BOOK REVIEW Economic & Political Weekly EPW MARCH 3, 2018 vol lIiI no 9 45 Interrogating the Hegemony of Biomedicine Nandini Bhattacharya P harmocracy: Value, Politics and Knowledge in Global Biomedicine confronts the relationships bet- ween power and global biomedical regi- mes squarely. In the process, it brings to the forefront the political economy of global production, distribution and con- sumption of biomedical drugs in the 21st century. Its principal problematic is to understand, as the author points out at the beginning, global therapeutic regimes within a democratic political system, however contingent the site of that demo- cracy might appear. In effect, therefore, it interrogates the manifestly powerful influence of the global biomedical behe- moths that operate within the global South, and particularly in India. The problem- atic is an enduring one: ever since the Trade-Related Aspects of Intellectual Property Rights ( TRIPS ) agreement (2005) in deference to the World Trade Orga- nization’s ( WTO) recommendation, the landscape of the Indian pharmaceutical industry and market has transformed entirely, with patent laws being tightened so as to make any informal transfer of technology impossible. Global Biomedicine The TRIPS agreement has been studied and critiqued, and its consequences for the Indian domestic pharmaceutical industry has not been as bleak as had been prophesied at the outset. This is principally because the domestic phar- maceutical industry has shifted to the bulk production of generic medicines that do not require the protection of intellectual property rights in the form of patents on new therapies. However, although the industry itself has bur- geoned and is now the third largest in the world in volume, the promises of greater innovation, foreign investment in manufacture (rather than marketing), and the greater good of public health, after the implementation of the TRIPS agreement have not quite materialised, the last having sounded hollow even at the outset. Sunder Rajan’s premise in this authoritative and yet moving book is to move beyond economic and “cynical” (p 7) accounts of the power of global biomedi- cal companies and instead, to focus on the processes by which they have secured hegemony over the political economy. This is where this book uniquely differs from others on the theme; it posits that this hegemony has allowed health “to be appropriated by the logics of capital … through the regimes of governance” (p 7) and despite resistances, is incorporated into “emergent forms of experimentation.” The hegemony of biomedicine (and here the author plays with “harmony”—the catchword of TRIPS that instituted the harmonisation of patent agreements be- tween the developed and developing worlds), therefore, involves not only the finished product and its marketing in the global South, but is itself constituted within and through it, thereby reformu- lating entirely the notion of public health in contemporary India. The author argues that two apparently discrete categories, the standardisation of clinical trials and universalisation of intellectual property, fused together in the making of this hegemony. The consequence of this hegemony is that surplus value, under- stood by the author in financial as well Pharmocracy: Value, Politics and Knowledge in Global Biomedicine by Kaushik Sunder Rajan, Hyderabad: Orient Blackswan, 2017; pp 328 , `1,095.