Wednesday, February 17, 2010

Jurors outraged by psychiatrist's conduct Felt she should share culpability in toddlers death

By Patricia Wen
Globe Staff
February 11, 2010


BROCKTON - The jury that convicted a South Shore woman this week of killing her 4-year-old daughter with an overdose of psychotropic drugs was also outraged by the conduct of the child’s psychiatrist and hoped the doctor would be held responsible in some way for the girl’s death, according to several jurors interviewed a day after the verdict.

“Every one of us was very angry,’’ said one juror, who requested anonymity to avoid retaliation for her role in Tuesday’s second-degree murder conviction of Carolyn Riley. “Dr. Kifuji should be sitting in the defendant’s chair, too.’’

Another juror said that while the 12-member panel found that the 35-year-old mother was primarily responsible for Rebecca’s death, many jurors were “off the wall’’ when they heard the testimony of Dr. Kayoko Kifuji of Tufts Medical Center. She said they were struck by how quickly Kifuji diagnosed Rebecca with bipolar and hyperactivity disorders, as well as how little the doctor seemed to supervise the mother’s dispensing of medications.

“It blew me away,’’ said that juror, who asked to remain unidentified for fear of reprisals.

Rebecca’s psychiatrist was the focus of some of the most powerful reactions from the jurors after a three-week trial that left them emotionally and physically exhausted.

While Kifuji’s attorney defended the psychiatrist and said jurors saw “only pieces of the full extent of diagnosis and treatment’’ of the girl, several jurors said they feel Kifuji bears some responsibility for the child’s overdose of psychiatric drugs, which were dispensed by a troubled mother.

Kifuji is facing a medical malpractice case filed by the estate of Rebecca Riley, though that case is not expected to go to trial for at least a year.

Other than the nationwide publicity given to the Riley case, in which Kifuji is mentioned repeatedly, the only overt sign that Kifuji had potentially questionable conduct is on the Board of Registration of Medicine’s website.

In a section dealing with disciplinary matters, the website lists the dates, from February 2007 to September 2009, in which Kifuji started and was permitted to end a “voluntary agreement’’ to stop practicing psychiatry.

Still, when asked if the board’s investigation concluded that Kifuji acted within acceptable medical standards, spokesman Russell Aims responded by saying that the board “closed the complaint against Dr. Kifuji without discipline.’’ He said the board, however, “reserves the right to reopen a case if new information comes to light.’’

The psychiatrist will not face criminal prosecution. A grand jury last summer declined to indict her, and Kifuji testified in Carolyn Riley’s trial only after being granted immunity from prosecution.

With her Boston attorney, Bruce Singal, at her side in court, Kifuji had initially declined to testify by invoking her right against self-incrimination. That move forced the government to grant her immunity as the only way to compel her to testify.

Singal defended the 55-year-old psychiatrist, saying by e-mail yesterday that her treatment of Rebecca has been “reviewed and cleared on numerous levels.’’ He said a Tufts Medical Center review found her care appropriate.

Singal went on to say that he is confident that any thorough examination of the doctor’s care of Rebecca would show she acted “in the best interests of this seriously ill child, and diagnosed and treated her in full accord with acceptable medical standards.’’

Several jurors in the mother’s trial said they never questioned whether Carolyn Riley was culpable, and an acquittal was never a possibility. When faced with a choice between first-degree murder and two lesser options of second-degree murder and manslaughter, the panel was divided.

Throughout much of their discussions, roughly half the members tilted toward a conviction of first-degree murder, one juror sought a manslaughter conviction, and the rest were focused on a second-degree murder conviction, according to a third juror, who also asked to remain anonymous.

Jurors wrestled over the meaning of “malice,’’ a condition they felt was necessary for a murder conviction but not for manslaughter. Ultimately, they decided the mother acted with malice through her routine use of pills to sedate her toddler, and her dispensing of toxic levels of clonidine in the hours before the girl died on Dec. 13, 2006. They united on a second-degree murder conviction, instead of a first-degree murder conviction, as a compromise.

The jurors said that during the 19 hours of deliberations behind closed doors, many wept while looking at photos of the girl’s body on the floor next to her parents’ bed. They said everyone felt the girl had pneumonia, but that she would not have died without dangerous levels of drugs in her body.

Patricia Wen can be reached at wen@globe.com
© Copyright 2010 Globe Newspaper Company.

