Thanks to the Physician Payments Sunshine Act, a bipartisan bill that was passed in 2010 as part of the Affordable Care Act, the public is getting a clear look at which Big Pharma players are paying physicians in order to maintain and grow market share for their products.

The “Top Ten” list, known as the “Dollars for Docs” Database, has been recently updated for the years 2013-15 by ProPublica. At the top of the list: Xarelto, a dangerous anti-coagulant medication from Janssen Pharmaceuticals. In 2015, the Johnson & Johnson subsidiary paid out a total of $28.4 million to health care providers in order to encourage them to prescribe Xarelto, which is currently the focus of over 15,000 injury lawsuits. That same year, Xarelto sales for the manufacturer came to more than $4.3 billion – representing a 1500% return on investment.

Another Johnson & Johnson product in the top five is Invokana, a medication for the treatment of Type 2 diabetes that has been implicated in kidney failure, nerve damage and pancreatitis. Invokana is also being targeted in litigation across the nation.

Other prescriptions on the Dollars for Docs Top Ten List include two other diabetic drugs, Bydureon and Victoza, anti-coagulant Eliquis (Xarelto closest competitor), and testosterone replacement drug Androgel. Also on the list: Humira, a treatment for rheumatoid arthritis, Viekira Pak, used to treat hepatitis C, Synthroid, a thyroid drug, and the synthetic hormone Lupron.

Every one of these medications have two things in common: they all face stiff market competition, and they have all been the subject of a cause of action in recent lawsuits, having allegedly caused injuries ranging from skin rashes to fatal hemorrhaging to pancreatic cancer. It’s also worth noting that these drugs are not cures: they are treatments. In the current profit-driven health care industry, it makes sense to develop treatments that can be sold over and over, rather than cures that would kill the geese that lay golden eggs for these companies.

Of course, pharmaceutical companies as well as physicians deny that all these gifts, speaking fees, meals and paid vacations and other perks have any bearing on the number of prescriptions written for these products. However, between the Dollars for Docs Database and an analysis of Medicare records, it is patently obvious that physicians who receive such payments prescribe name brand drugs far more often than those who do not. Results of the analysis show that physicians who get payments or other compensation of $5000 or more from major drug companies are 33% more likely to prescribe those products to their patients than physicians who do not.

Should we be surprised?

As we also might expect, a provision that would make it much more difficult to locate and disseminate information on Big Pharma payments to doctors was included in the recent “21st Century Cures” bill. Fortunately, this provision was stripped from the bill before it was passed by Congress.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.