Rebecca was betrayed on many different fronts. She was betrayed by a doctor who diagnosed her with mental disorders without doing anything about her real-life situation -- a dysfunctional family. Instead, Dr Kifuji took the "easy road" out and simply drugged her to death. Drug companies also betrayed Rebecca by pushing their medications to achieve maximum profits, hiring "opinion leaders" to promote not only the drugs, but the fabricated "disorders" they say require medications.
"Promoting the idea that bipolar is a genetic disorder is causing extreme harm to lots of little children like Rebecca," warns the director of Mindfreedom International, David Oaks.
In this case, he says, "the evidence seems to point towards her and her siblings having been abused and misdiagnosed as bipolar, considering that reports were filed against the father for child abuse."
Mr Oaks faults the psychiatrist, "for failing to recognize that, when all of the children in a family exhibit a particular behavior, that it may not be because of some unproven genetic theory but because of the well proven idea that humans respond to the treatment they receive from other humans."
"The bipolar diagnosis in young children is an absurdity and its drug cocktail treatment, an obscenity, when they prematurely close the door to otherwise potentially profound changes in family behavior," says Dr Lawrence Diller, the author of "The Last Normal Child."
Creation of life-long customers
The Riley family is a truly tragic example of how the psycho-pharmaceutical complex operates. The mental health professional provides each member with a diagnosis of a mental disorder serious enough to warrant a finding of disability, which makes them eligible for all pubic assistance programs, including medical coverage for office visits and drugs, and a family of life-long customers is created.
Michael and Carolyn were both unemployed, collected welfare, received disability benefits and lived in subsidized housing, according to a March 26, 2007 Associated Press report. "Michael Riley claimed to suffer from bipolar disorder and a rage disorder," and "his wife told police she suffered from depression and anxiety," the newspaper noted.
The drug companies alone were raking in close to three grand a month by drugging the three children in this one family alone. According to Drug Store.com, the price of Catapres (clonidine) is $303 for 180 2m tablets. One hundred tablets of 100mg Seroquel sells for $388, and 100mg pills of Dapakote cost $289 per hundred. Multiply the $3,000 by the 28 months that passed since Rebecca joined her siblings in the daily drugging regime and the total comes to about $84,000.
Police reports note that Dr Kifuji saw all three children together in office calls -- how much she was billing Medicaid for those visits, God only knows. Carolyn told police that she was taking Paxil for depression and anxiety and was also on prescription medication for migraines. Paxil costs $309 for ninety 30mg tablets at Drug Store.com.
Child drugging patterns
"There seems to be a clear correlation between the class of medication on patent and the diagnoses employed in psychiatry," according to child and adolescent psychiatrist, Dr Peter Parry, senior lecturer at Flinders University in Australia.
In the 1980s, and especially the 1990s, he notes, when the new SSRIs (selective serotonin reuptake inhibitor antidepressants) were the basis of the drug company profits and shareholder value, "we had an epidemic of 'depression' and an explosion of antidepressant prescribing."
Since the late 1990s, with SSRIs having some problems with suicidality and also coming off patent, he points out, "we have the emergence of a 'bipolar spectrum disorders' epidemic including treating pediatric bipolar disorder with antipsychotics and anticonvulsants rebadged as mood stabilizers."
The reports on Texas foster children covering the past several years provide support for this theory. For instance, the top five most commonly prescribed psychotropic drugs to Texas foster children in 2007, were Ritalin, Risperdal, Clonidine, Seroquel, and Adderall. These five alone accounted for half of the $37.9 million spent on psychiatric drugs for foster children in 2007, according to a report in the August 17, 2008 Dallas Morning News.
The list for the top 10 diagnoses for children ages 6 to 12 in 2005, shows bipolar disorder was diagnosed more often than depression. Likewise, of the top ten drugs prescribed to this age group, Risperdal and Seroquel combined beat out the two antidepressants on the list by more than two to one. There were 1,669 prescriptions for Risperdal and 1,103 for Seroquel, compared to 701 for Zoloft and 712 for Trazodone.
In fact, the only drug prescribed more often than Risperdal was Ritalin. The antipsychotic Abilify also made the top ten list with 667 prescriptions.
In the three-year old toddler group, 25 were diagnosed bipolar and 23 with depression. Combined, Risperdal and Seroquel, were prescribed 115 times, compared to 23 prescriptions for Mirtazepine (generic Remeron), the only antidepressant on the list. Risperdal also rated second highest in this age group, behind Clonidine.
Among the youngest children, age 0 to 2, prescriptions for Risperdal and Seroquel had a combined total of 28, compared to 8 for Mirtazepine.
The promotion of drugging "bipolar children," has been enormously successful, says Dr Peter Breggin, author of the new book, Medication Madness.
Before the 1990s, doctors hardly ever diagnosed kids with bipolar. In fact, Dr Breggin does not recall hearing of the diagnosis being given to children prior to the 1990s.
