The Scandal of Access: Pharmaceuticals in Pakistan
- Hayat, Zahra
- Advisor(s): Hayden, Cori
Abstract
Pakistan has among the world’s lowest drug prices, and Western multinationals rarely apply for drug patents there. Yet, despite the absence of these quintessential barriers to access, Pakistanis confront some of the highest global burdens of treatable yet untreated diseases, perpetual shortages of lifesaving drugs, and an epidemic of unpalliated pain at the end of life due to morphine scarcity. This paradox, devastating in its consequences, lies at the heart of this dissertation.The dissertation argues that to understand the paradoxes of access in Pakistan, we must radically rethink the relationships between access and its determinants. Specifically, it demonstrates the counterintuitive relationship between access and price, showing how prices that are too low can deprive people of medicines; between access and intellectual property, showing how drug patents can exert powerful effects even in places where they do not exist—what I call “spectral property”; and between access and quality, demonstrating that despite the proliferation of several competing brands of the ‘same’ drug in Pakistani markets, these versions are in fact so different from one another that consumers cannot know what they are ingesting, and whether it will heal, further sicken, or kill them. The dissertation develops an analytic of ‘scandal’, departing from familiar tropes of crisis and state failure to voice an ethical-political critique of how specific instruments of global capitalism articulate with national regulatory and legal systems to hinder access in counterintuitive ways.