The death of Baltimore Orioles pitcher Steve Bechler last month, while taking the weight-loss product ephedra, sparked a heated debate regarding the role of the federal government in regulating dietary supplements. In the wake of Bechler's death, Tommy Thompson, secretary of Health and Human Services, went so far as to say that he would never use ephedra himself or recommend it to family or friends.

Now, the Food and Drug Administration has moved to impose new rules and regulations governing manufacturing practices and content labels for dietary supplements that include not only ephedra but other herbs like ginko biloba, used to boost cognition, and St. John's Wort, taken for depression. With millions of Americans consuming these supplements daily, it's a matter of "buyer beware," according to FDA Commissioner Mark McClellan.

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BOSTON Not long ago, a cancer specialist I know faced a situation that chilled those of us who care for people with terminal illness. A young woman close to death lay suffering in a hospital bed, her husband at her side. Her leukemia had defied bone marrow transplant and experimental drugs. She had begun to bleed into her lungs and was gasping for air.

Months earlier, following common practice, the oncologist had had a frank discussion about dying with the woman and her husband. The greatest terror for her, as for most other patients, was that the final days of her life might be spent in unrelenting pain. An understanding was reached among the patient, the doctor and the family that if the time came when there was no real hope of surviving and she faced only pain and debility, no extraordinary means would be taken to sustain her and sufficient doses of drugs like morphine would be administered to ease the pain, even if that meant reducing her breathing or lowering her blood pressure and thereby expediting her death.

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