Pharmapolitics in Russia

Making Drugs and Rebuilding the Nation

Olga Zvonareva

• Publisher: SUNY Press
• Year: 2020
• Print ISBN: 9781438479927, 9781438479910
• eBook ISBN: 9781438479934
• Topic: Histoire
• Subtopic: Histoire de la Russie

Documents the surprising role pharmaceutical science and technology has played in Russia's search for national identity over a century of political turbulence.

Over the last one hundred years, the Russian pharmaceutical industry has undergone multiple dramatic transformations, which have taken place alongside tectonic political shifts in society associated with the rise and fall of the Soviet Union and the emergence of a post-Soviet order. Pharmapolitics in Russia argues that different versions of the Russian pharmaceutical industry took shape in a co-productive process, equally involving political ideologies and agendas, and technoscientific developments and constraints. Drawing on interviews, documents, literature, and media sources, Olga Zvonareva examines critical points in the history of the pharmaceutical industry in Russia. This includes the emergence of Soviet drug research and development, the short-lived neoliberal turn of the 1990s, and the ongoing efforts of the Russian government to boost local pharmaceutical innovation, which in turn produced a now widely shared vision of an independent and self-sufficient nation. The resulting industrial organizations and practices, she argues, came to embed and transmit particular imaginaries of the nation and its future.

Chapter 1

The Soviet Pharmapolitical Regime

Promising Social Justice

Immediately after the beginning of the Soviet state, its pharmaceutical industry was reorganized into a centrally managed and planned sector, production moved to state factories, and modern science was invoked to develop drugs and ways to manufacture them. Public research institutes and laboratories became linked to public medicine production and distribution facilities, with state institutions commanding the flow of resources and drugs within this system. This chapter analyzes the formation of the Soviet pharmaceutical industry through the pharmapolitical lens, that is, paying attention to “the strategic practice of designing or using technology to constitute, embody, or enact political goals” (Hecht 2001, 256). Viewing Soviet pharmaceuticals from this analytical angle, we see that they enabled a forceful articulation of the communist ideas about society, on one hand, and contributed to shaping Soviet political ambitions, on the other. In the USSR, pharmaceuticals and politics coproduced a vision of an ultimately socially just society that, as becomes clear in the following chapters, later was superseded by other dominant visions of the nation and its future.

In this chapter, I focus first on the early years of the Soviet pharmaceutical industry; second, on the organization and practice of developing drugs that gradually solidified in the Soviet Union; and third, on the culture of collecting and evaluating evidence in Soviet drug research and development (R&D). In conclusion, by focusing on these three key points, I elaborate on the contours of the Soviet pharmapolitical regime. The chapter is based on my reading of existing accounts of various periods in the history of Soviet pharmaceutical industry. Through a close reading and comparison of these accounts, I bring to the fore ideals and assumptions at play in the formation of the Soviet pharmapolitical regime.

Previous analyses of the Soviet pharmaceutical industry, some of which I draw on here, often emphasize the inefficiencies of the USSR’s drug development, production, and distribution and the USSR’s modest innovation record for medicines. These inefficiencies tend to be explained by a lack of relevant knowledge and understanding of business operations on the part of those who directed the industry. I offer an analysis of the Soviet pharmaceutical industry that makes visible the imaginaries of a particular kind of society at work in building the industry. Not disputing the shortcomings of the Soviet pharmaceutical industry, I argue that to understand the formation of the Soviet pharmaceutical project, it is also necessary to take account of how this sociotechnical endeavor came to be entwined with the vision of a future society saturated with a specific kind of social justice; this vision, in turn, was shaping the governance of the pharmaceutical arena.

The Foundation of the Soviet Pharmapolitical Regime

The Soviet pharmaceutical industry began when chemical and pharmaceutical enterprises were nationalized after the Great October Socialist Revolution of 1917. Nationalization began in April 1918 when a special administrative body called Pharmcenter was created within the Supreme Council of the National Economy to oversee the reform of the pharmaceutical industry. First, of all chemical and pharmaceutical production facilities and laboratories located in the Russian Soviet Republic, the twenty-two most sizeable ones were nationalized. Previously these enterprises belonged to private individuals, joint-stock companies or nongovernmental organizations (such as the International Red Cross), and all but six of them were located in Moscow (Natradze 1967). By the end of 1919, all sixty-two enterprises that produced medicines in the Russian Soviet Republic, which altogether employed about five thousand people, were managed by the state (Natradze 1957). The Soviet strategy further focused on consolidation: many of the nationalized units were closed or reorganized so that the largest plants received most equipment and resources to hereafter scale up the production of pharmaceuticals.

