David Goldhill’s Dec. 2 op-ed, “In health care, America is the world’s indispensable nation,” was a classic example of using somewhat misleading evidence to tell a story about how innovative our pharmaceutical industry and health-care system are. Yes, it is true that Americans spend far more on pharmaceutical products than people in other highly developed nations. It’s also true that foreign pharmaceutical companies, such as the mentioned Swiss company Novartis, avail themselves of our markets to increase their profits. But Mr. Goldhill didn’t mention that pharmaceutical companies in the United States spend more on sales and marketing (including consumer advertising and direct marketing to physicians and other health providers) than on research. Why, for instance, do we allow advertising of prescription drugs, when its only function is to have ill-informed patients pressuring physicians to prescribe particular drugs? A substantial amount of medical research is performed in our universities and financed by research grants from the National Institutes of Health, i.e., the taxpayers.