AMA to Congress: Ban ephedra diet aids

By G.W. Pomeroy
Air Force Surgeon General Public Affairs

WASHINGTON -- The American Medical Association testified before Congress on Oct. 8 about the dangers of the dietary supplement ephedra.

"The AMA urges the (Food and Drug Administration) to remove dietary supplements containing ephedra from the market," said AMA Trustee Dr. Ron Davis. "The risk/benefit ratio for these products is unacceptable."

Air Force surgeon general officials have "strongly advised" people to contact their physician or health care provider before taking dietary supplements containing Ma Huang, ephedra or ephedra alkaloids.

"Consultation is especially necessary if an individual has pre-existing medical problems, is taking other medications or exercises vigorously as part of (his or her) occupation or fitness program," said Royal Air Force Wing Commander (Dr.) Victor Wallace, chief of flight medicine at the Air Force Medical Operations Agency. Wallace is an exchange officer.

Such supplements, which include so-called energy boosters, over-the-counter diet pills and bodybuilding drinks or mixes, may pose health and occupational risks even for those not taking other prescribed drugs, Wallace said.

In his testimony before the Senate Subcommittee on Oversight of Government Management, Restructuring, and the District of Columbia, Davis said that the AMA "concurs with the National Institutes of Health guidelines for obesity treatment that say certain prescription drugs may be useful in some obese patients, but diet aids containing ephedra are not recommended for weight loss.

"And because of ephedra's effects on the cardiovascular and central nervous systems, it may cause cardiac arrhythmias, heart attacks, strokes, seizures and sudden death in both previously healthy people, as well as in those with risk factors for these conditions," Davis said

"More than 1,000 people have voluntarily submitted Adverse Event Reports associated with ephedra to the FDA," said Davis during his testimony.  "Some of these describe events that have resulted in death or serious illness in young, presumably healthy, adults. There are many more actual adverse events. One company recently admitted to having received more than 14,000 AERs for ephedra since 1995.

"Obesity is a significant public health problem," Davis said. "Appropriate treatment of obese patients requires a comprehensive approach involving diet and nutrition, regular physical activity, and behavioral change, with an emphasis on long-term weight management, rather than short-term extreme weight reduction.

"Because dietary supplements are classified as foods under federal law, they are assumed to be safe and are subject to limited regulatory oversight," he said. "Dietary supplements containing ephedra have significant risks, which may be serious or fatal to people with pre-existing illnesses, as well as those who were previously healthy. They should be removed from the market.

"The AMA is very concerned about the quality, safety and efficacy of all dietary supplements and urges Congress to require that dietary supplements be regulated the same way prescription and over-the-counter drugs are," Davis said.

Today, at least 20 states and the National Football League are among those who have banned or restricted use of ephedrine products.