I found that the shears made in Pakistan,Survived Horrible abuse,& Many,Many Cleanings in the Autoclave of a Hospital I worked at.Most hand instruments in Most hospitals are made in Pakistan.As with the changing times,Economy,etc.Made in China versions have appeared,I noticed within a few months,these very shears,& other instruments were in the trash,& the Pakistan stuff is the Dominant provider,once again.I worked in Engineering,& thus had access to Everything.I still have the extremely abused shears with me after 10+yrs. of Mal-treatment,lol!I have seen the China ones in pieces,I have Never seen the Pakistan ones in pieces.If you are going to purchase any,I would advise you to,Look for the stamping of where it was made!