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In Reply: Despite the claim to the contrary by Ms Joseph and colleagues, the recently announced ban on ephedra¹ provides excellent substantiation that the current system of postmarketing regulation of dietary supplements does indeed present a "real danger" to the public. As a result of the challenging legal standard in the DSHEA, definitive actions to prohibit sales and distribution of this dangerous product were delayed more than 9 months after clear evidence of harm was available,² and while additional evidence of harm continues to accumulate.³ Products such as ephedra—like many other dietary supplements—certainly have biological activity and are marketed as such.⁴ If this agent had been regulated with at least the same degree of oversight as that used for over-the-counter drugs, some ephedra-related morbidity and mortality most likely could have been prevented.

As the letter by Joseph et al also illustrates, the perception of the degree of regulation necessary for . . . [Full Text of this Article]

Catherine D. DeAngelis, MD, MPH; Phil B. Fontanarosa, MD
JAMA
Chicago, Ill

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