I build my account of the Soviet pharmaceutical industry’s early years, decisive for its further developmental path, on placing two scholarly sources in a dialogue: Mary Schaeffer Conroy’s The Soviet Pharmaceutical Business During the First Two Decades (1917–1937) (2006) and Onisim Magidson’s “History of the Development of the Chemical and Pharmaceutical Industry in the USSR” (1970). The two texts I selected represent two major narratives on which existing accounts of the inception of the Soviet pharmaceutical industry rely. Divergences and silences, made visible by reading them together, provide a fruitful vantage point for discerning joint workings of technology and politics.

Let us first take a look at how these two sources assess the state of the pharmaceutical industry in late imperial Russia and, correspondingly, of the industry development strategy chosen by the Soviets. Mary Schaeffer Conroy (2006), author of three meticulous books on the Soviet pharmaceutical industry, cites the presence of “one hundred or more Russian pharmaceutical enterprises … within the Russian Empire,” adding that “many concerns were small, owned by individuals or families” (11). She describes these enterprises as engaged mostly in botanicals rather than in medicines developed from advances in chemistry and related technologies (11–45). The latter was the broad domain where drug innovation (Achilladelis and Antonakis 2001, 536) clustered in the late nineteenth and early twentieth centuries—and during the First World War, Russian industry began turning its gaze toward medical chemistry (Conroy 2006, 33–35). Conroy suggests that these data demonstrate that the pharmaceutical industry in imperial Russia was quite viable.

Onisim Magidson, a chemist who actively participated in establishing the new Soviet drug R&D system (Ministerstvo meditsinskoi promishlennosti 1971), writes of the pre-Soviet pharmaceutical industry rather dismissively:

Before the Revolution, the chemical and pharmaceutical industry of Russia consisted of small primitive enterprises the proprietors of which occupied themselves mainly with commercial medicaments, articles for the care of patients, and perfumery and cosmetic products. Production was only subsidiary to trade and was a secondary affair. Consequently, the enterprises of the chemical and pharmaceutical industry mainly carried out the mechanical treatment of the pharmaceutical raw material (grinding, mixing, tableting, packaging) or the preparation of galenicals from plant and animal raw material (tinctures, extracts, ointments, etc.). In addition, some technical and perfumery and cosmetic articles were manufactured (soap, creams, face powders, etc.). (53)

While the two authors’ assessments of the state of the pre-Soviet pharmaceutical industry are conflicting, the basic premises on which their assessments are based are similar: the industry consisted largely of small enterprises and barely engaged in chemical synthesis of drugs. The authors, however, interpret the situation in precisely opposite ways. Conroy sees it as supporting freedom of entrepreneurship and encouraging innovation and therefore being the best for development and growth of the pharmaceutical industry. From this point of view, multiple small private enterprises driven by the desire to obtain profits would be creatively coming up with novel technologies, while market mechanisms would ensure their responsiveness to the health needs of the population. In this picture, chemically synthesized medicines and other novel drug groups would arrive soon, through entrepreneurs’ energy and creativity.

But Soviet reformers, including Magidson, viewed the pharmaceutical industry’s makeup of multiple private enterprises as disorderly and primitive. In their point of view, private entrepreneurs working in market conditions would be operating inefficiently, duplicating efforts, and overlooking population health needs in pursuit of profit maximization. Also, the introduction of medical chemistry and modern science and technology more generally in drug development and production would be too uncertain and dependent on the self-interest of business. Against this background, the Soviet reformers were determined to modernize the pharmaceutical sector into one that was centrally planned and directed and in which the most scientific and efficient approaches were employed to develop and produce medicines. The entire industry was to be centrally coordinated to achieve such ultimate efficiency. The system envisioned can be described by a statement by L. Ia. Karpov, the head of the Department of Chemical Industry in the Supreme Council of the National Economy, on May 30, 1918. Karpov conveyed that the state through its governance mechanisms had:

… the tasks to regularize and coordinate the activity of factories, review and approve budgets of the state factories, supply them with [financial] means, unite accounting and control, guarantee raw materials and fuel, [coordinate] technical control over production, supervise administration, review and approve the order of sales of the products. (Russian State Economic Archive [RGAE], fond 8126, opis 1, cited in Conroy 2006)

Therefore, Magidson, who viewed the Soviet way of building the pharmaceutical industry as the most rational and efficient one, considered the late imperial Russian industry to be in a dismal state.

