Not if, but when - a US ban on ephedra

Dietary supplements containing the herb ephedra are associated with more reports of death, heart attack, hypertension, stroke, and seizure than all other dietary supplements combined, according to Dr Sidney Wolfe, director of Public Citizen's Health Research Group, a Washington-based consumer watchdog.

Wolfe's views, heard during a US Senate committee earlier this month, are cited in a special news report in the 26 October issue of the British Medical Journal (BMJ), which covers the recent hearing on the dangers of the herb.

The report claims that last January Dr Wolfe wrote a letter to the American Medical Association asking for the association's support in urging the Food and Drug Administration (FDA) to ban dietary supplements such as ephedra, the plant that contains ephedrine alkaloids, from the US market.

Wolfe said the US government had been negligent "in protecting Americans from what is clearly the most dangerous drug that masquerades as a food supplement, ephedra."​

He also said: "There is no doubt that these products will be banned in the United States. The question is not whether, but when. Delaying tactics . . . are costing lives."​

Speaking before Congress, American Medical Association trustee Dr Ronald Davis recently urged the FDA to remove dietary supplements containing ephedra from the market. "The risk-benefit ratio for these products is unacceptable,"​ said Dr Davis.

The BMJ report cites statistics from the FDA's nutritional adverse event monitoring system which show that between January 1993 and February 2001, 42 per cent of the total 3308 adverse events for all dietary supplements were associated with ephedra.

The Canadian government also issued warnings and a recall of ephedra-containing products in January this year.

The report also quotes US navy surgeon general Richard Nelson, who said that all three US military services have documented medical cases where significant adverse events and deaths have occurred among service members taking certain dietary supplements, specifically preparations containing ephedrine alkaloids.

However several US trade bodies, such as the Council for Responsible Nutrition and the National Nutritional Foods Association, issued statements at the time of the hearing which stressed that the herb can be used safely, although they requested further safety measures be put in place to ensure consumer protection, such as mandatory reporting of adverse events and strong warning statements on products.