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Vanessa lives in London. She has cancer. Lemlem lives in rural Ethiopia. She has typhoid. Most people would agree that both women should have similar access to the medicines they need. But why is this harder for Lemlem? And why are fewer drugs developed for common diseases in Lemlem's part of the world? Is it that the pharmaceutical companies are driven only by a profit motive? Is it because of failing infrastructure in developing countries? Or are there more subtle answers? In this feature Keren Bright of The Open University investigates the idea that the patent system is too blunt an instrument to serve the interests of both pharmaceutical companies and the poor like Lemlem. There are smart solutions though; ways for everybody to win. Big questions. Fascinating answers.