Sofosbuvir-based medicines, approved in late 2013, offer a long-sought after cure for patients with hepatitis C, a virus that disproportionately affects marginalized populations around the world. But the prices set by its manufacturer at approximately $90,000 for a three- month regimen intensified a global debate about the pricing of breakthrough medicines. The dominant economic explanations for pricing have centered on ‘risk’, with prices representing the costly and failure-ridden process of drug development, and ‘value’, with higher prices said to reflect improvements in patient health as well as savings from averted downstream medical expenses. These economic explanations are limited, however, by their focus on prices at the point of exchange between drug manufacturers and public health systems. Instead, I took a historical view, using the case of sofosbuvir to trace the political- economic dynamics and organizational relations of power across the innovation process – from early stage science to deployment. Data from documentary sources, semi-structured interviews, databases, and observations at meetings allowed me to build an account of the sofosbuvir case. Combining this data with sociological and political economy literatures on the roles of an entrepreneurial state, the rise of financial capital, and the pricing and valuation strategies used by businesses, I argue that sofosbuvir’s prices did not represent the tangible costs of innovation or the health value for patients. Rather, the prices were a product of financialization: a pattern of accumulation in which growth was pursued through the capitalization and control of intangible hepatitis C assets in financial markets. As part of this pattern, I map the mobilization of speculative capitals behind Pharmasset, a small biotechnology company that emerged from public investments to develop the compound sofosbuvir, as well as the extractive logics driving the shareholders of Gilead Sciences, a large publicly traded pharmaceutical company that ultimately acquired Pharmasset and then set the prices for the therapy. I demonstrate that though an entrepreneurial state shaped the direction of the innovation process towards a curative therapy, the processes of financialization disconnected the distribution of risks and rewards, undermined the sustainability of future innovation, and diminished patient and public health outcomes. I conclude by responding to dominant economic answers on drug pricing in light of the evidence on financialization.

Thesis (Ph. D.)--University of Oklahoma, 1996. / Includes bibliographical references.

本研究以山地政策為焦點，從政治整合的理論出發，探討山地社會的整合。研究的主 題有三：（一）檢視政策的源起及其環境，（二）分析政策的制定、執行及其整合功 能，（三）測度政策目標的達成程度，檢討其得失並提出建議。研究方法以文獻分析 和樣本調查法並重。各章主要內容如下： 第一章緒論，說明（一）研究動機與意義，（二）政策與整合的概念和理論，（三） 分析的架構與研究設計。 第二章政策環境─整合的背景。主要為（一）分析山地社會的背景，（二）探討政策 的內外環境。 第三章政策制定與執行─整合的過程。從政策分析的角度說明整合的過程，分為（一 ）政策的形成，（二）政策的執行，（三）執行內容與整合。 第四章政策影響─整合的效果。為本文重心所在，分為（一）政治與經濟的整合，（ 二）社會與文化的整合，（三）綜合分析及檢討。 第五章結論。（一）摘述研究發現並說明其意義，（二）歸納數則建議事項，提供爾 後研究上及政策施行的參考。

隨著全球化所帶來的社會全面變遷，國家為了因應此巨大挑戰紛紛提出各式政策，其中具有代表國家民族精神的文化政策尤為重要。而在民主發展、公私協力概念的催化下，政府將視角移至蘊含豐沛能量的民間，此間的「社區」更成為其主要的政策選項，至於兩者之間的關係即為本研究的關注焦點。 而經由本研究發現，從《2004年文化白皮書》之文本分析中可歸納出我國文化政策的目標有四：發揚多元文化、建立文化主體性、促進經濟發展，以及營造生活美學。其中篇幅最多者為建立文化主體性，而社區發展則屬達成該主要目標的重要手段。此外，從個案中可以了解到社區其實是落實整個文化政策目標的基本單位，並且具體而微地展示了我國文化政策的全部內涵，故吾人可謂文化政策的推行即奠基於社區發展之上。最後，我們從社區發展的成功經驗中獲得了欲使文化政策更上層樓的重要啟示—政府內部精進部際之協調工作、政府外部加強與非營利和營利組織的合作、傳播媒體的經營，以及文化教育的傳承與發揚。 / With the whole aspects of social changes which globalization brings, nations have made kinds of policies facing these giant challenges. Among these policies, the culture policy representing nations’ spirit is especially important. In addition, because of prevailing ideas of the democracy development and public-private partnership, governments start to focus on the non-governmental circles filled with abundant energy, and the ‘‘community’’ is the main policy choice. As to the connection between the culture policy and community development is the focal point of this thesis. According to the text analysis of the book ‘‘ A White Paper on Culture in 2004,’’ my research concludes that there are four goals of Taiwan’s culture policy: exalting diverse cultures, establishing the culture body, facilitating economic growth, and constructing living aesthetics. Among them, establishing the culture body occupies the most pages and the community development is the important means to achieve that main goal. Moreover, from the case studies we know that communities are actually basic units of fulfilling all goals of culture policies, and they miniature the whole content of Taiwan’s culture policy. So, we can say that the implementation of culture policies is based on the community development. Finally, we have the important revelations making culture policies better from the successful experience of the community development: enhancing coordination between government departments, intensifying governments’ cooperation with NGOs and for-profit organizations, using the mass media, and the inheriting and promoting of culture education.