NY Times: Psychs Paid By Drug Companies To Prescribe Drugs

Fabrizio Costantini for The New York Times

Anya Bailey is among a growing number of children given antipsychotic drugs by doctors who are paid by the makers of those drugs.

http://www.nytimes.com/2007/05/10/health/10psyche.html?pagewanted=1&ei=5089&en=027f7584ba3fc3c4&ex=1336449600&partner=rssyahoo&emc=rss

The New York Times

Psychiatrists, Children and Drug Industry’s Role

By GARDINER HARRIS, BENEDICT CAREY and JANET ROBERTS

May 10, 2007

When Anya Bailey developed an eating disorder after her 12th birthday, her mother took her to a psychiatrist at the University of Minnesota who prescribed a powerful antipsychotic drug called Risperdal.

Created for schizophrenia, Risperdal is not approved to treat eating disorders, but increased appetite is a common side effect and doctors may prescribe drugs as they see fit. Anya gained weight but within two years developed a crippling knot in her back. She now receives regular injections of Botox to unclench her back muscles. She often awakens crying in pain.

Isabella Bailey, Anya’s mother, said she had no idea that children might be especially susceptible to Risperdal’s side effects. Nor did she know that Risperdal and similar medicines were not approved at the time to treat children, or that medical trials often cited to justify the use of such drugs had as few as eight children taking the drug by the end.

Just as surprising, Ms. Bailey said, was learning that the university psychiatrist who supervised Anya’s care received more than $7,000 from 2003 to 2004 from Johnson & Johnson, Risperdal’s maker, in return for lectures about one of the company’s drugs.

Doctors, including Anya Bailey’s, maintain that payments from drug companies do not influence what they prescribe for patients.

But the intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.

These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.

A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children.

From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota’s Medicaid program rose more than ninefold.

Those who took the most money from makers of atypicals tended to prescribe the drugs to children the most often, the data suggest. On average, Minnesota psychiatrists who received at least $5,000 from atypical makers from 2000 to 2005 appear to have written three times as many atypical prescriptions for children as psychiatrists who received less or no money.

The Times analysis focused on prescriptions written for about one-third of Minnesota’s Medicaid population, almost all of whom are disabled. Some doctors were misidentified by pharmacists, but the information provides a rough guide to prescribing patterns in the state.

Drug makers underwrite decision makers at every level of care. They pay doctors who prescribe and recommend drugs, teach about the underlying diseases, perform studies and write guidelines that other doctors often feel bound to follow.

But studies present strong evidence that financial interests can affect decisions, often without people knowing it.

In Minnesota, psychiatrists collected more money from drug makers from 2000 to 2005 than doctors in any other specialty. Total payments to individual psychiatrists ranged from $51 to more than $689,000, with a median of $1,750. Since the records are incomplete, these figures probably underestimate doctors’ actual incomes.

Such payments could encourage psychiatrists to use drugs in ways that endanger patients’ physical health, said Dr. Steven E. Hyman, the provost of Harvard University and former director of the National Institute of Mental Health. The growing use of atypicals in children is the most troubling example of this, Dr. Hyman said.

“There’s an irony that psychiatrists ask patients to have insights into themselves, but we don’t connect the wires in our own lives about how money is affecting our profession and putting our patients at risk,” he said.

The Prescription

Anya Bailey is a 15-year-old high school freshman from East Grand Forks, Minn., with pictures of the actor Chad Michael Murray on her bedroom wall. She has constant discomfort in her neck that leads her to twist it in a birdlike fashion. Last year, a boy mimicked her in the lunch room.

“The first time, I laughed it off,” Anya said. “I said: ‘That’s so funny. I think I’ll laugh with you.’ Then it got annoying, and I decided to hide it. I don’t want to be made fun of.”

Now she slumps when seated at school to pressure her clenched muscles, she said.

It all began in 2003 when Anya became dangerously thin. “Nothing tasted good to her,” Ms. Bailey said.

Psychiatrists at the University of Minnesota, overseen by Dr. George M. Realmuto, settled on Risperdal, not for its calming effects but for its normally unwelcome side effect of increasing appetite and weight gain, Ms. Bailey said. Anya had other issues that may have recommended Risperdal to doctors, including occasional angry outbursts and having twice heard voices over the previous five years, Ms. Bailey said.

Fabrizio Costantini for The New York Times

Anya Bailey has a painful nerve condition called dystonia, in which the muscles in her back clench as a result of taking an antipsychotic drug.

Fabrizio Costantini for The New York Times

Anya Bailey with her younger sister, Melanie, and her mother, Isabella.

Dr. Realmuto said he did not remember Anya’s case, but speaking generally he defended his unapproved use of Risperdal to counter an eating disorder despite the drug’s risks. “When things are dangerous, you use extraordinary measures,” he said.

Ten years ago, Dr. Realmuto helped conduct a study of Concerta, an attention deficit hyperactivity disorder drug marketed by Johnson & Johnson, which also makes Risperdal. When Concerta was approved, the company hired him to lecture about it.

He said he gives marketing lectures for several reasons.

“To the extent that a drug is useful, I want to be seen as a leader in my specialty and that I was involved in a scientific study,” he said.

The money is nice, too, he said. Dr. Realmuto’s university salary is $196,310.

“Academics don’t get paid very much,” he said. “If I was an entertainer, I think I would certainly do a lot better.”

In 2003, the year Anya came to his clinic, Dr. Realmuto earned $5,000 from Johnson & Johnson for giving three talks about Concerta. Dr. Realmuto said he could understand someone’s worrying that his Concerta lecture fees would influence him to prescribe Concerta but not a different drug from the same company, like Risperdal.

In general, he conceded, his relationship with a drug company might prompt him to try a drug. Whether he continued to use it, though, would depend entirely on the results.

As the interview continued, Dr. Realmuto said that upon reflection his payments from drug companies had probably opened his door to useless visits from a drug salesman, and he said he would stop giving sponsored lectures in the future.

Kara Russell, a Johnson & Johnson spokeswoman, said that the company selects speakers who have used the drug in patients and have either undertaken research or are aware of the studies. “Dr. Realmuto met these criteria,” Ms. Russell said.

When asked whether these payments may influence doctors’ prescribing habits, Ms. Russell said that the talks “provide an educational opportunity for physicians.”

No one has proved that psychiatrists prescribe atypicals to children because of drug company payments. Indeed, some who frequently prescribe the drugs to children earn no drug industry money. And nearly all psychiatrists who accept payments say they remain independent. Some say they prescribed and extolled the benefits of such drugs before ever receiving payments to speak to other doctors about them.

