MEDGuide and patient package inserts--again?

This article will trace the history and effects of the PPI from the time of its original concept by the FDA in the early 1970's to its current status. It will also address the response to this FDA initiative by the industry, medical community and consumer groups. Initiatives in other countries and future issues will also be discussed.     

The State of American Federalism, 1996-1997

Federalism enjoyed political and popular salience during theperiod 1996–1997 as the so-called "Devolution Revolution"began to be implemented and analyzed in the United States. Whilethere were a few examples of important Revolutionary efforts,the federal government continued to hold much of the power andsignificance it has achieved over the past sixty years. Evenin the area of welfare policy, where in 1996 there were historicreforms enacted to end the federal entitlement, the federalgovernment maintained a significant presence that made the ideaof devolution of welfare policy responsibility some what questionable.Nevertheless, states continued to lead in policy innovationin areas ranging from education to health, and the U.S. SupremeCourt continued to question the limits of federal power. Thepast year illustrated, once again, the complexity of our federalsystem and how difficult it is to reform federalism—particularlywhen it involves a shift in power and creates the perceptionof winners and losers.     

Mental disabilities under the ADA: a management rights approach

While numerous sources have focused on employee rights and employer obligations under the Americans with Disabilities Act, this article will emphasize employer rights with respect to mental disabilities under the ADA. Specifically, it addresses the ADA's definition of "mental disability," the right of employers to screen job applicants in spite of the ADA, the conditions under which an employer may require an employee to undergo a "fitness for duty" examination, and the limits of the duty to "reasonably accommodate" an employee with a mental disability.     

The MacArthur Treatment Competence Study. II

This article reports the development and psychometric properties of three standardized and objectively scored measures, the MacArthur Treatment Competence Research Instruments. They were designed to assess abilities related conceptually to four legal standards for competence to consent to treatment: understanding, appreciation, rational manipulation (reasoning), and expressing a choice. Scoring reliability, internal consistency, intertest correlations, and test-retest correlations were examined with data from samples of hospitalized patients with schizophrenia, major depression, and ischemic heart disease, as well as matched non-ill community samples. The results indicate very good interscorer reliability and provide guidance for the use of the instruments and interpretation of their results in future research on patients' decisional abilities in treatment contexts.     

Population: malady or symptom?

The 1994 International Conference on Population and Development (ICPD) opened the dawn of a new era in discourse over population. A newfound consensus was reached between North and South which was not there during the two previous world population conferences in Bucharest and Mexico. While consensus was reached at the 1994 ICPD on the need for action, however, debate over population is far from settled. Causes of population growth, the links between population growth and economic development, and environmental degradation remain controversial topics. The authors analyze the basis of the ICPD consensus at the local, national, and global levels. They also compare the development discourse to the political discourse over population. Both discourses emphasize different aspects of a far more complex reality. The question is which discourse to choose as a basis for drawing policy recommendations. The emerging view on the way to Cairo was that consensus would be achieved on the basis of development discourse. Success on the action plan rests upon the belief that more contraceptives, more health services, and more schools will be enough to reduce fertility rates. The political discourse, however, is better than the development discourse as a basis for policy making because it stresses the need for integration rather than running the risk of exclusion. The political discourse is also more demanding.