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So, really it's not about a greater placebo effect in the US, but longer trials that change the placebo response.

No, it definitely IS about the placebo effect. Longer trials are only one of several possible explanations as to why the effect is significant in the US. An alternative theory as to the cause is the "direct-to-consumer advertising for drugs - allowed only in the United States and New Zealand".

A third option is that this study may simply be wrong: "I don't think that controlling the placebo response will increase the number of successful trials. What drug companies have to do is to find more effective drugs." -Fabrizio Benedetti, who studies placebo responses at the University of Turin, Italy.

http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511

The FDA's standards for response above placebo are very, very low.

"more than 90% of potential drugs for treatment of neuropathic and cancer pain have failed at advanced phases of clinical trials"

It should be harder to make new drugs that solve the same problem as existing ones: if it's not better, why should people have to pay higher prices for it (new drugs get new patents)?

While new drugs get new patents, the old drugs remain just as cheap. If you don't have a good reason to use the newer one... don't!

But new drugs are still important. Some people have bad reactions to components of certain drugs, but do fine with others. Different drugs have different side effects. The effectiveness of new drug may be significantly better than the existing drug on specific stages of illness (e.g. diagnosis too late-stage for the cheaper medication to be effective). Of all the problems that exist in pharmaceuticals, too-many good & effective drugs isn't one of significant concern.