Off-Label Prescribing: A Call for Heightened Professional and Government Oversight

Under current U.S. law, physicians may prescribe drugs and devices in situations not covered on the label approved by the Food and Drug Administration. Those supporting this system say that requiring FDA approval for off-label uses would unnecessarily impede the delivery of benefits to patients. Patients do benefit from off-label prescribing that is supported by sound scientific and medical evidence. In the absence of such evidence, however, off-label prescribing can expose patients to risky and ineffective treatments. The medical community and federal authorities should more actively promote patients' interests in receiving beneficial off-label treatments. To exercise responsible self-regulation, members of the medical community must determine whether available evidence justifies specific off-label uses and must promote information-gathering when the evidence is inadequate. Physicians should also discuss with patients the uncertainties accompanying off-label uses. Federal authorities should more closely monitor the effects of off-label prescribing and adopt other measures to reduce harm and enhance benefits produced by off-label prescribing.     

Making the case for school-based health: where do we stand?

School-based health centers (SBHCs) have proliferated rapidly nation-wide and remain politically popular. This article explores the disconnect between the evidence and the discourse on SBHCs, drawing upon the authors' evaluation of SBHCs in Newark, New Jersey, and a critical assessment of the evaluative literature and public discourse on school clinics to argue that a number of important issues are being overlooked by both research and advocacy. These issues include variations in the health needs and health care resources of different communities and the questions of whether and how SBHCs can best integrate with existing resources to fill unmet local needs. Furthermore, despite the cautions of experts that third-party reimbursement (via traditional fee-for-service insurance or participation in health maintenance organizations) cannot cover clinic expenses and is difficult to obtain, pursuit of reimbursement continues to be a goal of some SBHC sponsors, helping to promote a clinic model that in some communities is very likely not to be the best way to address student needs or to build on clinic strengths. Discussion around SBHCs should focus on diagnosing specific community needs, identifying the best approach to meeting those needs, and seeking funding sources that match the work that needs to be done.     

Book reviews

John P. Willerton, Patronage and Politics in the USSR. Cambridge: Cambridge University Press, 1992, xv+305 pp., $59.95, £40.00.

Michael Ellman & Vladimir Kontorovich, eds, The Disintegration of the Soviet Economic System. London and New York: Routledge, 1992, xv+281 pp., h/b £45.00., p/b £14.99.

Paul R. Josephson, Physics and Politics in Revolutionary Russia. Berkeley, CA: University of California Press, 1991, xix+423 pp., $39.95.

Hélène Carrère D'Encausse, The Great Challenge: Nationalities and the Bolshevik State 1917–1930. Nancy Festinger, Trans., Richard Pipes, Foreword. New York: Holmes & Meier Publishers, 1991, xviii+262 pp., $39.95.

Niels Erik Rosenfeldt, Stalin's Secret Chancellery and the Comintern. University of Copenhagen, Institute of Slavonic and East European Studies, 1991. 116 pp.

Christoph Bluth, Soviet Strategic Arms Policy Before SALT. Cambridge: Cambridge University Press, 1992, 317 pp., £40.00.

Roger E. Kanet, Deborah Nutter Miner & Tamara J. Resler, Soviet Foreign Policy in Transition. Cambridge University Press, 1992, xvi+308 pp., £40.00, $59.95.

M. A. Babkina, ed., New Political Parties and Movements in the Soviet Union. Commack, NY: Nova Science Publishers, Inc., 1991, 156 pp., $35.00.

S. Berglund & J. A. Dellenbrandt, eds., The New Democracies in Eastern Europe: Party Systems and Political Cleavages. Aldershot: Edward Elgar, 1991, xii + 237 pp., £39.95.

Gyorgy Csepeli & Antal Örkény, Ideology and Political Beliefs in Hungary: The Twilight of State Socialism. Trans., Brian McLean & Julianna Parti, London: Pinter, 1992, viii+148 pp., £35.00.     

Religious Innovation and Competition in Contemporary African Christianity

ABSTRACT

This introductory essay lays out the main themes of a special issue of Journal of Contemporary African Studies which brings together six empirically grounded papers by African social scientists of different disciplinary backgrounds. These works touch on various aspects of the social impact of religious innovation and competition in present day African Christianity. They represent the first fruits on the social science side of an interdisciplinary initiative that made 23 research grants for theologians and social scientists to study Christianity and social change in contemporary Africa. These articles focus on a variety of dynamics in contemporary African religion (mostly Christianity), including gender, health and healing, social media, entrepreneurship, and inter-religious borrowing and accommodation. The editors conclude that the research and learning reflected in this volume will enhance understanding of religion’s vital entanglement in contemporary African society. The articles reveal problematic ethical and psychological dynamics in some of these new movements, particularly among some of the neo-Pentecostal groups. Yet the authors are determined to go beyond perspectives that are overly fixated with African problems and victimisation. They are keen to explore opportunities for understanding African agency and African wellsprings of hope. The editors conclude that scholars of religion and religiosity in Africa need to invest new conceptual and methodological energy in researching what it means to be actively religious in Africa today.