findings and the funding, on
grounds that it suggests a loss of scientific rigour in this field.
23. I use magical here in the sense that I believe it is used colloquially in most US
medical science institutions, as contrasting with scientific, in the sense that it was
taken by early ethnologists as a pre-scientific form of logical thought (along the lines of
Frazer). It may be rational (Evans-Pritchard), but cannot approximate scientific
thought because it requires a leap of faith belief as opposed to empirical evidence,
to be explained.
24. This is most clearly visible in the research problem of the placebo. See Harrington
(1997), who explores Judaeo-Christian questions of spirituality in relation to
exploratory biomedical sciences.
25. I do not suggest by this that state-funded medical endeavours are solely devoted to or
unambiguously engaged in opposition to patients use of unproven medications. There
are branches of federally-funded research devoted to ensuring patients rights.
26. Lawrence Cohen (1994) has called this domain an epistemological carnival, giving it
some of the same features of casino capitalism, because research in alternative medicine
can be seen as a game that involves a gamblers risk, the spectacular and seductive
allure of not only great profits but also remarkable cures for terminal or intractable
diseases, and odds that are clearly stacked against certain players more than others.
27. From Kirsten Georgi, Commission on CAM, Acupuncture Today, Vol. 3, No. 2 (July
2001) (available from 396 Broadway, New York, NY 10013).
28. This is the figure offered by David Eisenberg [cited in Martin (1994): 89] for the
amount of money that Americans spent, beyond insurance coverage, for alternative
medicines for themselves or their family members.
29. Tibetan doctors and medical scholars are not uniformly committed to the idea of a
universal science, nor are they uniformly committed to the promise of confirmation
within Western medical frameworks, although that is the dominant perspective these
days: see Adams (2001b).
30. This is based on Steven Strauss presentation at the Wellcome Institutes Workshop on
Complementary and Alternative Medicine, held at the Wellcome Institute (London,
79 December 2000).
31. The International Scientific Conference on Complementary, Alternative & Integrative
Medicine Research, co-sponsored by the UCSF Osher Center for Integrative Medicine,
Harvard Medical School, and the Department of Medicine, Beth Israel Deaconess
Medical Center (San Francisco, 1719 May 2001).
32. This is taken from his plenary speech to the London Workshop (see note 30).
33. Advertisements I have seen for Tibetan medicines in China make use of both an
exotic and mystical dimension of Tibetan medicines (visible in brochures that use
glossy photographs of the remote snowy lands of Tibet, its monasteries and religious
figures), as well as claims to the scientifically established reliability of these drugs
several months of heating, and decanting) renders the dangerous contents of these
metals non-toxic. One wonders, off hand, how so many Tibetans could survive the
mercury poisoning that is imputed as a potential of these Tibetan drugs, given the
popularity of these medicines among Tibetans.
43. A similar process was revealed in the work of Jurgen Aschoff, a neurologist from the
University of Ulm, Germany, who studied Tibetan medical treatment for migraines and
explained effectiveness by reducing the treatment to the active ingredient, aconite: see
Aschoff et al. (1997).
44. That is, only Tibetan doctors who are putatively delivering their medicines on behalf of
the Principal Investigator MD who has legal permission to prescribe these medicines
are allowed to do so.
45. Kevin Ergil has been involved with research and practices of TCM in the United States
for over 20 years, and is a constant source of original insight on matters of translation
and epistemology in this field.
46. The FDA collects ingredient lists from the Tibetan providers and is obliged not to
share them with other researchers. In almost all the cases I have read about [see
Aschoff & Rosing (1997)], the pursuit of active ingredients makes the ingredient lists
public anyway.
47. The University of Medicine and Dentistry of New Jersey [UMDNJ], for example, has a
team of researchers exploring the food supplement market for oestrogen-containing
products. Several alternative medicine journals are now devoted to this sceptical cause
as well; see, for example, The Scientific Review of Alternative Medicine (Amherst, MA:
Prometheus Books). I do not mean to underestimate the benefit of such approaches in
being able to eliminate harmful products from the market. Nor am I suggesting that
Big Pharma is not often on the other side of the fence from the FDA and regulatory
agencies, since large pharmaceutical firms and their specific projects are often the target
for FDA regulations. The arrangements that enable Asian doctors to be excluded from
profits sometimes ally them with Big Pharma and sometimes pit them against Big
Pharma, and ally instruments of the state to pharmaceutical interests. The
arrangements linking together Big Pharma, government sanctions, and scientific claims
about efficacy sometimes do produce this lopsided configuration of power, which leads
to the distinct disadvantage of Tibetan doctors. At other times, things are not so neatly
lined up this way.
48. In his work on Indonesia, Seigel (1998) makes the point that criminalization works as
an instrument of media-based popular control for an authoritarian regime. A similar
process occurs with state-regulated regimes of medical research in the USA, but the
stakes are quite different and the instruments for criminalizing are different. The
similarity is that efforts to protect the public must also criminalize those it deems, by
scientific research, ineffective or dangerous to the public. We might think of this as
part of the magic of the millennial state [Coronil (1997); Taussig (1997)], relying on
not just a theatrical and ritual excess but also on excessively powerful techniques of
differentiation which criminalize the magical while authorizing its reclassification
under regimes of scientific legitimacy. Eliminating the magical by performing a certain
magic of its own. The Comaroffs (2000) have argued recently that organized forms of
criminal activities authorized by millennial capitalism can be understood in moral
frameworks invested with cultural sensibilities that are themselves authorized by a
displaced and refracted class consciousness. Identity and cultural politics become the
basis for participation and resistance within the casino of late capitalism, not class or
conditions of labour. Scientific regimes and clinical trials might also be studied with
this theoretical framing in mind. Again, Tibetan practitioners, no less than medical
scientists working at NCCAM, are enamoured of the idea of a universal gold standard.
It is this magical belief in the fairness of the system that authorizes the research itself.
It is also the allure of magic-like profits that attracts them to the table.
49. I refer to their argument about how, in the absence of credible witnesses as to genuine
phenomena of science, the air pump and other technologies served this purpose
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