They do spend some of their patient revenue on R&D, but they spend more on consumer and physician marketing.

Should they not? Ignoring money, if you have a product which has been shown to improve lives or increase lifespan, shouldn't you aim to make it as available as possible? In general, pharmaceuticals have to prove some benefit over the current standard of care to convince payers (insurance companies) to pay for the drug.

Disclaimer: I work in big pharma, though in discovery research, nowhere near pricing and business decisions. Of course, in my position, it would be great if all pharma invested more in R&D

I'm not objecting to all marketing spending, but I do think it's out of line with the benefit. I would prefer to see prescription marketing be much more low-touch that it is today.

Me too. I had a manager once suggest that you could set up a consortium of pharma companies based around a disease. So, for example, every company that has a drug targeted at psoriasis would buy in, then the consortium would be tasked with raising awareness that psoriasis is a treatable condition, so go talk to your doctor. Of course it has some flaws (what about companies that are first into an indication), but it might be a step better than what we have today.

Interesting. Very much like the milk boards and other agricultural councils that promote specific largely-fungible products.