“If someone takes the point of view that your doctor can be bought, why would you go to an E. R. with your injured child and say, ‘Can you help me?’ ” said Dr. Suzanne A. Albrecht, a psychiatrist from Edina, Minn., who earned more than $188,000 from 2002 to 2005 giving drug marketing talks.

The Industry Campaign

It is illegal for drug makers to pay doctors directly to prescribe specific products. Federal rules also bar manufacturers from promoting unapproved, or off-label, uses for drugs.

But doctors are free to prescribe as they see fit, and drug companies can sidestep marketing prohibitions by paying doctors to give lectures in which, if asked, they may discuss unapproved uses.

The drug industry and many doctors say that these promotional lectures provide the field with invaluable education. Critics say the payments and lectures, often at expensive restaurants, are disguised kickbacks that encourage potentially dangerous drug uses. The issue is particularly important in psychiatry, because mental problems are not well understood, treatment often involves trial and error, and off-label prescribing is common.

The analysis of Minnesota records shows that from 1997 through 2005, more than a third of Minnesota’s licensed psychiatrists took money from drug makers, including the last eight presidents of the Minnesota Psychiatric Society.

The psychiatrist receiving the most from drug companies was Dr. Annette M. Smick, who lives outside Rochester, Minn., and was paid more than $689,000 by drug makers from 1998 to 2004. At one point Dr. Smick was doing so many sponsored talks that “it was hard for me to find time to see patients in my clinical practice,” she said.

“I was providing an educational benefit, and I like teaching,” Dr. Smick said.

Dr. Steven S. Sharfstein, immediate past president of the American Psychiatric Association, said psychiatrists have become too cozy with drug makers. One example of this, he said, involves Lexapro, made by Forest Laboratories, which is now the most widely used antidepressant in the country even though there are cheaper alternatives, including generic versions of Prozac.

“Prozac is just as good if not better, and yet we are migrating to the expensive drug instead of the generics,” Dr. Sharfstein said. “I think it’s the marketing.”

Atypicals have become popular because they can settle almost any extreme behavior, often in minutes, and doctors have few other answers for desperate families.

Their growing use in children is closely tied to the increasingly common and controversial diagnosis of pediatric bipolar disorder, a mood problem marked by aggravation, euphoria, depression and, in some cases, violent outbursts. The drugs, sometimes called major tranquilizers, act by numbing brain cells to surges of dopamine, a chemical that has been linked to euphoria and psychotic delusions.

Suzette Scheele of Burnsville, Minn., said her 17-year-old son, Matt, was given a diagnosis of bipolar disorder four years ago because of intense mood swings, and now takes Seroquel and Abilify, which have caused substantial weight gain.

“But I don’t have to worry about his rages; he’s appropriate; he’s pleasant to be around,” Ms. Scheele said.

The sudden popularity of pediatric bipolar diagnosis has coincided with a shift from antidepressants like Prozac to far more expensive atypicals. In 2000, Minnesota spent more than $521,000 buying antipsychotic drugs, most of it on atypicals, for children on Medicaid. In 2005, the cost was more than $7.1 million, a 14-fold increase.

The drugs, which can cost $1,000 to $8,000 for a year’s supply, are huge sellers worldwide. In 2006, Zyprexa, made by Eli Lilly, had $4.36 billion in sales, Risperdal $4.18 billion and Seroquel, made by AstraZeneca, $3.42 billion.

Many Minnesota doctors, including the president of the Minnesota Psychiatric Society, said drug makers and their intermediaries are now paying them almost exclusively to talk about bipolar disorder.

The Diagnoses

Yet childhood bipolar disorder is an increasingly controversial diagnosis. Even doctors who believe it is common disagree about its telltale symptoms. Others suspect it is a fad. And the scientific evidence that atypicals improve these children’s lives is scarce.

One of the first and perhaps most influential studies was financed by AstraZeneca and performed by Dr. Melissa DelBello, a child and adult psychiatrist at the University of Cincinnati.

Dr. DelBello led a research team that tracked for six weeks the moods of 30 adolescents who had received diagnoses of bipolar disorder. Half of the teenagers took Depakote, an antiseizure drug used to treat epilepsy and bipolar disorder in adults. The other half took Seroquel and Depakote.

The two groups did about equally well until the last few days of the study, when those in the Seroquel group scored lower on a standard measure of mania. By then, almost half of the teenagers getting Seroquel had dropped out because they missed appointments or the drugs did not work. Just eight of them completed the trial.

In an interview, Dr. DelBello acknowledged that the study was not conclusive. In the 2002 published paper, however, she and her co-authors reported that Seroquel in combination with Depakote “is more effective for the treatment of adolescent bipolar mania” than Depakote alone.

In 2005, a committee of prominent experts from across the country examined all of the studies of treatment for pediatric bipolar disorder and decided that Dr. DelBello’s was the only study involving atypicals in bipolar children that deserved its highest rating for scientific rigor. The panel concluded that doctors should consider atypicals as a first-line treatment for some children. The guidelines were published in The Journal of the American Academy of Child and Adolescent Psychiatry.

Three of the four doctors on the panel served as speakers or consultants to makers of atypicals, according to disclosures in the guidelines. In an interview, Dr. Robert A. Kowatch, a psychiatrist at Cincinnati Children’s Hospital and the lead author of the guidelines, said the drug makers’ support had no influence on the conclusions.

AstraZeneca hired Dr. DelBello and Dr. Kowatch to give sponsored talks. They later undertook another study comparing Seroquel and Depakote in bipolar children and found no difference. Dr. DelBello, who earns $183,500 annually from the University of Cincinnati, would not discuss how much she is paid by AstraZeneca.

“Trust me, I don’t make much,” she said. Drug company payments did not affect her study or her talks, she said. In a recent disclosure, Dr. DelBello said that she received marketing or consulting income from eight drug companies, including all five makers of atypicals.

Dr. Realmuto has heard Dr. DelBello speak several times, and her talks persuaded him to use combinations of Depakote and atypicals in bipolar children, he said. “She’s the leader in terms of doing studies on bipolar,” Dr. Realmuto said.

Some psychiatrists who advocate use of atypicals in children acknowledge that the evidence supporting this use is thin. But they say children should not go untreated simply because scientists have failed to confirm what clinicians already know.

“We don’t have time to wait for them to prove us right,” said Dr. Kent G. Brockmann, a psychiatrist from the Twin Cities who made more than $16,000 from 2003 to 2005 doing drug talks and one-on-one sales meetings, and last year was a leading prescriber of atypicals to Medicaid children.

The Reaction

For Anya Bailey, treatment with an atypical helped her regain her appetite and put on weight, but also heavily sedated her, her mother said. She developed the disabling knot in her back, the result of a nerve condition called dystonia, in 2005.

