Keep in mind that I'm specifically addressing the situation in which Joe and I fail to come to an agreement (there's a line in there about that); much of what y

Keep in mind that I'm specifically addressing the situation in which Joe and I fail to come to an agreement (there's a line in there about that); much of what you're saying is more about the process leading up to (failure to reach) an agreement than what happens after you (fail to) reach an agreement. You're somewhat wrong about knockoffs being sustainable -- generally it is sustainable, it just means that a universe of knockoffs isn't going to see new drugs. This means that pharma becomes a low-margin industry, but it's sustainable. (Exceptions are for things like antibiotics and antivirals, which lose effectiveness over time as the wild population adapts; most other pharma products remain as effective as they ever were.) Given the economic conditions in the third world -- india being a perfect example -- it's not surprising that india has taken the strategy it's taken; until the crippling disease-riddled poverty is taken care of the smart thing to do is to let the private sector solve the problems it can by taking a soft line on international pharma patents. India could negotiate bulk purchases of pharma but clearly has decided it's not in its interest to do so; it's a large enough entity to get its own way and has done its own cost-benefit analyses that tip the balance in this favor; perhaps things wouldn't work out if everyone did it but then everyone isn't going to do it, anyways. As far as Gilead goes: I can assure you that Gilead has hired mckinsey, game-theory phds, and many other eggheads to arrive at a pricing strategy in each legal region by carefully examining: - expected purchase amount @ each pricepoint - likelihood of country going rogue @ each pricepoint ...and that prices are set to accommodate Gilead's particular risk preference (where risk == "chance of driving a country to go rogue").