And business is booming - it's up an estimated 300% from 1997 to 1999. More than 3 billion servings of dietary supplements containing Ephedra (ma huang) are now consumed annually by people who are desperate to lose weight.

According to the Ephedra Education Council supported primarily by members of the Ephedra Committee of the American Herbal Products Association, the supplement has been proven to be safe.

The Food and Drug Administration (FDA) disagrees. They counter with data dating to 1994 supporting over 1,400 reported health problems including high blood pressure, strokes and heart attacks in people taking products containing Ephedra. Included in that data are reports of more than 80 deaths.

While you might assume that it's hard to pin these widespread health problems on a single substance, you may be right. Yet there’s more to Ephedra than meets the eye.

In 1999 two Vancouver teens died when their car was struck by a woman who hit them from behind. Driving at a high rate of speed, she claimed to be hearing "voices from her car radio that were urging her to drive faster."

It was deemed she was "not criminally responsible by reason of mental illness." Yet there was another factor to consider.

Her psychosis is being blamed on a popular weight loss supplement called Xenadrine which contains a combination of ephedra and caffeine - a combo referred to as a "Speed Cocktail."

Despite the fact that data exists in the psychiatric literature to support the association between this cocktail and mental illness, Cytodyne, the supplement's manufacturer, denies the association. Interestingly however they fall back on their warning label which cautions people at risk, or who are being treated for any of the following: high blood pressure, liver problems, thyroid problems, diabetes, pernicious anemia, nervousness, anxiety, depression, seizure disorder, cardiac arrhythmias, stroke, pheochromocytoma, prostate enlargement and psychiatric disease.

While their label seems responsible on the surface, I'm having a great deal of difficulty rationalizing the value of a printed warning for people who do not suspect they are at risk for any of these stated disorders. To complicate matters further, what is the real danger for those actually suffering from these conditions who have yet to be diagnosed?

When the Public Citizen Health Research Group called on the FDA to ban the production and sale of Ephedra dietary supplements, the Ephedra Education Council reneged it as a public health concern when consumed according to current standards, which includes limits on serving size (25 mg) and daily consumption (100 mg). They also countered by comparing the relatively low number of Ephedra-related side effects with the rather high incidence of aspirin-related side-effects (13,000 per year).

Their last point is especially well-taken. Yet it doesn't seem rational to justify legitimacy of risk with the inherent danger of another unrelated substance that has been proven to have vast health benefits.

Such rhetoric only serves to cover up the real danger and the facts. Frankly as medical scientists we don’t have all the answers.

There’s no reasonable means to determine whether or not a person who presents to the hospital with a seizure, heart attack, stroke or psychosis is on an herbal supplement. Routine blood screening for every over-the-counter substance isn’t feasible, and it’s well-established that patients do not typically advise their physicians of such use.

Factor in the strong tendency to hide the use of these substances even from loved-ones and the real problem begins to surface. When side-effects do occur, how many Ephedra users are actually willing to acknowledge them? Does that occasional palpitation (irregular heartbeat) justify fitting into that fashionable outfit?

Human nature isn't surprising.

I strongly believe that no person should be taking an herbal dietary supplement without a thorough medical examination and follow-up. We cannot expect people to serve as their own doctors - few can correctly pronounce all the disorders listed on Xenadrine's warning label. Why would anyone realistically place their lives in the hands of a supplement sales person indoctrinated with marketing hype?

In conclusion, we do not have all the answers. We certainly need to know more, yet we must proceed with caution. Once Ephedra's safety and efficacy is established, it should then be prescribed only by a physician, who in the words of Paul Harvey, "knows the rest of the story" - Mind Over Matter!