He points out that a recent survey showed a 40-fold increase in children being diagnosed with bipolar disorder between 1994 and 2003. The survey also found that 90.6% of the children were receiving psychiatric medications, including 60.3% on mood stabilizers like Depakote and 47.7% on antipsychotics like Risperdal and Zyprexa, with most kids on combinations, he reports.
"The advantages to the drug companies are obvious," Dr Breggin says. "If children get several drugs at once, several dozen over their childhoods, they transform from being patients into cash cows for psychiatry."
Side Effects of Drugs Commonly Prescribed to Children, such at the Riley Children
The Drugs.com website reports that the more common side effects of Clonidine include: dizziness, drowsiness, fatigue, weakness, sedation, agitation, nervousness, nausea, and vomiting.
The side effects listed by Drugs.com for Depakote sprinkle capsules include: dizziness; drowsiness, change in appetite, nausea, vomiting and trouble sleeping.
The site warns to seek medical attention right away if any of these "SEVERE side effects" occur when using Depakote sprinkle capsules:
"Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); … changes in behavior; … confusion; … difficulty speaking; difficulty urinating or other urination problems; extreme tiredness; … lack of energy; loss of appetite; loss of coordination; … memory loss; mental or mood changes; … severe or persistent nausea, vomiting, … tremor; … unusual weakness; ..."
The FDA's information sheet on Depakote has a back box warning for "Hepatotoxicity." "Serious or fatal hepatotoxicity may be preceded by non-specific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, and vomiting," the warning states.
"Patients should be monitored closely for appearance of these symptoms," the label warns. "Liver function tests should be performed prior to therapy and at frequent intervals thereafter, especially during the first six months."
According to Pennsylvania psychiatrist, Dr Stefan Kruszewski, "Depakote is prescribed to many children for off-label uses such as mood disorders, anxiety, agitation, aggression."
"We can anticipate a series of tragic outcomes from Depakote's massive overuse," he says. "We can expect to see many patients with anemias, hepatic disease, diabetes type II, pancreatitis and other serious systemic and neurological dysfunctions."
Some of the "less serious side effects" of Seroquel listed by Drugs.com include: dizziness, drowsiness, or weakness, anxiety, agitation, and nausea and vomiting.
The drug's label contains a black box warning for Tardive Dyskinesia, which states: "A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs."
There is no known treatment for this disorder and the label warns that "Seroquel should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia," and further states:
"Chronic antipsychotic treatment should generally be reserved for patients who appear to suffer from a chronic illness that (1) is known to respond to antipsychotic drugs, and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate."
"In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically."
"Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including Seroquel," the warning label states.
"Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness," it notes.
The safety and effectiveness of Seroquel for treating bipolar disorder even in adults has not been tested in trials longer than 12 weeks, according to the labeling information. "The physician who elects to use Seroquel for extended periods in bipolar disorder should periodically re-evaluate the long-term risks and benefits of the drug for the individual patient," the label warns.
"The safety and effectiveness of Seroquel in pediatric patients have not been established," it says. "Anyone considering the use of Seroquel in a child or adolescent must balance the potential risks with the clinical need."
In the Riley case, the police reports do not indicate whether Dr Kifuji ever ordered any medical testing for the children to check for potential harm caused by the three drugs.
Overdue lawsuit filed
On April 3, 2008, Boston attorney, Andrew Meyer Jr, filed a medical malpractice lawsuit against Dr Kifuji on behalf of Rebecca's estate. "This child was subject to mostly telephone prescriptions and a slipshod diagnosis," he told the Boston Globe on April 4, 2008.
"They made her a 4-year-old zombie," he said. "We don't believe that she did suffer from bipolar or that this was the appropriate medication."
Mr Meyer contends that even if a jury finds Rebecca's parents guilty of murder, it does not alleviate Dr Kifuji of liability. "The primary responsibility falls on this doctor," he told the Globe.
"The failure of this doctor to respond to the warnings she was given and to thoroughly investigate the symptoms that her medication was causing ended with this very sad result here of a young girl dying," he said.
The lawsuit seeks unspecified damages for the wrongful death and pain and suffering endured by Rebecca, as well as the loss suffered by her brother and sister, who are in foster care and have been named beneficiaries of her estate, the Globe reports.
On February 7, 2007, the day after Michael and Carolyn pleaded not guilty to murdering Rebecca, Dr. Kifuji entered into a voluntary agreement with the Massachusetts Board of Registration in Medicine to not practice medicine pending an investigation.
"The Agreement entered into by Dr. Kifuji will remain in effect until further order of the Board," according to a February 7, 2007 press release by the Board.
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The firm has also handled many lawsuits across the country involving children and adolescents who have committed suicide or attempted suicide on Paxil, including a nationwide class action involving the false and misleading promotion of the drug as safe and effective despite evidence to the contrary.
This report was written as a 3-part series (click here to read Part 1) by Evelyn Pringle as part of the Pharmaceutical Litigation Roundup series and sponsored by the Baum, Hedlund, Aristei & Goldman law firm. Pringle is a columnist for Scoop Independent News and an investigative journalist focused on exposing corruption in government and corporate America .