The differences described between Conroy and Magidson in assessing the pre-Soviet pharmaceutical industry and, correspondingly, in their views on how industry was to be organized and governed cannot be explained by their drawing on different data, because they agree on initial facts, that is, on what the pre-Soviet Russian pharmaceutical industry looked like. I suggest, rather, that these differences are reflective of divergent sociotechnical imaginaries of the pharmaceutical industry and the society that this industry is to serve. The Soviet society was held strongly by an imaginary of how the country’s industry, including the pharmaceutical sector, would come to the forefront of science and technology and become the most rational and efficient in the world through its central coordination and planning and the exclusion of private profit motives and, in these ways, support progress toward a society of ultimate social justice. Entrepreneurial, private, diverse industry developing in a market society, where individuals are free to pursue private initiatives and profits, does not sit well with this imaginary. The Soviet insistence on building a pharmaceutical industry not subjected to market forces can be illustrated by the following statement:

… all medicines, to the last gram, have to be accounted by the state that knows how to rationally use them. … In our circumstances products will belong to the state only when the state itself makes them. (Archives of the USSR Ministry of Health, file #979-a from March 15, 1920, cited in Natradze 1967, 98)

This statement was made by the Board of the State Chemical-Pharmaceutical Factories in response to foreign pharmaceutical companies’ requests for concessions to operate pharmaceutical factories in the Soviet territory. In the same document, the authors also stressed that apart from not being willing to rely on market forces to satisfy the country’s needs in medicines generally, they found involvement of foreign businesses particularly dangerous because “[a]s a result we will have not the medicines we need, but the medicines that foreign capitalists deign to give us.”

Therefore, the divergent assessments of the starting conditions of the Soviet pharmaceutical industry can be understood as underpinned by the conflicting sociotechnical imaginaries implicit in Magidson’s and Conroy’s positions. Magidson envisions a society of ultimate social justice, not plagued by inequality and exploitation associated with private business operations, and a pharmaceutical industry organized without duplication of effort, resource waste, or biases of private interests in serving such a society. Conroy, by contrast, sees the freedom to engage in entrepreneurial activities as in fact a driver of societal development and a way to create both economic profits and societal value. Consequently, Magidson defines the state of the pharmaceutical industry in late imperial Russia as primitive and disorderly because it does not facilitate progress toward a society of ultimate social justice as conceived by him and the Soviet reformers. At the same time, Conroy perceives this state as vibrant and developing as it contributes to the emergence of a society of free enterprise and creativity, beneficial for the well-being of the individuals and groups who populate it.

After reviewing the two contrasting perspectives on the initial conditions of the Soviet pharmaceutical industry, I now turn to early Soviet drug R&D. I continue comparing the texts by Conroy and Magidson to analyze practices of drug R&D through discrepancies revealed.

Soon after the nationalization and initial consolidation, the early Soviet pharmaceutical industry gained another element decisive for its shaping—a centrally positioned R&D institute. In 1919, Pharmcenter received a programmatic document from one of its members, Aleksei Chichibabin, who was a prominent organic chemist, a professor at Moscow University (Zaitseva 2001). In this document, Chichibabin argued that creating such a pharmaceutical R&D institute was paramount for the systematic growth of the Soviet pharmaceutical industry, which required a technoscientific foundation (Magidson 1967). The response was positive, and from November 30, 1920, building 15 on Bolshaia Nikolskaia Street in Moscow, where the private Ferrein Laboratory was located before the revolution, housed Pharmaceutical Chemical Scientific Research Institute (NIKhFI) (Mashkovskii 2000). NIKhFI was tasked with:

1.Development of methods for synthesizing medicines and their verification for use in production factories;

2.Substitution of imported raw materials with domestic ones;

3.Research and utilization of medicinal plants;

4.Technoscientific support of the industry. (Natradze 1957, 5)

Confronted with a lack of import opportunities due to frictions in the international political arena, the Soviet state expected pharmaceutical science and technology, concentrated in the NIKhFI, to swiftly find ways to substitute previously imported items and catch up with development and production processes from abroad.

The achievements of early Soviet pharmaceutical science and technology are again assessed differently by the authors whose texts I compare here. Conroy (2006) writes that in 1927, among nineteen new medicines developed by the NIKhFI and introduced into production on a factory scale were

Pantopon (a Roche and, in 1922 a Poehl product); Dionin and Stypticin; the hormone products Adrenalin, Mammin, Ovarin and Tyreoidin (in 1922 a Poehl product for skin diseases). … Exactly how these new preparations … heretofore imported from abroad were developed was not disclosed. Undoubtedly it was through reverse engineering.” (131, italics in the original)

She stresses that most formulations and production methods developed by the NIKhFI in the first years of its existence were not original; rather, its staff found ways to manufacture drugs already available elsewhere. Therefore, Conroy’s evaluation of the NIKhFI’s work is not especially positive.

