The impact of global patent regulation in the form of the WTO’s TRIPS Agreement has far reaching effects for the research based pharmaceutical industry and global public health This paper explores the role of accounting in reinforcing the primacy of capital interests over global public interest by its ability to capture and measure an abstraction - knowledge. This commodification of knowledge serves to transfer the responsibility of the global health agenda to the market. However, this market based solution is not sensitive to many important issues faced by governments in relation to the global pharmaceutical research and development agenda, such as ‘neglected diseases’. The terms and global nature of the TRIPS Agreement effectively constrains the ability of governments, particularly in least-developed countries, to address their individual public health issues. The adoption of TRIPS presents significant challenges and opportunities in an era of globalisation for both the pharmaceutical industry and policymakers.