The road to market for drug compounds is a treacherous one, generally involving a huge temporal and financial investment. The role of structure-based drug design or lead optimisation ranges wildly in importance in different pharmaceutical companies. The adoption of these aids to provide routes to high affinity ligands has not received widespread acceptance. This is based on a number of factors, from the perceived failings of such methods, to the belief that rapid screening of compound libraries alone is the most effective way to discover drugs. The panacea of being able to take a computer generated representation of the structure of a target site of a given biomolecule and rationally design an high affinity inhibiting compound has proved seemingly unreachable for three major reasons: (1) current capabilities in computing; (2) the requirement for atomic resolution structural detail; and (3) determination of how structural features can be related to the thermodynamics of interactions. It is the last of these points that this review seeks to address. In particular the use of isothermal titration calorimetry is discussed in the light of the accumulation of accurate thermodynamic data and examples are given where this has been applied to understand the structural aspects of formation of drug-biomolecular complexes.