When the Broward County, Florida, medical examiner determined in March that ephedra contributed to the death of Major League Baseball pitcher Steve Bechler, it added to mounting evidence against the "herbal supplement." Bechler died of complications related to heatstroke while taking Xenadrine RFA-1, an ephedra/caffeine supplement, which is labeled as a "clinically proven rapid fat loss catalyst."

Ephedrine is a central nervous system stimulant that causes increased heart rate and blood pressure and carries a significant risk of heat illness, arrhythmias, heart attacks, strokes, seizures and sudden death.

Ephedra, a naturally occurring chemical found in the herb ma huang, and ephedrine HCL, a synthetic pharmaceutical, have the same actions in the body. However, they are regulated differently. Herbal ephedra is "protected" by the 1994 Dietary Supplement Health and Education Act (DSHEA). Under this act, the FDA must prove a supplement dangerous before it can act on behalf of consumers.

Ephedrine HCL has been approved since 1948 as a drug, and therefore can be used only with a prescription under the supervision of a physician. The drug currently is minimally used as a decongestant or asthma medication. The American Medical Association argued before a Senate subcommittee last fall that since dietary supplements are classified as foods they are subject to limited regulation, and therefore should have no risks.

An article published in the Annals of Internal Medicine found that even though ephedra supplements make up less than 1 percent of all dietary supplement sales, they accounted for 64 percent of reported adverse events associated with dietary supplements. Ephedrine products are marketed in three ways. First, they are advertised as legal alternatives to street drugs under names such as Yellow Jackets, Black Beauties and Herbal Coke. A 16-year-old Illinois high-school football player died last fall of a heart attack after taking Yellow Jackets. Obviously, this type of marketing should raise a red flag.

Second, ephedrine is marketed as an athletics performance enhancer under names such as Ripped Fuel, Ultimate Orange and Herba Fuel. But ephedrine also impairs the body's ability to dissipate heat by its vasoconstrictive properties, and may increase the risk of heatstroke. Also, by increasing heart rate and blood pressure, it increases the risk of arrhythmias, heart attack and strokes. The risks far outweigh any perceived performance benefits.

Third, ephedrine is marketed as a weight-loss product. Some research shows modest weight loss compared to placebo, but the National Institutes of Health guidelines for the treatment of obesity do not recommend ephedrine compounds as part of a weight loss program.

Ephedrine is banned by the United States Olympic Committee. The NCAA banned ephedrine in 1997 and began year-round drug testing for it in 2002 on recommendations from its competitive-safeguards committee.

The NFL banned ephedrine in the wake of football player deaths in 2001. Canada has labeled ephedrine a class-1 health risk and issued a voluntary recall of most ephedrine products in early 2002. The United States military has pulled ephedrine-containing supplements from all of its bases after it was found that the deaths of 33 servicemen probably were linked to use of ephedrine. Major League Baseball also is likely to ban ephedrine in the near future in the wake of Bechler's death.

The FDA recently called for strong new warning labels on ephedrine supplements. They were first proposed in 1997 but blocked by a powerful supplement industry lobby. At the very least, ephedrine products should be pulled from shelves until appropriate safety and efficacy studies can be completed. But because "herbal ephedra" is protected by the DSHEA, the FDA has no legal grounds on which to make this decision.

In November 2002, a federal jury awarded $4.6 million to plaintiffs who claimed Metabolife, an ephedra supplement manufacturer, sold them a dangerous product. Metabolife claimed that the product was safe if taken under the care of a physician.

But ephedrine supplements are not taken by prescription under the care of a physician; rather, they are sold in grocery stores with consumers assuming these products are as safe as a loaf of bread. The risks are real and significant, and every NCAA institution should take extra steps to warn their student-athletes of the dangers of ephedrine supplements.

Michael D. Krauss is the senior team physician at Purdue University and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.