There are many serious issues raised by the Trans-Pacific Partnership (TPP), but the one that may have the greatest long-term impact is its provisions on drug patents. The explicit purpose is to make patent protection stronger and longer. While these provisions are likely to lead to higher drug prices in the United States, they will have their greatest impact in the developing world. In most developing countries, drugs are far cheaper than in the United States. This is especially the case in India. The country has a world-class generic industry that produces high-quality drugs that typically sell for a small fraction of the price in the United States. The U.S. drug industry desperately wants to eliminate this sort of price gap, which can exceed a ratio of one hundred to one. This should have everyone very worried.