JAMA meta-analysis on dangers of ephedra

mikeynov

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Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance. A meta-analysis. JAMA 2003; 289:1537-45.

My sister (a doctor) sent me a review of this, and the general implication was overwhelmingly AGAINST ephedra (which coincides with legislation against ephedra, eg in illinois and california). Browsing around medline, I can't even find much to implicate ephedra for anything non-transient. The current thrust (including of the afore mentioned article) is that ephedra promotes 'short term weight loss' but is 'extremely dangerous.' This sounds very...fishy.
 
Did she send you the actual article itself, or just a half baked review of the article?
reading over it now, its not actually poorly constructed. they have collated a large (probably all of it) proportion of the scientific data, and produced a metaanalysis of the use of ephedra for weight loss (combined loss of approximately 0.9kg over a number of months.) and also a list of odds ratios for various adverse events.
This is the list (OR calculated by comparing with placebo)
Psychiatric Symptom 3.64
Autonomic hyperactivity 3.37
Heart Palpitations 2.29
Hypertension 2.19 (not sig buthuge variations)
Upper GI symptoms 2.15
Headache 1.64 (but not sig)
Heart palpatations not reported (as there was 0 in placebo, but 6 in the ephedra group)

The whole article was just a meta-analysis that was requested by the US department of health and human services. To quote the article "the National institute of health will use this information to guide an expanded research effort to better understand the safety of ephedra alkaloids"

and the final conclusion from the analysis was
"Ephedrine and ephedra alkaloids promote modest short-term weight loss(~0.9kg/mo more than placebo) in clinical trials. There is no data regarding the long term weight loss, adn evidence to support use of ephedra for athletic performance is insufficient. The use of ephedra or ephedrine and caffeine is associated with increased psychiatric, autonomic or gastrointestinal symptoms and heart palpatations."

so, overall the report wasnt negative. But people could come to that conclusion after the matter.
 
[b said:
Quote[/b] (Aaron_F @ May 28 2003,10:42)]Did she send you the actual article itself, or just a half baked review of the article?
reading over it now, its not actually poorly constructed. they have collated a large (probably all of it) proportion of the scientific data, and produced a metaanalysis of the use of ephedra for weight loss (combined loss of approximately 0.9kg over a number of months.) and also a list of odds ratios for various adverse events.
This is the list (OR calculated by comparing with placebo)
Psychiatric Symptom 3.64
Autonomic hyperactivity 3.37
Heart Palpitations 2.29
Hypertension 2.19 (not sig but
huge variations)
half-baked review, but more insight into the specifics of the article would be appreciated :)
 
Done now, the other article in the jama issue would be more worrying.

"Fontanarosa etal. The need for regulation of dietary supplements-lessions from ephedra. Jama:289:1568-70"
 
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