In the middle of the main aisle at a large discount chain in Indianapolis, a clerk stood on a stepladder, stacking bottle after bottle of Xenadrine RFA-1, a supplement that contains ephedra.

It was March 2003, less than a month after Baltimore Orioles pitcher Steve Bechler died of heat stroke during spring training in Florida. The media reported that a bottle of Xenadrine RFA-1 was found in Bechler's locker, and the coroner in Florida had linked his death to ephedra use. The story was well-documented in the national media.

The clerk building the pyramid of product stopped when asked about her efforts. "I don't know if it works or not, but we just can't sell enough of it. That's why we're putting it out here in the aisle," she said of the supplement. "Ever since people heard about that pitcher back East, everyone wants some."

"But didn't the pitcher die?"

"I suppose he did, but that's not what people remember," she said. "They remember that he was taking it to lose weight, and some other athletes (in the news) said they were taking it, too. I can't explain it, but I know people want it. And it's legal."

Mike Perko, associate professor and coordinator of the health education program at the University of North Carolina, Wilmington, is not surprised -- either by the conversation at the store or the fact that people would seek to purchase something linked to a professional athlete's death.

"We live in a culture that says if it's legal, it must be OK for me to do," Perko said. "Since 1994, the supplement industry has been self-regulating. That means you can buy supplements anywhere -- a discount store, a gas station, at the mall. To most people, that says, 'This is harmless. It's not going to hurt me.' Even in the face of facts to the contrary, many people still think that."

Perko, author of the book, "Taking One for the Team: The New Thinking on Young Athletes and Dietary Supplements," says supplements have become such a part of our culture that college student-athletes think nothing of taking them, and parents sometimes think nothing of supplying supplements for their children.

"There's always been a culture of enhancing athletics performance. It just happens right now to be in the form of a pill, drink or a powder," he said, noting that a study he did in 1998 found that the word "harmless" was often used by consumers to describe supplements..

Perko notes that parents of today's athletes -- often baby boomers who have been the targets of marketing for supplements claiming to do everything from grow hair, encourage weight loss and increase sex drive -- have raised children who have seen their parents looking for a quick fix to a variety of problems.

"With college athletes now, we're talking about the sons and daughters of these people who have always known supplements to be available to them. To these young people, making the decision to take a supplement is not a tough one. They see supplements as a safe and legal alternative."

Ed Etzel, associate professor of sports psychology and psychologist at West Virginia University, agrees.

"Supplements are now part of the entire culture of Olympic, professional and college sports. People have for years -- going back to the beginning of time -- looked for ways to do better, to get ahead. And supplements have become a pervasive part of that," Etzel said. "There's really a culture of trying to perform better, and there's certainly marketing that fosters this and a culture of sport that fosters this. In my opinion, Americans are fans of a quick fix. So on some simplistic level, our supplement use makes sense."

Etzel also notes that some supplement use is due to peer pressure. "It's become the cool thing, the trendy thing to do," he said.

Cottage industry to mainstream mansion

Perko points to two government actions that have made supplements an important part of the athletics culture in the last decade: the Anabolic Steroid Control Act, passed in 1990, which outlawed steroids and sent many athletes looking for an alternative that would build muscles quickly; and the Dietary Supplement Health and Education Act (DSHEA), which effectively removed supplements from governmental control.

"When the Anabolic Steroid Control Act passed, the major supplement for muscle building was effectively taken away (from law-abiding consumers), but there was still a huge demand for athletics success. Supplement companies were a natural fit, and supplements went through the roof," Perko said, noting that names like General Nutrition Companies (GNC), Met-Rx, and many others quickly became a part of the athletics culture.

"It went from being a cottage industry to the mansion on the hill almost overnight. The supplement industry is now a $19 billion business and a major economic force."

Marketers are aware of the American tendency to pursue the trendy and the quick fix. And that's the message supplement marketers rely upon to deliver their messages.

"As a society, we have such a tendency to want to take shortcuts, to take the easy way," said Frank Uryasz, director of the Center for Drug Free Sport. "And if you look at the advertising around supplements, it's all built around the idea of getting results quickly."

Uryasz notes that our society is prone to seek medications as a cure-all, from Ritalin for hyperactivity to excess antibiotics for minor illnesses.

"Everybody is looking for a pill or powder to fix what ails them, and the supplement industry has capitalized on that," he said. "Even a lot of coaches and universities have bought into the mentality that you need supplements to get ahead. I've heard reports of schools spending tens of thousands, hundreds of thousands of dollars on supplements."

