Of course, the number of people who have died from taking aspirin is way higher- more people take aspirin than ephedrine. The jury's probably stil out on whether or not ephedrine has a higher *risk* of serious adverse event. The abstract cited below would indicate that the incidence of a serious adverse event asociated with ephedrine (or ephedra) is fairly low- 37/926, or about 4%. This is somewhat misleading, though- what we really need is a study that gets at something called *attributable risk*, or the risk of an outcome like this that can be directly attributed to exposure to ephedrine. That would be tough to do without a controlled trial. What *is* interesting is that 36 of the 37 cases used ephedra within the suggested dosing guidelines- that's pretty compelling, even with such a small sample size.
BTW, I wasn't talking only about deaths. A much more common adverse outome with ephedrine exposure is non-fatal cardiovascular or cerebrovascular event, such as stroke and hemorrhagic myocardial infarction. No argument that the ball player who collapsed last summer was overweight and dehydrated- it was a classic case of heat stroke.
On another note, your link was to a site sponsored by the ephedra industry. Just like the FDA, they have a particular axe to grind, and whatever they say should be carefully and objectively evaluated. Not ignored, but carefully considered.
Finally, a note of disclosure- I am an epidemiologist, so I'm a member of the "establishment," but to some extent I do agree with your comment about the FDA. I think the evidence is weak at this point to recommend banning ephedrine and ephedra-containing preparations. I think the same is true of the ban on PPA, especially in cold preparations. However, I do feel that caution is in order. Like you point out, *no* drug (and ephedrine and its natural and synthetic analogs, and yes, even water, are drugs) is absolutely safe. My personal view on this is that without further evidence either way, I'd rather err on the side of caution and consider ephedrine a poor alternative to adjusting diet and activity during a cutting cycle. For those who want to take ephedrine, I say go in peace, but do it cautiously and with your eyes wide open- this stuff's not completely benign.
Jake
Samenuk D. Link MS. Homoud MK. Contreras R. Theohardes TC. Wang PJ. Estes NA 3rd. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clinic Proceedings. 77(1):12-6, 2002 Jan.
OBJECTIVE: To evaluate possible cardiovascular toxic effects associated with use of dietary supplements containing ma huang, an herbal source of ephedrine. METHODS: We reviewed the comprehensive database Adverse Reaction Monitoring System of the Food and Drug Administration, which included clinical records, investigative reports, and autopsy reports related to ma huang use. The main outcome measurements were stroke, myocardial infarction, and sudden death. RESULTS: From 1995 to 1997, 926 cases of possible ma huang toxicity were reported to the Food and Drug Administration. In 37 patients (23 women and 14 men with a mean +/- SD age of 43 +/- 13 years), use of ma huang was temporally related to stroke (in 16), myocardial infarction (in 10), or sudden death (in 11). Autopsies performed in 7 of the 11 patients who experienced sudden death showed a normal heart in 1, coronary atherosclerosis in 3, and cardiomyopathies in 3. In 36 of the 37 patients, use of ma huang was reported to be within the manufacturers' dosing guidelines. CONCLUSIONS: Analysis of the 37 patients indicates the following findings: (1) ma huang use is temporally related to stroke, myocardial infarction, and sudden death; (2) underlying heart or vascular disease is not a prerequisite for ma huang-related adverse events;and (3) the cardiovascular toxic effects associated with ma huang were not limited to massive doses. Although the pathogenesis of the cardiac toxic effects of ma huang remains incompletely defined, available observational and circumstantial evidence indicates that use of the substance may be associated with serious medical complications.