The reaction was rare but not unknown. Atypicals have side effects that are not easy to predict in any one patient. These include rapid weight gain and blood sugar problems, both risk factors for diabetes; disfiguring tics, dystonia and in rare cases heart attacks and sudden death in the elderly.

In 2006, the Food and Drug Administration received reports of at least 29 children dying and at least 165 more suffering serious side effects in which an antipsychotic was listed as the “primary suspect.” That was a substantial jump from 2000, when there were at least 10 deaths and 85 serious side effects among children linked to the drugs. Since reporting of bad drug effects is mostly voluntary, these numbers likely represent a fraction of the toll.

Jim Minnick, a spokesman for AstraZeneca, said that the company carefully monitors reported problems with Seroquel. “AstraZeneca believes that Seroquel is safe,” Mr. Minnick said.

Other psychiatrists renewed Anya’s prescriptions for Risperdal until Ms. Bailey took Anya last year to the Mayo Clinic, where a doctor insisted that Ms. Bailey stop the drug. Unlike most universities and hospitals, the Mayo Clinic restricts doctors from giving drug marketing lectures.

Ms. Bailey said she wished she had waited to see whether counseling would help Anya before trying drugs. Anya’s weight is now normal without the help of drugs, and her counseling ended in March. An experimental drug, her mother said, has recently helped the pain in her back.

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Convicted Psychiatrist Remained on Federal Payroll for Months: LA Times

Convicted Psychiatrist Remained on Federal Payroll for Months: LA Times

According to the Los Angeles Times Wenesday, psychiatrist Trey Sunderland, a senior researcher at the National Institutes of Health (NIH) and “a lasting symbol of the agency’s entanglements with drug companies,” remained on the federal payroll several months after he pleaded guilty to a federal conflict-of-interest charge relating to hundreds of thousands of dollars in payments from pharmaceutical companies. Last December, a U.S. District Judge fined Sunderland $300,000 and sentenced him to two years of supervised probation and 400 hours of community service. Representative Joe L. Barton called the NIH "an ethical Potemkin village [something that appears effective but isn't], where a hollow system appears to provide the illusion of integrity, but transgressors never leave."

The Citizens Commission on Human Rights says that criminality is rife within the mental health system, so much so that it has tracked more than 1,000 convictions of psychiatrists, psychologists and mental health workers and created a database as a public warning. Found at www.psychcrime.org, it was established as a public service to law enforcement agencies, health care fraud investigators, medical and psychological licensing boards and the general public.

The LA Times story follows Massachusetts psychiatrist Daniel J. Carlat’s admission to the Boston Globe this week, stating: “Our [psychiatric] field as a whole is progressively being purchased lock, stock, and barrel by the drug companies: this includes the diagnoses, the treatment guidelines, and the national meetings.”

To read more about conflicts of interest in the mental health field, read CCHR’s publication, Psychiatric Diagnostic Manual Link to Drug Manufacturers.

You can contact CCHR at (800) 869-2247 or email humanrights@cchr.org.

Drug Company Verdict Costs Them More Than Half A Billion

This from the Wall Street Journal. The idea of holding drug company execs and employees responsible for misleading the public just brought a 600 million dollar verdict. Soon we'll see the day when the drug company people responsible for pushing so-called "anti-depressants" that actually cause depression will be indicted for manslaughter.

ROANOKE, Va. -- The maker of the powerful painkiller OxyContin and three of its current and former executives pleaded guilty Thursday to misleading the public about the drug's risk of addiction, a federal prosecutor and the company said.

Purdue Pharma LP and the executives will pay $634.5 million in fines, U.S. Attorney John Brownlee said in the news release.

Earlier this week, Purdue Pharma agreed to pay $19.5 million to 26 states and the District of Columbia to settle complaints over its promotion of the powerful painkiller OxyContin, especially to doctors, the company said.

The states complained the Stamford, Conn., drug maker had been encouraging physicians to prescribe the drug for use every eight hours, instead of the 12-hour dose approved by the Food and Drug Administration. OxyContin is a time-release painkiller that can be highly addictive. Designed to be swallowed whole and digested over 12 hours, the pills can produce a heroin-like high if crushed and then swallowed, snorted or injected.

Time For An Investigation

National FOX TV VIDEO - Click here: http://www.youtube.com/watch?v=GAeABmVOS0s

The psycho/pharmaceutical industry and their minions are shamelessly using the recent Virginia Tech shootings to push for more forced drugging, more involuntary commitment, and more mental health "intervention" . Any rational person must ask why there has not been a federal investigation into psychiatric drugs as they relate to the carnage.

These drugs have been documented by the FDA to cause mania, suicide, psychosis, worsening depression and even homicidal ideation .

If more than 1/2 the shooters were taking PCP or smoking Crack -- there would be an investigation, but those are illegal drugs and do not rake in billions in profit for vested interests.

Why aren't these mental health "experts" asking what drugs Cho Seung-Hui was taking after investigators found "depression medication" in his belongings?

Role of Antidepressants in Killings Needs Review

http://www.modbee.com/local/story/13533556p-14137410c.html

The Modesto Bee

Role of antidepressants in killings needs review

By TY PHILLIPS
April 29, 2007

The murderous rampage that left 33 people dead at Virginia Tech has stirred countless emotions: sadness and anger, fear and hatred, grief and disgust.

When Dr. Ann Blake Tracy heard the details, she felt many of those same emotions. Yet there is one sentiment Tracy does not share with much of the rest of the world: surprise. As terrible as it sounds, after nearly 20 years researching links between violent crime, suicide and antidepressants, Tracy is surprised only that it doesn't happen more often.

Details continue to emerge about the lonely life of killer Seung-Hui Cho, who had a history of mental illness. Among Cho's effects, officials found prescription medications related to the treatment of psychological problems.

Though it's still premature to draw conclusions without toxicology results, these are the details Tracy, an author and the executive director of the International Coalition for Drug Awareness, expected from the moment she heard about the Virginia Tech shootings. In her experience, when it comes to investigating high-profile shootings, antidepressants are as common as the presence of loneliness, despondence and rage.

"I'm just so tired of seeing people die, I could scream," Tracy said during a phone interview. "It's happening daily in this country. It's so massive, it's just unreal. We've got so many school shootings now, I can't even begin to keep up with them all. And the reason is so incredibly obvious. You don't have to look at much to figure it out."

2006, Bailey, Colo. — Duane Morrison shot and killed a girl and sexually assaulted six others. Antidepressants were found in his vehicle.

2005, Red Lake Indian Reservation, Minn. — Jeff Weise shot and killed nine people and wounded five before committing suicide. Prozac.

1998, Springfield, Ore. — Kip Kinkel killed his parents, then went to school and opened fire in the cafeteria, killing two and wounding 22. Prozac.

