Excerpted from The New York Times, February 25, 2003.

Dangers of an Herbal Supplement

The death of a young Baltimore Orioles pitcher who took pills containing ephedra ought to shock Major League Baseball from its cavalier attitude about the use of dietary supplements by players desperate to get in shape or gain a competitive edge. But it will be a shame if the current round of soul-searching over these largely unregulated supplements ends there. Ephedra is a danger to all Americans foolish enough to take it. The supplement ought to be banned as a threat to public health.

Nobody knows for sure whether ephedra killed Steve Bechler, a 23-year-old pitcher who was taking three pills a day in an effort to shed excess pounds during spring training. An autopsy attributed his heat stroke to a convergence of factors, including not only the pills but also an enlarged heart, abnormal liver function, borderline hypertension, excess weight and failure to eat well for several days.

Still, there is mounting evidence that ephedra is dangerous. A new study published online by The Annals of Internal Medicine found that ephedra is by far the most dangerous herbal product on the market. Products containing ephedra accounted for 64 percent of all adverse reactions to herbal supplements reported to American poison control centers in 2001 even though such products represented less than 1 percent of the market.

The substance is marketed to promote weight loss or increase energy, making it seductive to many athletes. Ephedra stimulates the central nervous system, speeds metabolism and increases the rate at which a person burns calories. But it also drives up blood pressure and heart rate. It can promote heat stroke by creating excess metabolic heat and constricting blood vessels in the skin that are crucial for cooling the body. These side effects can be especially dangerous in people who are dehydrated, out of shape or overweight, as Bechler was.

The American Medical Association has urged that ephedra supplements be banned because they may contribute to heart attacks and strokes. Ephedra has been banned by the National Football League, the National Collegiate Athletic Association and the International Olympic Committee, but professional baseball, basketball and hockey have been reluctant to follow.

The deeper problem is that ephedra is widely available to everyone, not just athletes, through health food stores, drugstores and the Internet. A reckless 1994 law approved by Congress at the behest of the supplement industry and its loyal consumers allows herbal supplements to be sold legally in this country even without proof of their safety unless the Food and Drug Administration can prove them dangerous.

Federal health officials are awaiting completion of a RAND analysis of ephedra before deciding how to proceed. If that analysis confirms the mounting evidence of harm, regulators should have the proof they need to ban ephedra.

Excerpted from The New York Times, February 25, 2003.