Drug companies also spend more on marketing than R&D, and given that marketing drugs is largely banned in other nations, the bulk of it is also spent in the US.

Further, that R&D is often more production development of drugs or drug families first identified in public research efforts. The pipeline for which has been drying up in recent years because of gov't austerity - and in response the billions per drug brought to market number has been going up for the commercial drug company efforts.