Magidson (1970), on the other hand, also does not claim that the first achievements of the Institute were highly original, writing that “[i]n a comparatively short time the institute developed and introduced into practice several manufactures new to Russia” (295), that is, admitting that the newly produced drugs were new to Russia, not necessarily to the world. But, he added, “even in the first years of its existence and in spite of various kinds of difficulties (the small number of personnel—60–70 [people], poor equipment), the Institute proved to be of real use to industry and acquired scientific authority” (295). This addition shows that Magidson saw the job of the Institute, where he worked for many years, differently, and, against this background, his evaluation of the NIKhFI’s achievements is much higher than Conroy’s.

To Magidson, the task at hand was to move forward from an industry heavily focused on botanicals and natural remedies and catch up with the technoscience-based pharmaceutical industry abroad, first of all, in Germany, which had already produced two generations of radically innovative drugs based on advances in chemistry, physiology, and bacteriology, and was preparing for a leap to the third generation (Achilladelis and Antonakis 2001). The urgency of the task was aggravated by the continuing reliance on importing drugs from countries not too sympathetic to communism building. This reliance was not considered a suitable option for the Soviet Union, as illustrated by Magidson with an example: “The complete lack of anesthetics and the necessity of replacing imported cocaine made it necessary to create a basic assortment of synthetic preparations of this group” (1970, 55). If it took reverse engineering to reach these goals, Magidson and others involved in these efforts did not see it as problematic; rather, success was perceived as building internal capacity to synthesize and produce modern drugs.

Divergent views on what innovation is can be discerned in these conflicting assessments of achievements of the early Soviet pharmaceutical science and technology, although Magidson does not use the term innovation in his writing. For Conroy, consistent with her implicit view of a free entrepreneurial society as beneficial for people’s well-being, innovation is associated with a concrete, commercializable pharmaceutical product that had not existed before. An important part of this conception is patenting, because innovation is protected by a patent, and those who violate patents, as the Soviets did, engage in anything but innovating. Thus Conroy’s view on innovation is consonant with the influential view of innovation as centered around profit, entrepreneurial firm, and market. This view has dominated most scholarly discussions and theorizing about innovation. By contrast, Magidson, consistent with his aspiration for a society of ultimate social justice as conceived by the architects of Soviet reforms, views innovation in a different way. In his writing, he recalls how the establishment of the NIKhFI itself became a new form of organizing drug development, embedded in the novel socialized institutional structure of the Soviet pharmaceutical industry. Learning how to produce modern drugs and finding ways to do so in the circumstances of scarcity and societal turbulence was innovative for the Soviet reformers, who were opposed to the capitalist mode of production and circulation of goods that form the crucial background of the understanding of innovation articulated by Conroy.

Consequently, understanding innovation in divergent ways, Conroy and Magidson assess in divergent ways the achievements of the NIKhFI and early Soviet pharmaceutical science and technology more generally. For Conroy, these achievements were only imitations that therefore had little value; for Magidson, these were valuable innovations in the organization and processes of drug development and production that were uniquely suited to the harsh conditions of the early Soviet Union. Again, these authors do not disagree on basic data; Conroy writes that “the Soviet Union prototypes rolled off the assembly line at dizzying speed” (2006, 221). It is the interpretation and significance of these facts that are the basis for the disagreement, which can be understood as grounded in opposing ideas about what innovation is and in conflicting sociotechnical imaginaries of the societies these innovations are meant to serve.

To complete an overview of the early years of the Soviet pharmaceutical industry, I briefly describe below the types and quantities of drugs that it came to develop and produce. By 1920, in the conditions of civil war, lack of raw materials, and drastic reforms, the volume of medicines produced fell and constituted about 80 percent of the volume in 1916 (Natradze 1957). The centrally set production plans could not be fulfilled. For example, i...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Illustrations
• Acknowledgments
• Introduction: Drug Development and Politics
• Chapter 1 The Soviet Pharmapolitical Regime
• Chapter 2 Neoliberal Experiments in the Post-Soviet State
• Chapter 3 The Arrival of Commercial Clinical Trials in Russia
• Chapter 4 Pharma-2020 Policy
• Chapter 5 Innovation Environment
• Chapter 6 Pharmapolitics in Russia and Beyond
• Notes
• Bibliography
• Index
• Back Cover