The grant of a patent is not a reward. Rather it is an opportunity for the patent owner to pursue profits using the patent monopoly to exclude competition. Profit-maximising patent owners focus their monopoly powers on markets in which profits are the greatest. In the case of patents over medical products this leads to well known problems of access to medicines for poor people. The costs and abuses of the patent system in the pharmaceutical sector have been persistent and known for a long time, as John Braithwaite’s magisterial 1984 study, Corporate Crime in the Pharmaceutical Industry vividly illustrates. The failure to do anything substantial about these costs and abuses is a function of the power of pharmaceutical transnational corporations (TNCs) and US and EU hegemony over standard-setting in the international patent framework.