1989, Stockton — Patrick Purdy used an assault rifle to spray bullets through a playground at Cleveland Elementary School, killing five children and wounding 29 people before he killed himself. Elavil.

'It's all so intertwined'

There are dozens of other examples of violence at schools and the presence of antidepressants, but the carnage hardly is limited to our campuses. Countless families have been destroyed around the world through homicides and suicides committed by adults on antidepressants.

In June 2001, Texan Andrea Yates drowned her five children under the influence of four psychiatric medicines, including Effexor.

In February 2004 in Polk Township, Pa., Samantha Hirt, hours after taking a pill for manic depression, set fire in a bedroom where her two toddlers were playing, closed the door and sat on a sofa watching television while the fire spread, killing both children. Effexor.

Other famous cases include the 1998 deaths of actor Phil Hartman and his wife, a murder/suicide committed by her (Zoloft); the 1999 home and office killing spree by Atlanta day trader Mark Barton (Prozac); the 1998 shooting deaths of four co-workers by Connecticut lottery accountant Matthew Beck, who then killed himself (Luvox); and the 1994 New York City subway bombing by Edward Leary, which injured 48 (Prozac).

The list (which can be found at www.drugawareness.org) encompasses hundreds and hundreds of cases.

"You start linking them together and looking at all the similarities and you say, 'Good grief, it's all so intertwined,'" said Tracy, who has appeared on programs including "20/20," "Dateline" and "60 Minutes" and served as a consultant on high-profile cases including Columbine and Andrea Yates. "I keep asking, 'When is somebody going to see this?' But we've been so brainwashed about drugs, we think legal means safe.

"Most people don't know LSD once was prescribed as a wonder drug. Most people don't know that PCP was considered to have a large margin of safety in humans. Most people don't know ecstasy was prescribed and sold for five years to treat depression. Few know that history of drugs, and I think that's our biggest problem. We're just not educated enough to have concerns."

Prozac nation, indeed

The Northern San Joaquin Valley certainly is not immune. Stanislaus County Coroner Kristi Herr, who has investigated hundreds of the county's 4,000 annual deaths, including many accidental overdoses of prescription medicines, said she regularly goes into homes of deceased people and finds medicine cabinets loaded with prescription medicines. Sometimes there are so many pill bottles that large garbage bags are needed to transport them all.

"It seems to me a large portion of our society is on antidepressants," Herr said. "That isn't based on statistics. That is just based on my experience of going into homes and evaluating the cases that come through here."

In 2003, then-Newman resident Lorraine Slater's 14-year-old daughter, Dominique, killed herself after being treated for depression with several antidepressants, including Celexa and Wellbutrin. As her depression and erratic behavior worsened, her doctor prescribed her a double dose of Effexor. Fifteen days later, she was dead. Her body later was found in the Delta Mendota Canal in Patterson, not far from the family's home.

"On the drug, she became more agitated, combative and restless," Slater said. "And she had never been like that before. It's like our daughter was on LSD. It was a real Dr. Jekyll and Mr. Hyde experience."

Shortly after Dominique's death, the FDA released a warning that one in 50 patients, or 2 percent, will experience an adverse reaction to Effexor, which can include suicidal thoughts.

Slater has become a consumer advocate working to raise awareness of possible dangers of antidepressants. On May 9, she will testify at a hearing at the state Capitol concerning a bill that would require drug companies to disclose results of all clinical trials.

"We're not against medication," Slater said. "We just want disclosure about results from their trials. In their internal memos, marketers are told to downplay the side effects, and a lot of doctors aren't aware of the real dangers.

"We're just saying these companies need to give the citizens they're supposedly trying to help the information about possible symptoms so people can make informed decisions. If their medicine is so good, what is there they have to hide?"

Arguments against link

Of course, the logical argument against tying violent crimes to antidepressants is that there are countless factors that motivate a person to commit a violent act.

And those who carry out these deeds often are people with mental illness, so the presence of antidepressants can be expected. These are solid points; correlation does not in itself mean causation. And there is no doubting that countless people have benefited from these drugs.

Still, as one looks at the details of violent crimes around the country, too often there is an array of antidepressants. At the very least, this is a topic that deserves greater scrutiny.

In early 2005, the FDA issued a warning that antidepressants can cause both suicide and violence. The agency also mandated a black-box warning — the most serious available — that states these drugs can produce side effects that include anxiety, agitation, panic attacks, irritability, hostility, aggressiveness, impulsivity and mania.

The FDA also has warned that abrupt withdrawal of antidepressants can produce suicide, psychosis or hostility.

Eli Lilly, which makes Prozac, repeatedly has denied claims that Prozac causes violence, even though the company's own documents acknowledge "nervousness, anxiety, self-mutilation and manic behavior" are among the "usual adverse effects" of the medicine.

It's the same Eli Lilly that has paid more than $1.2 billion to 28,000 people who claimed they were injured by the drug Zyprexa during the past decade, according to a Jan. 5 article in the New York Times.

Paying $1.2 billion over 10 years may sound like a lot of money until compared with the $4.2 billion the company made last year alone selling Zyprexa, which has been taken by 20 million people worldwide since its introduction in 1996.

Most antidepressant drugs, including Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro and Effexor, are known as selective serotonin reuptake inhibitors, which alter brain chemistry in an attempt to manage depression.

Serotonin, a neurotransmitter, is a chemical that facilitates communication within the brain, allowing one to experience happy feelings upon its release. Essentially, the antidepressant drugs prevent reabsorption of serotonin in an attempt to make the happiness experience last longer.

Mother of a monster

One of the former lead chemists at the National Institute of Health, whose work eventually led to the development of many antidepressant drugs, first spoke out against the drugs nearly 10 years ago.

"I am alarmed at the monster that Johns Hopkins neuroscientist Solomon Snyder and I created when we discovered the simple binding assay for drug receptors 25 years ago," said Dr. Candace Pert in the Oct. 20, 1997, issue of Time magazine.

She said Prozac and other SSRI (selective serotonin reuptake inhibitor) antidepressants may cause heart problems and affect the entire body, where the vast majority of serotonin is produced.

The medical profession "ignores the body as if it exists merely to carry the head around," said Pert, who's now scientific director of RAPID Pharmaceuticals in Potomac, Md. "These molecules of emotion regulate every aspect of our physiology."

A recent study by the Centers for Disease Control and Prevention found that half of all Americans take at least one prescription drug, and that antidepressant use has nearly tripled in the past decade. According to some estimates, 30 million Americans take antidepressants. FDA statistics show U.S. physicians issue more than 10 million antidepressant prescriptions each year to patients younger than 18. FDA-approved prescription drugs injure 2.2 million and kill at least 100,000 Americans each year, according to numerous published studies.

