Introduction: Two Medical Systems and One Drug?

In 2021, consumers of healthcare services face the same destiny as their pre­decessors in the 1990s, if not a more complex one. There are two legally recognized medical systems in coexistence, Korean medicine and (Western) biomedicine.

This chapter examines the advent of manufactured herbal products whose therapeutic principles are based on Korean medicine. The mass production and marketization of herbal medicines and related products has accelerated in the past few decades. Like many other Asian medical systems, Korean medi­cine has been around for thousands of years, with variations and modifications over time accommodating and emulating Western medicine and differentiating from Chinese medicine and Japanese Kampo.^[780] As scholarly works have noted,^[781] Asian medical practices and principles are pluralistic and diverse and cannot be captured under the umbrella of Western medicine, biomedicine, or scientific medicine (however it is termed). Medical systems have developed in unique ways that are impossible to lump together even under grand traditions of Chi­nese medicine, Ayurveda medicine, and Unani medicine. Healing practices are as pluralistic as there are diverse histories and cultures within and across Asia.^[782]

South Korea maintains a mutually exclusive, dual medical system. The two medical systems—Western medicine (WM) and Korean (Oriental) medicine (KM)—are independent, autonomous, and separate at the institutional and prac­tice levels. Each of the two systems has distinct formal educational institutions,

Classification as a Technology 219 hospitals and clinics, and licensing requirements. Each also had its own nation­wide association, with branches in each provincial city, and each publishes inter­nal newsletters and specialized journals.^[783] Korean medicine (han ui hak in Korean) is also known as Korean Oriental medicine in English.

This parallel medical system reflects a series of political and social trans­formations that took place in twentieth-century Korea: colonial experience, post-war politics, state-driven modernization projects, and democratization movements. Japanese colonial experience was a defining moment in the his­tory of Korean medicine, during which the hierarchical relationship between the two medical practices, institutionally and epistemologically, took shape. Japanese colonial authority institutionalized WM in the public domain—edu­cation, the licensing system, public health policy, and hospitals—whereas KM became marginalized and pushed to the private sector.^[784]

Han yak, medicinal herbs or herbal remedies, are based on Korean medicine and have long been used for therapeutic and preventive purposes in South Korea. As with the advent of technoscience and medical technologies and their entry into healing practices, the status and perception of han yak have changed accordingly, As evidence grounded on scientific ideas and methods is accepted as a norm in the circulation and governance of pharmaceuticals at the national and international levels, health products derived from natural plants, including 220 Eunjeong Ma functional foods, dietary supplements, and drugs, have been gradually brought under the purview of legal and regulatory frames.¹⁰

The Korean case has similarities with so-called “traditional medicine” in Asia, in that medical and pharmaceutical culture has developed in the fluctu­ating political environments.¹¹ And the shaping of the herbal pharmaceutical industry is a prime example to illustrate the complexity and heterogeneity of medical culture. It has emerged at the “confluence of ‘traditional’ medical knowledge, modern science, policy regulations, and the capitalist market”.¹² Like many other Asian medicines, Korean medicine and drugs have turned into a lucrative, innovative industry that can be best understood as an asym­metric assemblage of post-colonial relations linking domestic and international

10 Kim, J.

11 Kim, J. S., Lee S. W. and Kim Y. K., “A study about policy regime for the protection of the rights of Korean traditional medicine in the world market: Focusing on Chinese legislation cases” (2014) 14(1) Journal of Law and Politics Research 103, 103-139; Lee, T. H., “The Dispute on the Mod­ernization of Korean Medicine after the Restoration of Independence - Based on the 1950s and from the 1990s to the Present” (2012) 16(3) Journal of Society of Preventive Korean Medicine 53, 53-73; Lee, T.

12 S. Kloos et al., “The transnational Sowa Rigpa industry in Asia: New perspectives on an emerging economy” (2020) 245 Social Science & Medicine 112617.

Classification as a Technology 221 regulatory authorities, consumer market agencies, techno-scientific research institutions, the academy, and medicinal plants. The processes of the trans­formation of herbs and herbal remedies into contemporary or modern phar­maceuticals or health products are strongly tied to domestic and international political environments. The pharmaceuticalization of Korean medicines (herbal remedies), from the raw materials to production processes and to mar- ketization, has been a state’s business, in particular starting with the colonial government and accelerating with the postcolonial governments. The notion of “assemblage” is relied on and resonant with “pharmaceutical assemblage” that refers to “the heterogeneous, contingent elements that come together, through the process of pharmaceuticalization, in the form of the traditional pharmaceutical industry and contemporary health care”.^[785] The state, whether a colonial state or a nation state, has been at the center to initiate and drive to assemble, both with regulatory and legal networks and funding opportunities, heterogeneous and contingent elements to produce new entities that may be aligned and harmonized with international regulatory standards.

First, this chapter is situated in historical contingencies conditioned to shape the contemporary medical and pharmaceutical practices and policies. Dur­ing and after Japanese colonial occupation (1910—1945), Western medicine was referenced as a scientific and advanced medical system to emulate within official sectors such as public health policies, medical education, hospitals, and medical and pharmacy laws.^[786] Although Korean people had been consuming

herbal medicines and associated therapeutic and nutritional services and prod­ucts based on Korean medicine, the government stayed ambivalent towards Korean medicine, treating it as something to be modernized, abolished, or integrated into scientific medicine.^[787]

During postcolonial nation-building periods, because of Korean people’s heavy reliance on Korean medicine and the shortage of medical personnel and facilities, the government had to endorse Korean medicine in the laws.

Second, this chapter is set in the context of localization of global trends, namely government-driven market formation. Changes at the global level affected the ways in which herbal medicines or natural resources were perceived from regulatory and governmental perspectives. The rise of Asian medicine in

Classification as a Technology 223 global markets has attracted the attention of regulatory bodies and the pharma­ceutical industry at the domestic and transnational levels. The South Korean government has also supported the pharmaceutical industry to develop innova­tive herbal products in order to create “innovative yet traditional” drugs for the biomedical disorders of an international as well as Korean clientele. To put it bluntly, it was a government-driven reformulation regime in the drug indus­try.^[790] The government began to allocate research and development (R&D) resources to the modernization and commercialization of medicinal plants, which inevitably relied on the knowledge of Korean medicine.^[791] Starting in the 1990s, the South Korean government recognized market values of Korean medicine in the domestic and global markets and began to put heavy research and development money into the commercialization of KM.^[792]

Third, this chapter is set in the periods when KM practitioners collectively and strategically fought for governmental attention and resources, which opened up widely political, epistemic, and ontological battle ground over han yak (herbal medicines) between supporters of scientific medicine and KM.^[793] The former is represented by the government, the pharmaceutical industry, and pharmacists and physicians trained in the tradition of western biomedicine. The government’s initiatives to commercialize traditional Korean medicines rekindled deep-seated, unsettling issues among interested professional organiza­tions over how to legally categorize new medicinal compositions. The classifi­cation and categorization of purportedly novel products have posed regulatory challenges such that a simple food versus drug demarcation does not apply to products with health claims.

III.