Autopsy cites ephedrine, liver problem, hypertension
FORT LAUDERDALE, Fla. (AP) -- A weight-loss drug containing a stimulant probably contributed to the heatstroke death of Baltimore Orioles pitching prospect Steve Bechler, a coroner said Tuesday.
Bechler had been taking an over-the-counter supplement that contained ephedrine, which has been linked to heatstroke and heart trouble, Broward County medical examiner Dr. Joshua Perper said.
Ephedrine has been banned by the NCAA, the NFL and the International Olympic Committee, but not by major league baseball.
Perper urged baseball to ban the stimulant, and its risks -- along with warnings about hot weather -- were a topic of clubhouse conversation throughout big league training camps.
While it appears likely that the ephedrine issue will be re-examined, no one wants to make any decisions yet.
"We're going to wait until we know more about what happened," baseball spokesman Rich Levin said.
Dangerous drug?
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Union head Donald Fehr added: "I'm not going to say anything until after the funeral and the burial. It would be inappropriate."
Bechler died Monday, less than 24 hours after a spring training workout sent his temperature to 108 degrees. Preliminary autopsy findings indicated he died from complications of heatstroke that caused multi-organ failure, Perper said.
Only toxicology tests can confirm whether there was ephedrine in Bechler's system, and those results won't be available for at least two weeks, Perper said.
Among other factors cited by Perper as contributing to the 23-year-old pitcher's death:
* a history of borderline high blood pressure;
* liver abnormalities detected two years ago but not diagnosed;
* warm, humid weather during the workout when he became ill Sunday;
* he was on a diet and hadn't eaten much solid food the previous two days.
"All of those factors converged together and resulted in the fatal heatstroke," Perper said.
But Perper spent the bulk of his 30-minute news conference focusing on ephedrine, the active substance in the plant ephedra. Though common in supplements, Perper said they're too risky for athletes.
Herbal supplement linked
to health hazards
NEW YORK (AP) -- The over-the-counter stimulant ephedrine, often used to increase endurance and lose weight, is under increasing scrutiny for its possible health risks.
While the precise hazards are still unclear, a variety of reports have linked its use to heart attacks, strokes and seizures, and heatstroke.
Baltimore Orioles pitching prospect Steve Bechler died Monday of heatstroke after a spring training workout in Fort Lauderdale, Fla. His temperature reached 108.
Broward County medical examiner Dr. Joshua Perper said Tuesday that ephedra, the herbal form of ephedrine, probably contributed to Bechler's death. Bechler had been taking Xenadrine, an over-the-counter drug containing ephedra, Perper said.
When the NFL banned ephedrine, it cited concern that the stimulant could interfere with the body's ability to regulate heat. The drug also is banned by the NCAA and the International Olympic Committee, but not by Major League Baseball.
Ephedra, also known as ma huang, is considered a dietary supplement and is not regulated by the Food and Drug Administration. Because of the health issues, however, the Department of Health and Human Services hired the RAND Corp. last summer to do a comprehensive review.
The concern results, in part, from reports to the FDA of people falling ill or even dying after taking the supplements.
Two years ago, Drs. Christine Haller and Neal Benowitz of the University of California, San Francisco, reviewed 140 of these reports.
They concluded that one-third of the cases definitely or probably resulted from ephedrine, and another third possibly did. These included 10 deaths and 13 cases of permanent impairment.
The most commonly reported ill effects were heart related, including high blood pressure, palpitations and heart attacks. Strokes and seizures, especially in outwardly healthy young adults, were also apparently triggered by ephedrine.
The California doctors estimated that in 1999, about 12 million Americans used the supplements.
"I would like to hope that this very unfortunate and tragic death would prompt perhaps the baseball association and other athletic groups to ban them from their practice," he said.
Perper, who interviewed the player's family and Orioles officials, said he was told Bechler took three tablets each morning of Xenadrine RFA-1, a weight-loss drug that contains ephedrine.
Cytodyne Technologies, which makes Xenadrine, noted that the recommended dosage for the drug is two capsules twice a day.
"Physicians warn that many adverse events related to ephedra are due to people taking more than the recommended dosages," the company said in a statement. "Xenadrine has been the subject of numerous clinical trials on people, which have conclusively demonstrated that the product is safe and effective when used as directed."
A bottle of Xenadrine was found in Bechler's locker after he became ill and shown to paramedics, Perper said. The contents couldn't be analyzed because the bottle was inadvertently thrown away by someone with the team, he said.
"They figured it's not important," Perper said.
Major league teams have cautioned players in the past about the dangers of ephedrine. Medical personnel with the New York Yankees and San Francisco Giants were among those warning players anew Tuesday about the risks.
In addition, the Yankees left an article entitled, "The Effect of Heat on Athletes," on every player's locker room seat.
Orioles team physician Dr. William Goldiner said he hopes the coroner's findings trigger a baseball ban.
"This is not just a problem of major league baseball," Goldiner said. "This is a problem of over-the-counter supplements that are dangerous, and they are unregulated to the point where you don't even know what's in some of these things."
A native of Medford, Ore., Bechler was a third-round draft pick by the Orioles in 1998. He made his major league debut last September and was expected to begin this season with the club's new Class AAA affiliate in Ottawa.
Bechler and his wife, Kiley, were expecting their first child in April. She visited camp Tuesday and met with team officials but left without speaking to reporters.
The 6-foot-2 Bechler had battled a weight problem since joining the Orioles organization and weighed 249 pounds Friday, 10 pounds above his listed weight. Struggling with his conditioning, he was unable to complete running drills Saturday and was scolded by manager Mike Hargrove.
Teammate Matt Riley said Bechler later acknowledged he had failed to train properly during the offseason.
"He was really distraught," Riley said. "He was like, `I messed up. I want to change.' He wanted to change his work ethic."
The mourning Orioles resumed drills Tuesday at Fort Lauderdale Stadium, where the center field flag was at half staff, and on a cloudless day the gloom slowly began to lift during the workout.
Coach Rick Dempsey clapped his hands and shouted encouragement, and there was even an occasional joke exchanged behind the batting cage.
"We wanted to keep people busy and try to fill the day," Hargrove said. "I think it was a good decision."
For Hargrove, the challenge of resuming a routine was painfully familiar. He was manager of the Cleveland Indians 10 years ago when two of their players, Tim Crews and Steve Olin, died in a boat crash during spring training.
"Every circumstance is different," Hargrove said. "What we're having to go through is not nearly as difficult as what Kiley and the rest of the family are having to go through."
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