This paper examines the current conflicts surrounding the implementation of patent protection for pharmaceuticals. Part II outlines the specifics of trade agreements shaping the global intellectual property regime and the consequences for governments seeking to devise an essential drugs policy. Part III analyzes the process of obtaining consensus and compliance with patent protection rules through the negotiation and implementation of trade agreements, and the utilization of dispute settlement mechanisms. This section also examines the aggressive application of unilateral measures to induce adherence to levels of protection beyond those established at the multilateral and regional level. Part IV considers alternative approaches for international governance of pharmaceuticals that aim to maximize equitable outcomes while preserving incentives for innovation.