The media has played an important role insinuating supplements into the athletics culture as well, according to Arnold Mazur, staff physician at Boston College Health Services and a member of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports.

"Our culture promotes things to make people happier and stronger," he said. "There are many different types of products available, and they are often endorsed by prominent athletes, entertainers and coaches."

"People who are in sports are trying to be the best that they can in their sport and they are very susceptible to whatever they think will make them better. There is a large subculture out there that says there are things that will help you, and they are legal," Mazur said. "What the NCAA is trying to do (by telling student-athletes to steer clear of supplements) is counter-cultural."

Mazur points out that student-athletes are accustomed to reaching for pills.

"The messages student-athletes and others hear is that you can work through the pain if you take this medication," he said. "It creates a mindset that something will help. And student-athletes are accustomed to taking medicines; they frequently take pain medications because what student-athlete doesn't want to keep playing? The concept carries over to supplements."

An unstoppable appeal

Just as the fact that supplements are legal makes them appealing to some people, the aura of danger around some supplements makes them appealing to others, particularly risk takers like college students, says Perko.

"Before GNC announced that they were going to stop selling ephedra, they actually did something that made it much more desirable to young people -- they put it behind glass," he said. "Now tell me what young person hasn't seen other products, like alcohol, on display like that and want it. That's pretty good marketing."

Perko also notes that GNC's promise to stop selling ephedra may mean less than it appears. (See Briefly in the News in the May 12 issue of The NCAA News.)

"Just because they've said they're going to be ephedra-free doesn't mean they're not going to sell ephedra's cousins, and ephedra has a lot of cousins, many of which would result in a positive drug test," he said.

West Virginia's Etzel also notes that any relative of ephedra that is continued to be labeled "extreme" will attract a crowd because a subsection of young people have embraced anything using the word "extreme," from soda pop to athletics competitions featuring cutting-edge sports such as snow boarding.

"There's an 'extreme' theme that's very popular these days, and if you look at many supplements, their marketing somehow makes use of that word," Etzel said. "There's certainly an adolescent population of sensation seekers who pursue that, and it also goes with the mentality of 'Well, it won't kill me.' "

Rachel Olander, resource specialist at the Center for Drug Free Sport, hears that a lot. She speaks to student-athletes, coaches, administrators, parents and others about supplement use as part of Drug Free Sport's Resource Exchange Center.

"They don't believe it's going to hurt them. Whatever (the supplement) has done to others, they think it's not going to happen to them," she said. Olander also notes that the Internet is a main source of information for many people on supplements, and much of the information is false or misleading.

"When people have questions, they go to the Internet and typically locate materials written by marketers. And because there's no regulation of supplements, there's no limit really to what people can say about them. It's another area where people think because something is legal, it's safe and it works as advertised."

Olander has identified five reasons student-athletes take supplements:

While the notion of supplements to improve performance goes back to the beginning of time, the notion of supplements to improve appearance while performing is not something that's talked about. Still, Olander says, it exists, and it may be a growing reason for some athletes to take supplements, particularly those billed as "weight-loss aids."

Etzel, a sports psychologist, says taking supplements to improve appearance is especially prevalent in certain sports such as volleyball, swimming and diving, and gymnastics.

"Certainly, appearance sells tickets, so there might be some added pressure from coaches in some sports, " he said, noting that the uniforms often worn in women's volleyball feature tight shorts or skimpy briefs. "And in diving and gymnastics, where people are judged partly on appearance, there would be additional motivation (to take supplements to maintain appearance)."

Uryasz, whose Center for Drug Free Sport conducts drug testing for the NCAA and aids in supplement education efforts, knows it's an uphill climb to convince student-athletes that good food and hard work are safer and more effective than supplements.

"You do sometimes feel like the lone voice in the wilderness," Uryasz said. "But performance enhancement really comes from good nutrition, good training and good coaching -- not from a pill or powder."

Because supplements are so pervasive, and much of the problems with them stem from the fact that they are unregulated and untested, Uryasz has tried to think outside the box and consider testing them and regulating them. He just can't bring himself to consider it further.

"If we do that, do we just buy into the mindset that pills and powders are the solution? I think a lot of these products are just training wheels for anabolic steroids. I think it's a slippery slope," he said.

"I'm an optimist. I think we need more government regulation, and I think it will happen. Unfortunately, you don't get that government regulation until bad things happen to good people. You don't get that flashing yellow light in an intersection until enough people get killed that somebody decides it's too dangerous."