According to data from the U.S. Centers for Medicare and Medicaid, in 2014 Johnson & Johnson spent nearly $20 million on payments and various “perks” to doctors and hospitals to promote their diabetes drug Invokana. That’s some serious sugar Johnson & Johnson doled out, and it was enough to take home the number two spot for money spent on payments to doctors and hospitals for promotion of a drug. With their cash, Johnson & Johnson paid doctors’ speaking and consulting fees, and meal and travel expenses in association with marketing Invokana. In other words, Johnson & Johnson paid doctors to travel around the country and tell other doctors and hospitals how wonderful Invokana is.

Invokana has been available in the U.S. since early 2013, and its sales have been huge- $278 million in the first quarter of 2015 alone. However, the FDA has recently linked Invokana to a serious condition called diabetic ketoacidosis, a condition which can lead to major organ failure and even death if not treated timely and appropriately. Moreover, early indications from a study suggests Invokana also presents a significant increased risk of heart attack and stroke.

With this questionable risk profile, and because there are cheaper and well tested alternatives that have been available for years, if not decades, Invokana’s high sales have been surprising. In fact, Jerry Avorn, a Professor of Medicine at Harvard Medical School, notes that he is surprised by the amount of money spent on marketing drugs like Invokana because it is an expensive new drug that is “by no means [the] first-line choice[.]” Yet still, Invokana sales are booming, almost as if Johnson & Johnson went around the country and paid doctors to prescribe it. Professor Avorn goes on to note that “No one is spending this kind of money to educate doctors about metformin, the inexpensive generic drug that’s the most important foundational treatment we have for this disease.”

So why does Johnson & Johnson need to dole out so much cash to the doctors and hospitals to promote an expensive and dangerous drug that is not the first choice course of treatment? Johnson & Johnson will tell you it is about education, but we know it’s all about the sugar. Attorney Tim O’Brien, who is handling Invokana litigation for the Levin Papantonio law firm, says: “it’s simply repulsive that a company would pay medical providers tens of million of dollars to push a drug that they know puts patients at a higher risk of kidney failure, myocardial infarction (heart attacks), other cardiovascular issues and ketoacidosis, when there are safer and cheaper substitute drugs available.”