Some experts who have learned about the report’s findings were surprised at the mention of ephedrine, which was banned by the Food and Drug Administration in 2004. Although ephedrine can be used for resuscitation, the doctors say that it is unlikely that emergency personnel called to Jackson’s home would have used the stimulant for that purpose.

Ephedrine is the active ingredient in the herb ephedra, which was once commonly marketed for weigh loss before the FDA ban went into effect. Ephedra, also known as ma huang, was also sometimes combined with other herbal products and marketed as “herbal Fen Phen” after the agency ordered a recall of the popular diet drug combination Fen Phen in 1997.

The FDA warned about the risk of side effects with herbal Fen Phen shortly after the Fen Phen recall was issued. In 2004, following the deaths of two high profile athletes and at least 100 other ephedra users, the FDA banned herbal Fen Phen and other products containing ephedra or ma huang.

According to the Mayo Clinic warning, consumers may face serious health risks by taking herbal supplements, especially if they are taking other medications or are about to undergo surgery. In addition to increasing the risk of life-threatening problems such as liver or kidney damage, bleeding or an irregular heartbeat, herbal supplements can interact with other drugs a patient may be taking or alter the safety of surgical procedures.

The Mayo Clinic advised patients who are taking anti-clotting drugs, heart medications, anti-seizure drugs or immunosuppressants to speak with their doctor before taking over-the-counter herbal products due to the risk of side effects. Some of the supplements sited in the Mayo Clinic warning included St. John’s wort, garlic, ginseng, ginger and S-adenosylmethionine (SAM-e).

In addition to the risk of drug interactions or surgical complications, herbal supplements have also been linked to a number of other serious side effects. In 2004, the Food and Drug Administration banned all herbal products containing ephedra (ma huang)—including some ephedra-containing supplements that were marketed as “herbal Fen Phen” in the wake of the 1997 Fen Phen recall. At least 100 deaths were linked to the use of herbal Fen Phen or other ephedra products at the time the recall was issued.

While the FDA has the power to review and monitor the safety of prescription drug products, these powers are much weaker when it comes to dietary supplements. While drugmakers must demonstrate that their products are safe before the FDA allows them on the market, supplement manufacturers do not have to subject their products to FDA pre-approval. The manufacturers are supposed to inform the FDA of safety problems which arise with these supplements and to voluntarily recall them in the event of serious safety concerns.

The FDA can only recall supplements when it receives reports of serious problems with a supplement and can prove substantial health risks. Because of this, many consumers may be injured by unsafe supplements before they are recalled. In 2004, the FDA issued a recall of herbal Fen Phen products that contained ephedra, but only after the agency had received more than 16,000 side effects reports involving ephedra products.

Travis Tygart, the head of the United States Anti-Doping Agency, which controls the drug testing of American Olympic athletes, says that the FDA’s “ineffective regulatory scheme” keeps it from having enough power to protect consumers from the health risks of dangerous supplements. “Consumers who don’t hear or read about the warning will continue to use them because it’s so hard to recall them,” Tygart says.

Ephedra, also known as ma huang, is an herbal product that was sometimes marketed to consumers as “herbal Fen Phen” after the diet drug combination was recalled in 1997. In April 2004, the Food and Drug Administration banned the sale of supplements containing ephedra, citing its increased risk of causing serious injury or death.

According to reports following his death, Belcher was taking Xenadrine RFA-1, an ephedra-based supplement, when he collapsed during team workouts with a fever of 108° and died several days later. A coroner’s report found that ephedra had played a role in Belcher’s death.

Belcher’s widow subsequently filed a $600 million ephedra lawsuit against the manufacturer of the supplement her husband was taking at the time of his death.