Aug. 13, 2003 -- You know it as ephedra, ephedrine, ma huang --
Aug. 13, 2003 -- You know it as ephedra, ephedrine, ma huang -- and doctors say it's trouble waiting to happen. Strokes, heart attacks, deaths have been linked to this stuff.
But on the Internet, ephedra's dangers get little or no mention, according to a new study that looks at Internet marketing of ephedra-containing products.
It's a lightening-rod issue: Ephedra is a popular weight loss drug and there's evidence that it can work short term. Yet 140 studies link ephedra to heart attacks and strokes. A number of people have died.
The FDA is currently holding hearings, looking at whether ephedra should be removed from the market entirely.
Ephedra's Dangers Not Revealed
In this study, researchers look at web sites that market ephedra -- finding that one-third issue "statements that are undeniably misleading or incorrect," says Bimal H. Ashar, MD, professor of medicine at The Johns Hopkins University School of Medicine in Baltimore.
His report appears in the latest Mayo Clinic Proceedings.
Ashar and colleagues plugged the phrase "herbal weight loss" into four search engines. Of the 32 web sites they analyzed, they found 32 products and advertisements.
They found:
- 41% failed to disclose either adverse effects or other warnings.
- 53% did not provide dosage information.
- 34% made incorrect or misleading statements.
Among the erroneous claims, according to the researchers:
- Some suggested that their product was FDA-approved. Most commonly, it was through statements that "'the product was made in an FDA-approved laboratory or made following strict FDA guidelines,'" says Ashar. "That doesn't mean it's FDA-approved."
- On one web site, a question-and-answer section included the question, "Is this formula FDA approved?" The answer: "All products are manufactured in an FDA-approved laboratory." "That's very blatantly misleading," Ashar tells WebMD.
- One web site claimed that the product was completely safe for long-term use. "That's kind of vague. There has never been a study looking at ephedra for more than six months of use. In my mind, that's not long term. And saying 100% safe is simply incorrect."
Ephedra Not Like Sudafed
A number of web sites tried to compare ephedra with the over-the-counter sinus medication pseudoephedrine (such as Sudafed), Ashar reports. The web sites stated their product contained a lower dosage of ephedra than in children's Sudafed. But Ashar says pseudophedrine is a weaker derivative of ephedrine. "Comparing Sudafed with ephedra is apples and oranges," he tells WebMD.
Ephedra was marketed under various names, including epidonin, ma huang, and Sida cordifolia. "Consumers need to be careful," says Ashar. "Some web sites won't even list ingredients. If you don't know what it contains, don't try it. Bring a printout from the web site to your doctor."
For Answers, Look North
Donald Marcus, MD, professor of medicine and immunology at Baylor University School of Medicine, sees it all the time. "They're all false claims on the Internet," he tells WebMD. "There is little or no data on any herbals, not just ephedra. The best you can say is, there are small studies.
"These are not dietary supplements, they are not food," he adds.
His idea: Adopt changes like those occurring in Canada. Next year, Health Canada will implement 53 new regulations plus a new regulatory category called "Natural Products," which includes herbs and other supplements, says Marcus.
New warning labels will appear on all herbs and supplements produced in Canada. Also, these products must be registered with the Canadian government, so that regulations can be enforced and "adverse events" - such as heart attacks, strokes, deaths -- can be tracked. Ephedra's dangers, like others, would appear on warning labels on the products.
American companies are not required to report serious adverse events. Also, the FDA is not required to keep records of these events, Marcus says.
"The Federal Trade Commission has the responsibility to govern marketing of these products, but it's difficult to enforce any regulation of Internet marketing of ephedrine or any supplement because the Internet is such a fluid medium," Ashar tells WebMD.
Even if ephedra vanishes from the market, the supplement regulation problem still exists, says Ashar. "The FTC is left with the formidable task of trying to enforce [advertising] rules. The FTC has taken action against a number of companies, but it's impossible to keep track of the Internet. If you issue a warning to a company, they switch to a different web site."
