Of course, a drug may have reasonable evidence supporting its use in particular clinical situations even if the FDA has not defined these as approved indications, perhaps because a manufacturer has not formally applied for that designation. For example, propranolol was initially approved for tachyarrhythmias, and its use as an antihypertensive and antianginal agent was at first “off-label.” At present, rosuvastatin (Crestor, AstraZeneca, Wilmington, Delaware) is the only statin that is approved by the FDA for some patients with high C-reactive protein and normal low-density lipoprotein cholesterol levels, although many researchers in this area believe that other statins may have similar efficacy for this purpose. Thus, off-label prescribing can run the gamut from adequately data-driven to truly implausible and potentially harmful. The latter case is illustrated by gabapentin (Neurontin, Pfizer, New York, New York), whose manufacturer agreed in 2004 to pay the government $430 million to settle charges of improper off-label marketing. Its promotional campaigns had been so successful that by 2004, an estimated 90% of Neurontin sales were for off-label uses (6), including many indications with little convincing evidence of efficacy. A recent review of off-label prescribing among office-based physicians found that a sobering 73% of off-label prescribing had little or no scientific support (7).