Re: Ephedra/ephedrine-exacerbated psychosis and Health Canada

Issue: BCMJ, vol. 54 , No. 10 , December 2012 , Pages 493 Letters

The well-written case report on ephedra-exacerbated psychosis by Drs Bates and MacEwan [BCMJ 2012;54:465-467] provides another example of an adverse reaction to ephedra/ephedrine.

On 4 June 1997 the US Food and Drug Administration (FDA) first proposed some restrictions on the sale of dietary supplements containing ephed­rine alkaloids. This was followed by a complete ban in the US by the FDA in 2004 due to serious cardiovascular, central nervous system, and psychiatric adverse reactions, as well as deaths. After the US Supreme Court declined to hear the appeal from the manufacturer in 2007, dietary supplements containing ephedrine alkaloids were banned from the US market.

A resolution proposed by the Al­ternative Therapies and Allied Health Committee “to make the recent voluntary recall by Health Canada on certain natural health products containing ephedra/ephedrine compulsory” was passed at the 2002 BCMA Annual Meeting.

Health Canada intermittently issues stop-sale orders on dietary supplements that exceed the limits of its partial ban.[1] However, the current natural health product compliance guide on ephedra/ephedrine issued by Health Canada Natural Health Products Directorate is not more restrictive than those imposed by the US FDA 1997 proposal, some 15 years earlier.

For the health of Canadians, Health Canada should seriously consider a total ban on the sale of ephedra/ephedrine, similar to that of the US FDA, which was supported by the US Supreme Court. A total ban would prevent adverse reactions, especially in more vulnerable populations as noted by the authors. 
—H.C. George Wong, MD
Vancouver


References

1.    Wong HCG. Ephedrine: FDA and Health Canada. BCMJ 2011;53:262-263.

H.C. George Wong, MD, FRCPC. Re: Ephedra/ephedrine-exacerbated psychosis and Health Canada. BCMJ, Vol. 54, No. 10, December, 2012, Page(s) 493 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply

CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.