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This article examines a range of potentially abusive behaviour by dominant pharmaceutical manufacturers. Abuse of the patent system can take a number of forms and two in particular are identified: (i) abusive extension of the period of patent protection; and (ii) abusive withdrawal of marketing authorisations and products. The article draws out the circumstances in which such behaviour might arise, examines its effects and considers the extent to which it may be objectively justified. In addition, the article analyses a number of recent decisions in which challenges have been brought against pharmaceutical manufacturers who have refused to supply drugs albeit where such refusals are sought to be justified along the lines envisaged in the recent GlaxoSmithKline decision which is also discussed.