In a wide-ranging conversation, access to medicines advocate Tahir Amin explains how patent rules, neoliberal policy and corporate influence shape who gets lifesaving care

Tahir Amin has spent years tracing a through line from patent law to pharmaceutical pricing to the question of who really holds power in both the U.S. and global economies. In this conversation, he explains how his path from private law practice to the access to medicines movement led him to a central conclusion: “I’m not practicing law, I’m practicing power.” We sat down to discuss how this power translates to the financial and physical health of Americans, and other themes from the new book he co-authored, Pharma Monopoly: The Battle for the Future of Medicines , which is out this week.

Nyandoro: Your work sits at the intersection of law, policy, global health and power. Before we get into all that, how did you find your way into this fight over pharmaceutical monopolies?

Amin: It was a bit of a journey. I grew up in the north of England. My parents were Pakistani Muslim economic migrants to the UK and we grew up in a working-class mining town called Doncaster. The options were pretty limited there because the North had been hollowed out by policies that people would call Thatcherism or Reaganism here. Somehow I made my way to law school. I was actually more on the athlete side at first. I wanted to play professional soccer. But like many South Asian children, I was told I had to get an education. My parents were not educated themselves, so we had to figure out our own path. I got into law, then into private practice and eventually spent about 10 years there.

Nyandoro: How did that move from private practice to political consciousness happen?

Amin: Around 2001 and 2002, after the U.S. invasion of Iraq, I became more politically active and joined anti-war movements. I started asking what the connection was between these wars and the rules being imposed on countries by the U.S. and the West. I had a friend of a friend who was in Iraq and said the U.S. had literally written the patent and IP laws for Iraq afterward. That really got me thinking. I was also representing some of the largest corporations in the world and seeing how much power they had. Their legal budgets were endless. If they were going against a small trader, we could send a cease and desist letter and the person would just cave even if there was no legal ground. One example, MasterCard was a client, and they wanted to own the two interlocking circles of their logo. We were even going after the Olympic five circles, that’s how crazy and aggressive intellectual property can be. And I just saw that I was no longer able to represent my clients in the way I was ethically bound to.

Nyandoro: So when did you realize the connection between what you were doing and the flip side of it?

Amin: I realized that in corporate law, especially in intellectual property, you are often helping shape the law in ways that expand corporate territory. I saw that I’m not practicing law, I’m practicing power. So I started thinking about how to use my skills differently. I had also become more politically aware through dinner table conversations with my partner at the time, who was working in the nonprofit world in Ghana. That was opening my mind. Then I went to Palestine in 2003 and saw human rights violations firsthand. By then I had changed quite a bit.

Nyandoro: How did those dots connect to the work you do now around drug pricing and access?

Amin: I ended up moving to India, where there was a huge HIV pandemic. That was one of the biggest public health crises and the global Access to Medicine Movement was born in that context. I wanted to find a way to use my private practice skills in the public interest. A lot of what was happening then involved reports and NGO work, but not really a practice element. India was also about to become fully compliant with the World Trade Organization requirements and developing countries had been given 10 years to transition. Those systems and legal requirements were imposed by the Global North on the Global South. In India, there was a massive movement to safeguard patent law so the pipeline of generic medicines going to Africa would stay open. If patents started getting granted, those cheaper medicines would not be available. I got involved because I had legal skills and there was a provision in Indian law where you could challenge patents before they were granted. That became our vehicle to shape the law.

Nyandoro: So it sounds like that was a way for you to center community?

Amin: Exactly. It was about civil society, NGOs, patient groups and people living with HIV/AIDS, who were the most marginalized. We were filing legal oppositions on their behalf. These were based in science because that is how the patent system works. I came to it somewhat inadvertently, but really I wanted to challenge systemic structures. The medicine system was the way I could do that. It let me use my legal practice skills to help those who did not have a voice in the system.

Nyandoro: High drug prices or limited access are not accidental. They are constructed through policy. Why do you think that is the case and why do you think we allow that to be the case?

Amin: Historically, if you look at the 1960s and 1970s, a lot of this starts to emerge there. There was a global economic crisis, stagflation and many countries that had emerged from broken European empires were demanding a fairer political economy. That movement was rooted in the Bandung Conference in 1955 and then the New International Economic Order in the 1970s. That rubbed up against Global North countries that were saying the world was changing. At the same time, the older Keynesian and more socialist policies started to die and privatization rose. The language of shrinking government and handing things to private interests took over. That was in the 1970s and 1980s and then in the 1980s you saw more direct Reaganomics. Later, the Clintons and the Blairs came with what we call third-way neoliberalism, which dressed it up with a human face while still shrinking social programs and using austerity. Over time, we have all been infected and affected by neoliberalism. It is the only language many of us grew up with, so escaping it is hard.

Nyandoro: When we look at the current U.S. conversations around Medicare drug negotiations, pricing reforms and proposals like TrumpRx, what do you think people believe is being fixed and what do you think is actually staying exactly the same underneath it all?

Amin: A lot of it is window dressing. Medicare drug negotiation is a remarkable achievement in the United States, especially since most of the industrialized North has long negotiated drug prices. But it is only a beginning. We should not confuse that with the ceiling. People are desperate for wins and I understand that, but we cannot shortchange ourselves with incrementalism. A lot of these reforms, including ACA in its own way, were diversions. They pull people away from deeper structural change. The TrumpRx stuff is also mostly image. It is being used to apply trade pressure and it may actually help pharmaceutical interests more than anyone else. The public gets sidetracked by the language and the narrative.

Nyandoro: So what do most people miss about how monopoly power actually works in pharmaceuticals?

Amin: People often understand more than policymakers think they do. The organization I run, I-MAK , did a national survey last year through the Franklin & Marshall Center and 80 percent of respondents, regardless of party, said they wanted changes to the patent system so generics could get to market faster. People know something is off. They can see that countries in Europe or Canada are getting medicines at generic prices while they are not. With GLP-1 drugs, for example, people are looking at the fact that they may not see cheaper versions in the U.S. until 2032 because of our policies. They are adding two and two together. The challenge is to keep the language simple without watering down the issue.

Nyandoro: How do we make it relevant without watering it down?

Amin: We need more public participation in the institutions that are captured by corporate interests. Patients living with HIV/AIDS once sat in front of patent examiners in India and said, this could affect my life. That connection had not been made before and it was powerful. We need more of that. We need community advocates and organizations and NGOs to help spread the message. We also need to dismiss the idea that only technical experts can have the conversation. That kind of language is often just a way to keep power where it is.

Nyandoro: That goes back to who gets to hold power and the role of community in all of this.

Amin: Exactly. When people say something is too complicated or too pragmatic, I just hear gaslighting. It is often a way of saying: “stay in your place and do not challenge us.” The real issue is power.

Nyandoro: I’m here in Mississippi, where the gaps in health care are not abstract. They show up in maternal mortality rates, infant health and families delaying care or prescriptions they cannot afford. How do we understand the relationship between pharmaceutical monopolies and weak public health safety nets in places like this, and how do they reinforce each other?

Amin: The two are deeply connected. When public systems are weak, people have fewer protections against high prices and monopoly power has more room to operate. That means the burden lands hardest on communities that are already dealing with worse health outcomes and fewer resources. It is part of a bigger system where policy, pricing and access all reinforce one another, so the people who need care most are often the ones facing the steepest barriers.

Nyandoro: What gives you hope?

Amin: The next generation. This is a generational fight and I want people coming up behind us to question the narratives and the framing. I also think we need to think hard about AI and who gets to own knowledge in the future. These monopolies will keep evolving. What matters is whether we pass the baton and move toward real structural change.