Some survive and forgive

Problem is, when antidepressants don't work as intended, the harmful fallout isn't limited to the user. The victims often are those within striking distance. They are people like Mark Taylor, who was sitting outside and reading a Bible when he was shot numerous times by Eric Harris at Columbine High School.

"The first one hit me in the back of the leg. That was the shotgun blast," Taylor said in a recent phone interview. "That was the most painful. And then I got hit several more times in the chest; the bullets went right through me. They tried to make sure I was dead. I laid down and pretended I was dead.

"I think Eric Harris, from the medication, didn't really know what he was doing. I don't really hold him responsible for it. Eric and Dylan were both taking medicines. They just didn't seem to have any reaction to what they were doing. They were having fun with it, laughing and enjoying it and having a good time. I feel that antidepressants were the cause of the Columbine shooting."

Taylor, now 24, travels the country and speaks about the importance of forgiveness. Since the Virginia Tech shootings, he has been besieged with interview requests. His interviews included an appearance on "The Morning Show with Mike and Juliet," a national Fox News Network program. The hosts invited Taylor because they wanted to hear from someone who had survived a school shooting, someone who presumably could offer insight to help other children survive such an incident.

"Forgiveness," Taylor told them, "that's how I survived it."

But Taylor said the show's commentators weren't much interested in his message of forgiveness. Instead, the show focused on interviews with FBI agents and police tacticians, who offered survival tips that we are supposed to use to arm our children as we send them off to school.

Is this what it's come to? Do we now simply accept that frequent school shootings are a part of today's society and prepare ourselves for when tragedy strikes? Too often, instead of working to find the cause of problems, we react to symptoms. That same kind of thinking is what has so many Americans taking antidepressants in the first place.

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Video: School Shooter and Psych Drugs: http://www.youtube.com/watch?v=GAeABmVOS0s

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This One Is From A Psychiatrist

It's from Newsday. I can't provide the link, because it is to a letters page that changes.
http://www.newsday.com

Newsday (New York)
April 25, 2007 Wednesday
LETTERS

More mental health services, and even involuntary mental health screenings, have been proposed to prevent repetition of the Virginia Tech massacre. But the mass murderer did get mental health care in a hospital.

He then rejected further treatment. The drug-only treatment he got may well have aggravated his disturbance.

Good mental health care is based on continuing, caring human contact: knowledgable people helping troubled people with problems, while strengthening and reassuring them. Medication, often with little or no meaningful human contact, has now almost entirely replaced that older care pattern. That's what the killer got. And anti-depressant drugs, like those he was given, can themselves intensify suicidal and homicidal thoughts and behavior.

When considering the effectiveness of mental health services, we should recognize that in the 50 years since drugs began to be psychiatry's main treatment modality, there has been a five-fold increase in the fraction of mentally disabled in the population.

Before hurrying to expand mental health services, we should examine more critically the results of treatment methods.

Dr. Nathaniel S. Lehrman
Editor's note: The writer is former clinical director of Kingsboro Psychiatric Center and former assistant clinical professor of psychiatry at Albert Einstein and SUNY Downstate Colleges of Medicine.

Media Blasts Psychiatry...

CNN News Blasts Pedophile Psychiatrist (video):

http://mms.tveyes.com/ExpandGuest.asp?ln=167390

Are Kids Given Antipsychotics Too Often?

Child's Death Reignites Debate Over How Aggressively Kids Should Be Treated with Psychiatric Drugs

http://www.cbsnews.com/stories/2007/03/10/eveningnews/main2556370.shtml

Big Lie That There is ADD or OCD

Michael Savage, nationally syndicated talk show host (3 minute audio here):

http://www.youtube.com/watch?v=C29OuQ9dmiU

TeenScreen - a National Fraud (video):

http://www.youtube.com/watch?v=RfU9puZQKBY

Sign the Stop TeenScreen Petition:

http://www.petitiononline.com/TScreen/petition.html

After years of CCHR (Citizens Commission On Human Rights International) hammering the media, state and federal legislators and the public with information about the fraudulent and unscientific nature of the Diagnostic and Statistical Manual of Mental Disorders, psychiatrists themselves are finally conceding that normal people are being diagnosed as “mentally ill” and that there are major problems with the diagnoses.

http://www.cchr.org/index.cfm/9027/19786

Hard To Get People To Understand

We've been preaching for a long time that the use of psych drugs creates psychotics. It is a repeating phenomenon that people get upset or are perceived by others as being upset, so they are sent to a psychiatrist for help. Then they get on psychiatric drugs, then they go really really crazy and start killing themselves and others. It seems to be hard for people to understand the point, which is that psychiatrists, psychiatric techniques, and psychiatric drugs make people worse, and shouldn't be used at all under any circumstances.

"So what do we do with these people?" That's a good question. Something needs to be done when you have a psychotic like the guy in Virginia. But not psychiatric "help". He went crazy AFTER he got his "help". The "help" from the psychiatrists and the psychiatric drugs drove him over the edge.

Here's a story about another victim of psychiatry; a boy from Wisconsin who gunned down his principal in a school hallway. Note that he got lots of psychiatric "help" and he says he was in "anger management classes for years but found them useless." So of course that means he was in contact with psychs, which means he was taking psych drugs, because that's always the first line knee-jerk thing psychs do is put people on psych drugs.

Read the story here: http://www.cnn.com/2007/LAW/04/21/principal.shooting.ap/index.html

A Psychiatrist Tells The Truth

What do you think this man would say about Virginia Tech?

Peter R. Breggin, M.D. began in the full time private practice of psychiatry in 1968. Dr. Breggin's background includes Harvard College, Case Western Reserve Medical School, a teaching fellowship at Harvard Medical School, a two-year staff appointment to the National Institute of Mental Health, and a faculty appointment to the Johns Hopkins University Department of Counseling. Dr. Breggin is the author of nineteen professional books.

Here is a small part of his commentary:

"Mental health interventions do not protect society because the person is almost always quickly discharged because his insurance coverage has run out or because mental health professionals, who as a group have no particular capacity to make such determinations, will decide that the patient is no longer a danger to himself or others. Indeed, in December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found "his insight and judgment are normal." Need I say more about the hazards of relying on mental health screening and evaluation to identify dangerous perpetrators--even after they have already been threatening people?"

"The violence unleashed on the Virginia Tech campus should not lead to calls for more mental health screening, more mental health interventions, or more drugs. Instead, the violent rampage should confirm that psychiatric interventions don't prevent violence and instead they can cause it."