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Tuesday, February 9, 2010

Glaxo to Shift Away from Antidepressant Research CEO admits antidepressant research only based on subjective mood surveys

Wall Street Journal
By Jeanne Whalen
February 5, 2010


GlaxoSmithKline PLC said it will stop research into new antidepressants and focus on diseases for which it believes it can develop more valuable drugs, a major shift for a company that developed some of the biggest-selling antidepressants of the past 20 years.

Profits at the U.K. drug giant, which posted a 66% increase in fourth-quarter earnings Thursday, were long fueled by the antidepressants Paxil and Wellbutrin, which at their peak generated billions of dollars a year in sales. Similar medicines, such as Eli Lilly & Co.’s Prozac and Pfizer Inc.’s Zoloft, also generated big sales for those companies.

However, low-cost generic copies have eroded demand for name-brand antidepressants, which accounted for just 2.3% of Glaxo’s total sales last year, down from 14% in 2002. Chief Executive Andrew Witty said Thursday that the company thinks further investment in the market wouldn’t be prudent.

Part of the reason is financial risk. Clinical trials of antidepressants are among the “most expensive and highest-risk” of all drug trials, Mr. Witty said, because companies often don’t know until the end of very large studies whether a drug works. It is also hard to prove that a depression drug is working, he said, because patient improvement is measured by subjective mood surveys, and not by the clear-cut blood tests and biological measures used in other diseases.

That’s a drawback in an era when insurers and other health-care payers want to see clear value for their money, Mr. Witty said.

Payers “want big benefits to make it worth their while to invest their resources,” he said, adding that Glaxo would scrap research into pain drugs for the same reasons, focusing instead on diseases including Alzheimer’s, Parkinson’s, multiple sclerosis and a clutch of rare diseases.

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AstraZeneca facing 26,000 suits over Seroquel

Bloomberg News
February 4, 2010
By JEF FEELEY and MARGARET CRONIN FISK


AstraZeneca PLC is facing as many as 26,000 lawsuits over its antipsychotic drug Seroquel as the drug maker prepares for its first jury trial over claims the medicine causes diabetes, according to court filings.

Attorneys for AstraZeneca, which has its U.S. headquarters in Fairfax, met with plaintiffs' lawyers in court-ordered mediation sessions last month to discuss a possible settlement, according to court filings. Consumers' lawyers said they had about 26,000 cases in their inventories, Stephen Saltzburg, a George Washington University Law School professor who served as mediator, said.

"I wish there were a magic wand that could be waved to settle all Seroquel cases instantly," Saltzburg said in the filing. "Such a wand does not exist."

In a Securities and Exchange Commission filing last week, AstraZeneca executives noted the company has paid about $656 million to defend itself in Seroquel cases. That's an increase of 28 percent, or $144 million, over last year's Seroquel defense costs, according to regulatory filings. The company said it had insurance of $521 million to cover Seroquel defense costs as of December.

The company said in the SEC filing it faces more than 25,000 claims that Seroquel caused diabetes. That's a 65 percent increase in cases over the number the company reported in a January 2009 regulatory filing. Many of the suits also claim AstraZeneca promoted Seroquel, approved for schizophrenic and bipolar patients, for unapproved uses.

Saltzburg said the two-day talks didn't generate a resolution, but he expects negotiations will take place at some point between the company and individual users' lawyers.

"The question is what is fair for plaintiffs and what is fair for AZ," the professor said in the report. "The parties are far apart at the moment on resolving that question."

AstraZeneca's stock fell last week after the drug maker's sales forecast and stock-buyback plan disappointed some analysts and fourth-quarter profit missed estimates. The company plans to buy back as much as $1 billion of shares this year, managers said Jan. 28.

A New Jersey judge has set a Feb. 16 trial date for the first of thousands of Seroquel cases filed in that state to go before a jury. Seroquel, which generated sales of $4.9 billion last year, is AstraZeneca's second-biggest seller after the ulcer treatment Nexium.

"The evidence, looked at fairly and fully, does not back up the allegations that Seroquel was responsible for the plaintiffs' alleged injuries," AstraZeneca spokesman Tony Jewell said in an e-mail.

In November, a judge in Florida who is overseeing all federal-court litigation over Seroquel ordered the company to meet with plaintiffs' lawyers and Saltzburg to discuss settlement.
U.S. District Judge Anne Conway in Florida, who is overseeing pre-trial proceedings in federal Seroquel litigation, said in November that she would ask a panel of judges to return the 6,000 cases consolidated before her to their home courts for trial.

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