On December 13, 2006, paramedics arrived at the Plymouth County, Massachusetts, home of four-year-old Rebecca Riley only to find her slumped over on her parents’ bed, dead.
The medical examiner on hand identified the cause of death as heart and lung failure brought about by the medications she was on. Rebecca was being prescribed Depakote, Seroquel, and Clonidine by Dr. Kayoko Kifuji, a Tufts–New England Medical Center child psychiatrist.
She had diagnosed Rebecca with ADHD and bipolar disorder when she was two years old. Rebecca’s death provoked a national debate on how a child as young as two could ever be diagnosed with major mental illnesses and be put on powerful tranquilizers. Katie Couric eventually covered the story in a CBS 60 Minutes segment.
Ultimately, Rebecca’s parents were tried for and convicted of murder due to allegedly overdosing her. But this harrowing outcome didn’t take the national spotlight off the shocking revelation that a toddler could be diagnosed with mental illness and put on not just one but three powerful tranquilizers.
None of the drugs Rebecca was prescribed was approved by the Food and Drug Administration for use with kids her age—not then and not now. There was absolutely no robust scientific justification for Dr. Kifuji making the medication choices that she made. How could a reputable psychiatrist be so inclined to diagnose a child so young with diagnoses so severe and treat with medications so unapproved? The main answer lies with the spectacular success of twenty-first-century pharmaceutical marketing of psychiatric drugs.
In 2008, psychiatric drugs sold in the United States netted their makers $40.3 billion. A good portion of that amount involved drugs commonly prescribed to kids. A Wall Street Journal report indicates that between 2002 and 2007, prescriptions for psychiatric drugs for kids rose by nearly 45 percent. The most recent estimates suggest that up to eight million American kids are on one or more psychiatric medications. Meds for kids are big business and highly profitable.
Prices of ADHD meds at the middle dose for ninety pills on Drugstore.com in 2011 were Concerta, $540; Vyvanse, $532; Intuniv, $500; Adderall, $278; and Ritalin, $191. The price of the most common antidepressants, like Prozac, Celexa, Lexapro, Zoloft, Cymbalta, and Wellbutrin, for ninety pills, was around $380. Two of the drugs prescribed to Rebecca Riley by Dr. Kifuji happen to be quite pricey. Drugstore.com rates in 2011 for 180 500 mg tablets of Seroquel were $1,048 and for Depakote, $708.
Among drug reps, it is common knowledge that kids are a lucrative market. At the urging of doctors, parents, and teachers, kids are required to buck up and take their meds.
In the words of Gwen Olsen, who worked for fifteen years as a drug rep with such pharmaceuticalindustry mainstays as Johnson & Johnson and Bristol-Myers Squibb: “Children are known to be compliant patients and that makes them a highly desirable market for drugs, especially when it pertains to largeprofit-margin psychiatric drugs, which can be wrought with noncompliance because of their horrendous side-effect profiles.”
Most large-profit-margin psychiatric drugs are approved by the FDA strictly for use with adults, not kids. However, doctors are allowed to use their discretion and prescribe them to kids for “offlabel” purposes. Doctors can use their medical instincts to determine whether a drug approved for adults might also ease the suffering of kids.
But there is no scientific backing for such use. The studies haven’t been conducted. The FDA approval hasn’t been obtained. Off-label prescribing relies on doctors’ instincts alone. While drug manufacturers and their marketing staff are bound by law not to influence doctors’ off-label prescribing habits, it’s not the law that’s foremost on the minds of drug reps fanning out to doctors’ offices all over the country.
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