Read his convincing condemnation of psychiatric intervention here:

http://www.huffingtonpost.com/dr-peter-breggin/the-real-mental-health-l_b_46327.html

33 Dead -- And He Was On Psych Drugs! Are We Surprised!

Now it's 33 dead in Virginia -- at the hand of a man who was a psych drug victim. And as usual, he went crazy and started killing people AFTER he got his "treatment". This paragraph from Associated Press tells the whole story:

News reports said that he may have been taking medication for depression and that he was becoming increasingly violent and erratic.

Yes, because that's what medication for depression does -- it causes people to become suicidal and homicidal.

If he wouldn't have killed himself this young man would have gone to trial for a grisly murder spree. But when are we going to indict the Big Pharma people who colluded to cover up this aspect of psychiatric drugs -- that they kill. These people are guilty of murder, too. For the last years, since Prozac et al came on the scene, it has been onesies and twosies in the murder/suicide stories for the most part. But this one killed 33. How many does it take before we rip the cover off the cover-up?

Prozac causes depression. And suicide. And homicide. And so do the myriad of other drugs identified as "SSRIs" like Prozac -- including Luvox, Paxil, Zoloft and the others. The FDA puts on warning labels, stronger ones each time, but that's not enough. We need to take the drugs off the market, and serve indictments for manslaughter to those who swept the truth under the rug while making billions off the sale of these drugs.

National Institute of Health Conflict of Interest

National Institute of Health Conflict of Interest Under Investigation.

Learn how and why dangerous drugs are approved for our loved ones and what is being done to investigate this by Congress.

Also see a link below re 2 year old being drugged.

"Following strong criticism from Congress, the investigative arm of the Department of Health and Human Services also has begun a review of conflict-of-interest policies at the NIH, one of the world's premier medical research centers.

The review affects not only government scientists but also the way NIH oversees grant recipients who perform research at universities or other nonfederal institutions." ...

"Who knows how much damage these conflicts of interest have done to the NIH mission of protecting the public's health?" said Ned Feder, a former NIH scientist who works now with the private Project on Government Oversight. "A review of the facts and the policies is long overdue." ...

"We would submit that the damage these conflicts of interest caused can be measured by the harmful treatments that NIH and its grant recipients in academia have promoted. Their recommendations enriched their corporate benefactors but maimed and cut short the lives of patients." ...

Are People Catching On?

Are people catching on to the fraud of psychiatric drugs? Check out this page. It appears that even state governments are realizing they must act in the public interest. Lawsuit after lawsuit are being filed by state governments against the pushers, like Eli Lilly, Pfizer, and others. This is in spite of the fact that these Big Pharma companies have tremendous financial power in dealing with legislators. It is refreshing that governments are apparently saying, "I don't care how much money you contribute to our campaigns. You're criminal, and we're coming after you."

Child Psychiatrist Accused of Molesting

Associated Press
April 6, 2007, 10:42 AM CDT

SAN MATEO, Calif. -- A child psychiatrist who once headed the American Academy of Child and Adolescent Psychiatry was arrested amid allegations he had molested male patients dating back to the 1960s.

Dr. William Ayres, 75, was taken into custody Thursday at his San Mateo home and charged with 14 felony counts of lewd and lascivious acts with a child under 14. The charges involve multiple victims, but authorities declined to say how many. The arrest followed a four-year investigation.

Ayres, a prominent psychiatrist who retired last year, had been honored in 2002 by the San Mateo board of supervisors with a lifetime achievement award for "his tireless effort to improve the lives of children and adolescents." He also served as president of the American Academy of Child and Adolescent Psychiatry from 1993 to 1995.

"The real tragedy here is that parents entrusted their children to this doctor for help, and they were victimized while in his care," San Mateo police Capt. Mike Callagy said. "That's so tragic."

Ayres was being held on $1.5 million bail and was scheduled to be arraigned Friday. His attorney did not return a phone call seeking comment and The Associated Press was not immediately able to reach Ayres' family.

Suspicions have dogged Ayres since 2003, when one former patient sued, accusing him of molesting him under the guise of a medical exam on several occasions in the late 1970s when the patient was 13. In July 2005, the two sides reached a confidential settlement in which Ayres' attorney said the psychiatrist did not concede any wrongdoing. Ayres said under oath that he didn't remember the alleged victim and denied molesting him. He acknowledged that he sometimes conducted physical exams of patients, according to a transcript of his deposition in the lawsuit. "I do not think there is any standard of care that says it's inappropriate for a physician who is a child psychiatrist, that they should not do physical examinations," Ayres said, according to the transcript.

At least two other molestation reports against Ayres arose before the lawsuit, but one was determined to be "unfounded" in 1987, and the other alleged victim wouldn't cooperate with police, according to court records.

In 2005, at least two other men said Ayres molested them when they were teens in the 1960s and 1970s, but authorities couldn't proceed with the cases because the statute of limitations had expired, police reports show.

Psychiatric Manual Under Fire

After years of CCHR hammering the media, state and federal legislators and the public with information about the fraudulent and unscientific nature of the Diagnostic and Statistical Manual of Mental Disorders, psychiatrists themselves are finally conceding that normal people are being diagnosed as “mentally ill” and that there are major problems with the diagnoses.

• There have been articles in New York Times, Washington Post, Indianapolis Star, Boston Globe, Chicago Tribune and reports on ABC, CNN Cable and FOX National News about a new study published in the Archives of General Psychiatry, which found that normal grieving reactions connected to unpleasant life experiences are similar to the psychiatric checklist for “depression,” and that there is often no clear distinction between those who are supposedly “disordered” and those who are “non-disordered.”

• Lead author Jerome Wakefield and researcher Allan Horwitz said their study pointed out that sadness has increasingly come to be seen as pathological in the United States.
• A Washington Post article on this story, entitled “Criteria for Depression Are Too Broad, Researchers Say: Guidelines May Encompass Many Who Are Just Sad,” cites Horwitz, who says that pharmaceutical companies, the psychiatric profession and patient advocacy groups have all contributed to the phenomenon of transforming normal sorrow into “depressive disorder”.
• Horwitz said that companies stand to make more money from the one-size-fits-all approach, researchers find the cookie-cutter model of disease to make it easier to do studies, and psychiatry has come to think of itself as "the arbiter [judge] of normality," he said.
  

Support a group that is doing something about it. Nobody helps more to expose the fraud of psychiatry and their labels. Go to https://www.cchr.org/store/index.php?cPath=23

Anna Nicole's Psych Prescribed Eleven Medications

From a story on CNN:

MIAMI, Florida (AP) -- One doctor authorized all 11 prescription medications found in Anna Nicole Smith's hotel room, most of them in the name of the Playboy Playmate's companion, according to documents released by the medical examiner's office Wednesday.

