The current 20 year patent term set out in international trade agreements does not have a firm evidentiary basis, but rather is a mostly arbitrary product of history. At one point there was experimentation among different countries, but that has been eliminated through the uniform rules of the TRIPS Agreement. However, economists are increasingly calling lengthy patent terms into question, and recent concerns about medicine prices could provide the impetus for policy-makers to take another look at the issue. The existing domestic and international legal regime makes rethinking patent terms difficult, but in order to get innovation policies right, it is important to think carefully about the foundations of the patent regime