High medication costs are not justified by industry spending on innovative work (research and development), contend specialists in The BMJ today. Aris Angelis and colleagues point out that from 1999 to 2018, the world's 15 largest biopharmaceutical companies spent more on selling, general, and regulatory activities (including marketing) than on research and development, and that most new drugs developed during this time period offered little clinical advantage over existing medicines. By pulling together their spending, they say drug organizations "could give more inventive medications at reasonable costs," and they call for government activity to support innovative work situated to meet