WEDNESDAY, Feb. 19, 2003 (HealthDayNews) -- The weight-loss aid ephedrine has been banned by the National Football League, the National Collegiate Athletic Association and the International Olympic Committee.
But now that a medical examiner in Florida has said a product containing ephedrine may have contributed to the death Monday of Baltimore Orioles pitcher Steve Bechler, experts wonder whether Major League Baseball is on deck to prohibit the substance.
"Clearly, this was an accident waiting to happen," says Dr. Gary I. Wadler, medical advisor on doping for the White House's Office of National Drug Control Policy and a member of the World Anti-Doping Agency.
Ephedrine, the active ingredient in the herb ephedra, increases metabolic rate, heat production, and the risk of heatstroke. Wire stories on Tuesday reported that the 23-year-old pitcher, who collapsed Sunday at the team's spring training camp in Ft. Lauderdale, Fla., had been taking Xenadrine, an over-the-counter drug that contains ephedra. A preliminary autopsy indicated he died of heatstroke and multiple organ failure.
"When you burn anything, you generate heat, and a normal person under normal circumstances will get rid of that heat, usually by perspiring," Wadler explains. "Obviously, something went awry in this particular player, because the heat he generated was not adequately dissipated. It kept rising, rising, rising, and eventually cooked his own organs."
On the other hand, Wadler points out, the use of ephedrine is legal in the United States. And perhaps that needs to be reviewed, he adds.
"You have to recognize [Bechler] did not violate the law of the land by taking it and he did not violate the law of baseball, so I think one has to look back at the law of the land and the law of baseball," he adds.
An official with the Major League Baseball Players Association, speaking on the condition of anonymity, told HealthDay that the union's position on ephedra is that the substance is legal and adults have the right to make a choice. Teams have trainers and doctors who can help them make informed choices, the official adds.
Last year's agreement between the union and Major League Baseball did not address ephedra use. But the union's executive director, Donald Fehr, told Congress last June that the government should take a renewed interest in looking at the labeling of substances like ephedra and steroids. The union might re-examine its position if the government did the same, Fehr said at the time.
Although products containing ephedra and ephedrine have been linked with a number of football deaths, including that of Minnesota Vikings tackle Korey Stringer in 2001, Bechler's death, one week into the Orioles' spring training season, might be the first in professional baseball.
Unlike baseball, football has a history of heatstroke, with players succumbing nearly every year, says Dr. Robert Cantu, medical director of the National Center for Catastrophic Sports Injury Research and past president of the American College of Sports Medicine.
"The reality is that football has unique problems because athletes normally come in somewhat deconditioned in the summer, they wear helmets -- which prevents perspiration from evaporating the heat off of the head -- and they are asked to do incredibly vigorous physical activities compared with baseball," Cantu says. "I suspect that's the backdrop to why football has banned substances like ephedra, which do increase one's risk of heatstroke as compared with a sport like baseball, which has never had a heatstroke death. Now that they've got one, they may take another view of it."
However, Cytodyne Technologies, the company that makes Xenadrine, says it's way too early to start pointing fingers in the case.
"I think based on the fact that a toxicology report is not yet available, and won't be available for another two to three weeks, it's certainly premature, and possibly reckless, for the medical examiner to suggest that ephedra products played any role whatsoever in the untimely death of Mr. Bechler," says Shane Freedman, general counsel for the company, which is located in Manasquan, N.J.
Freedman says that Xenadrine bears "a very comprehensive warning on the label designed to inform consumers as to the benefits and potential risk of the product."
There have been no other reports about the product "under these circumstances," Freedman adds. "I am not aware of any reports linking the use of Xenadrine to heatstroke under these circumstances."
Certainly, there were other factors that may have contributed to Bechler's death.
"This player was overweight and he was probably in poor condition," says Fred Mueller, director of the National Center for Catastrophic Sports Injury Research in Chapel Hill, N.C. "Another factor is no one knows if he was acclimatized to the heat at all. Was he working too hard for the short time he was in Florida?"
But the questions on ephedrine also remain.
The U.S. Food and Drug Administration regulates ephedrine differently than either "conventional" foods or drugs, both prescription and over-the counter. Under the terms of the Dietary Supplement Health and Education Act of 1994 (DSHEA), the manufacturer is responsible for making sure a dietary supplement is safe before putting it on the market. If something goes wrong after that point, the FDA can take action.
That doesn't impress Cantu.
"Not even a prescription is needed. You can get this over the counter," Cantu says. "I think that if something can kill you and you can buy it over the counter, maybe you shouldn't be able to."
"The whole supplement industry doesn't have to pass FDA standards," he adds. "And the problem with that is you don't really know precisely the levels of the various substances in non-regulated medication because it isn't being held to a standard."
John Hathcock, vice president for nutritional and regulatory science for the Council for Responsible Nutrition, a supplement industry group in Washington, D.C., says the industry has been petitioning the FDA to impose dosage limits and reinforce labeling.
"The government and individual companies are the ones that need to say loud and clear that label warnings should be followed. It's not an idle gesture," he says. "If the reports are correct and [Bechler] was hypertensive, he shouldn't have been taking the product at all. Why was he?"
More information
To learn more about heatstroke, visit the CDC.
Learn more about ephedrine from the Ephedra Education Council.
For more on the National Football League ban, check out NFL.com, the league's official Web site.