More than 600 pills were missing from prescriptions no more than five weeks old at the time of Smith's death, although it was unclear if she took all of them, according to information obtained by The Associated Press through a public records request.

Dr. Joshua Perper, Broward County's medical examiner, has said all of the drugs were meant for Smith, though they were prescribed in the names of others.

A probe by the Seminole Police Department agreed with Perper's assessment that Smith's death at 39 was an accidental overdose and that there was no foul play.

Information released by Perper's office shows eight of the prescriptions were issued under the name of Howard K. Stern, the starlet's lawyer-turned-companion. Two were for Alex Katz, though it was unclear if that was an alias or the name of someone connected to Smith. One prescription was under the name of Smith's friend and psychiatrist, Dr. Khristine Eroshevich.

Eroshevich traveled with Smith to Florida, where she died. The medical examiner's office said Eroshevich authorized all the medications found at the Seminole Hard Rock Hotel and Casino in Hollywood, Florida, where Smith was found unresponsive before her death February 8.

Calls to Eroshevich were not immediately returned Wednesday.

FDA Tells Novartis To Stop Selling A Drug

So now the FDA is getting responsible, or what? They have asked Novartis to voluntarily cease selling Zelnorm, a drug to counteract constipation in victims of irritable bowel syndrome, because it causes heart trouble. The drug was first approved in 2002.

This is a hopeful sign. It's rare that the FDA kills a drug after it's approved. But the pressure coming from people like me and you is making a difference. We have to ratchet it up another notch, though. Until the pressure from us is greater than the carrot from drug company money, the FDA will not do what they need to do; end the production of killer SSRI psychiatric drugs like Prozac, Zoloft, Paxil etc.

The whole story on Zelnorm is here.

We Protect Kids From Everything But Fear

I'm posting this because although it doesn't directly address psych drugs or the psych environment, it is an illustration of the world that our psych-influenced schools and social environment have led us to. At the bottom, in red, is my postscript.

Paula Spencer
Newsweek
http://www.msnbc.msn.com/id/17770831/site/newsweek FULL ARTICLE

April 2, 2007 issue - Four 11- and 12-year-old girls stood in front of my open pantry, mouths gaping wide. "Look! Fruit Roll-Ups!" "Oh, my God! Chocolate-chip cookies!" "You have regular potato chips? We only get the soy kind."

After 14 years and four kids, I thought I'd feel comfortable as a mother. Instead, I'm increasingly aware of a prickly new sensation:
that I'm some kind of renegade. Who knew that buying potato chips would become a radical act? Or that letting my daughters walk home from school alone would require administration approval? How did I, a middle-of-the-road mom, become a social deviant?

Fear is the new fuel of the American mom. If it's not fear of her child becoming obese, it's the fear of falling behind, missing out on a sports scholarship or winding up with a thin college-rejection envelope.

Apparently I'm not nervous enough. Last summer while I was loafing in front of the TV with my kids, the most benign things morphed into menaces. For example, the sun: long-sleeved, UV-protective swimsuits were all the rage at my neighborhood pool, while I could barely remember to bring the year-old sunscreen. The water wasn't safe
either: at the beach I saw tots dressed in flotation belts and water wings­for shelling along the shore. And goodbye, cotton candy and hot dogs! At a major-league game I saw moms and dads nix the stuff as if they'd never eaten the occasional ballpark treat. As if their children would balloon into juvenile-diabetes statistics if a single swig of sugary soda passed their lips.

Half my kids' friends­who already make A's and B's­had summer tutors in order to "keep it fresh." I thought vacation was for relaxing and recharging. What would our pioneer foremoms think? (You want something to worry about, let me show you frostbite, typhoid and
bears!) Heck, what must our own mothers think? (Snap out of it! Go worry about something truly scary, like how you're going to pay for
retirement!)

I thought that once the kids were back in school, things would calm down. Instead, a fresh seasonal crop of anxiety sprouted, this time over corruptive candy fund-raisers and insufficient use of hand sanitizer. I know one mom who wants to change her son's schedule because he doesn't know anyone in his classes; she's worried he'll be "socially traumatized" all year. Another is afraid of a learning disability she just read about, though her child seems bright and charming to me.

The fears are as irrational as they are rampant. Recently my children's elementary school failed to meet adequate yearly progress goals for a particular minority's reading progress under the No Child Left Behind Act and was placed on a warning list. This meant parents might gain the right to transfer their children to another school in the district. Never mind that this very same school sent more kids to the district's gifted program than any other, or that this entire district has the highest SAT scores in the state. The day the news broke, six different moms (none in the affected minority) asked me if I was planning to transfer my kids. From neighborhood pride and joy to threat to child's future overnight.

It's not that I think parents shouldn't worry about anything. I'm personally petrified of SUV drivers on cell phones. I fret as much as the next mom about how to pay for college. I pray my kids won't wander onto MySpace and post something dumb.

But you can't go around afraid of everything. It's too exhausting! No matter how careful you are, bad stuff happens (diaper rash, stitches, all your friends assigned to another class). And it's seldom the end of the world.

Watching my daughter's friends ogle my pantry, I realized there's one big, legitimate fear that I haven't heard anybody mention: what's the effect of our collective paranoia on the kids? Yes, these very kids we want to be so self-sufficient, responsible, confident, happy and creative (not to mention not food-obsessed). They're growing up thinking these weirdly weenie views are healthy and normal.

Walking out my front door that day, each girl happily clutched a plastic baggie stuffed with the exotic kid snacks that my daughter had doled out in pity. I may be a rebel mom, but at least I'm not afraid of a chocolate-chip cookie.

Spencer lives in Chapel Hill, N. C.
© 2007 Newsweek, Inc.

The bottom line is there is no greater proponent for the "dangerous environment" than psychiatry/psychology. The schools are all conditioned to be testing children for possible "suicide" indicators, but their solution when they supposedly find one of these potential kids is to give drugs that cause people to consider, or even commit, suicide. The idea that people's psyches are fragile is the primary push behind the entire idea of the dangerous environment. Anybody who is acting up or not doing well is a "victim" and is coddled. People who are bold and think for themselves are chastised or penalized. Homogenization is the order of the day. The writer of this article may not have realized how well she illustrated the fallout from this psych bomb that has been exploded in our society.

Psychiatrist Says People Being Erroneously Labeled

Here's a GREAT article in Newstarget.com.

It seems the Columbia University psychiatrist that is largely responsible for the entire list of modern psychiatric "illnesses" including ADD and ADHD, admits that there is no science behind these labels, and that many people may have been erroneously diagnosed since "normal" people might exhibit the same symptoms.

The psychiatric emperor with no clothes is being found out.

A Child Is Quieted Forever, By Pills

From an article in the St. Petersburg Times.

