> Are you suggesting that local “legitimate” users pay higher costs to recoup R&D expenses? I’d love to hear the evidence

Yes ? Are you suggesting they that comes out of pharma profits?

> it sounds a lot to me like the “piracy is theft” argument which has not been proved or well supported.

No because not taking medication isn't an option like not watching a pirated movie.

Perhaps a closer analogy is shoplifting . Sure some amount of stealing is accounted for in the system but large scale shoplifting gets passed on to consumers.