Prosecutors charge Rebecca Riley's parents with murder and child psychiatry comes under scrutiny after the 4-year-old dies of an overdose of prescribed drugs.

By ASSOCIATED PRESS
Published March 25, 2007

---

HULL, Mass. - In the final months of Rebecca Riley's life, a school nurse said the little girl was so weak she was like a "floppy doll."

The preschool principal had to help Rebecca off the bus because the 4-year-old was shaking so badly.

And a pharmacist complained that Rebecca's mother kept coming up with excuses for why her daughter needed more and more medication.

None of their concerns was enough to save Rebecca.

Rebecca - who had been diagnosed with attention deficit hyperactivity and bipolar disorder, or what used to be called manic depression - died Dec. 13 of an overdose of prescribed drugs, and her parents have been arrested on murder charges, accused of intentionally overmedicating their daughter to keep her quiet and out of their hair.

Interviews and a review of court documents make it clear that many of those who were supposed to protect Rebecca - teachers, social workers, other professionals - suspected something was wrong, but never went quite far enough.

The tragic case is more than a story about one child. It raises troubling, larger questions about the state of child psychiatry, namely:

- Can children as young as Rebecca be accurately diagnosed with mental illnesses?

- Are rambunctious youngsters being medicated for their parents' convenience?

- Should children so young be prescribed powerful psychotropic drugs meant for adults?

Dispensing drugs to children diagnosed with mood or behavior problems is "the easiest thing to do, but it's not always the best thing to do," said Dr. Jon McClellan, medical director of the Child Study and Treatment Center in Lakewood, Wash. "At some level, I would hope that you'd also be teaching kids ways to control their behavior."

According to the medical examiner, Rebecca died of a combination of Clonidine, a blood pressure medication she had been prescribed for ADHD; Depakote, an antiseizure and mood-stabilizing drug prescribed for the little girl's bipolar disorder; a cough suppressant; and an antihistamine.

The amount of Clonidine alone in Rebecca's system was enough to be fatal, the medical examiner said.

The two brand-name prescription drugs are approved by the Food and Drug Administration for use in adults only, though doctors can legally prescribe them to youngsters and do so frequently.

Rebecca's parents, Michael and Carolyn Riley, say they were only following doctor's orders. Rebecca, they told police, had been diagnosed when she was just 2 1/2, and Rebecca's psychiatrist prescribed the same potent drugs that had been prescribed for her older brother and sister when she diagnosed them with the same illnesses several years earlier.

Rebecca's teachers, the school nurse and her therapist all told police that they never saw behavior in Rebecca that fit her diagnoses, such as aggression, sharp mood swings or hyperactivity.

Prosecutors say the Rileys intentionally tried to quiet Rebecca with high doses of Clonidine. Relatives told police the Rileys called Clonidine the "sleep medicine."

Through their attorneys, Michael Riley, 34, and Carolyn Riley, 32, have accused Rebecca's psychiatrist, Dr. Kayoko Kifuji, of overprescribing medication.

Kifuji did not return calls for comment, but she has vehemently denied any role in Rebecca's death. She has agreed to a suspension of her license while the state's medical board investigates.

Kifuji told police Rebecca had been her patient since August 2004, when she was 2. She said she based her diagnoses of ADHD and bipolar disorder on the family's mental health history, as described by Carolyn Riley, and Rebecca's behavior, as described by Carolyn and briefly observed by her during office visits.

Kifuji told police she became alarmed in October 2005 when Carolyn Riley told her she had increased Rebecca's nighttime dose of Clonidine from 2 to 2 1/2 tablets, and warned Carolyn that the increase could kill Rebecca.

But Carolyn told investigators Kifuji told her she could give Rebecca and her sister extra Clonidine at night to help them sleep.

Tufts-New England Medical Center, where Kifuji works, issued a statement supporting Kifuji, saying her care of Rebecca "was appropriate and within responsible professional standards."

In the months leading up to Rebecca's death, others noticed there was something wrong.

Teachers and staff members at the Johnson Early Childhood Center in Weymouth, about 20 miles south of Boston, say they called Rebecca's mother repeatedly to tell her that Rebecca was "out of it," but her mother said the girl was tired because she wasn't sleeping well.

A neighbor who lived next door to the family in the last month of Rebecca's life said Rebecca and her siblings seemed listless.

'Like little robots'

"They looked like little robots. They looked very lethargic," Phyllis Lipton said. "I said, 'Wow, they don't look right,' but who knew?"

Pharmacists at Walgreens in Weymouth called Kifuji twice to complain that Carolyn Riley was asking for more Clonidine, even though her prescription was not due to be refilled, according to state police.

Once, Riley said she had lost a bottle of pills, and another time, she said water had gotten into her prescription bottle and ruined the pills, according to police.

Kifuji authorized refills, but after the second incident, she began prescribing Clonidine in 10-day refills instead of 30-day supplies, investigators said.

On Aug. 16, a prescription for 35 Clonidine tablets - a 10-day supply - was filled at Walgreens, even though the Rileys had obtained a 10-day refill only the day before, investigators said.

Walgreens spokeswoman Tiffani Bruce said: "The scrip was filled as written, as it was prescribed by the doctor, and all the appropriate information on the medications was given to the family."

After Rebecca's death, police found only seven Clonidine tablets in the family's medicine tray. Altogether, prosecutors say, Carolyn Riley got 200 more pills in one year than she should have.

The Rileys' lawyers call them unsophisticated people who did not question their children's doctors.

Both are unemployed; they collect welfare and disability benefits. Michael Riley, who is also awaiting trial on charges of molesting a stepdaughter in 2005, claimed to suffer from bipolar disorder and a rage disorder; his wife told police she suffered from depression and anxiety.

"They are not the sort of people who go on the Internet and look on WebMD. These are the sort of people who, when they go to a doctor, the doctor is God and they do what the doctor says," said John Darrell, Michael's lawyer.

In July, after a therapist filed a complaint with the state Department of Social Services, social workers met with the family's doctors and other medical professionals and were assured that the medications Rebecca was taking were within medical guidelines.

"There were lots of medical eyes on this case and none of them seemed to say there was an issue of overmedication in this case," said Social Services Commissioner Harry Spence, who has come under fire for the agency's handling of the case.

Rebecca's uncle, James McGonnell, and his girlfriend, Kelly Williams, who lived with the Rileys, told police that the Rileys would put their kids to bed as early as 5 p.m. Rebecca, they said, often slept through the day and got up only to eat.

According to McGonnell and Williams, Rebecca spent the last days of her life wandering around the house, sick and disoriented. But the Rileys told police they were not alarmed. "It was just a cold," Carolyn said during police interviews.