Long before Baltimore Orioles pitcher Steve Bechler collapsed from heatstroke and died, the dietary supplement found in his locker had been linked to at least 54 deaths and about 1,000 medical problems ranging from insomnia to severe heart arrhythmia, seizures and stroke.
Ephedra, a Chinese folk remedy used for thousands of years to treat asthma, first surged in popularity in the United States as a stimulant known to college students as "legal speed," then moved into mainstream America as a workout enhancer and weight loss aid.
Last night Orioles players, staff and families attended a memorial service for Bechler in the Orioles' clubhouse at Fort Lauderdale Stadium, a service that came a day after Broward County Medical Examiner Joshua Perper told reporters that Xenadrine RFA-1, an ephedra supplement found in Bechler's locker at the Orioles' spring training complex, may have contributed to his death.
Definitive information on whether there was ephedra in Bechler's bloodstream will take weeks, and yesterday the New Jersey-based supplement company Cytodyne Technologies, makers of Xenadrine RFA-1, criticized Perper's remarks as "premature, bordering on reckless."
"At this point, it is sheer speculation as to whether Mr. Bechler ever even used Xenadrine," General Counsel Shane Freedman said in an interview. He said seven company-funded studies have demonstrated that Xenadrine is "safe and effective" when used as directed.
Whatever happens in the Bechler case, however, it is clear that the ephedra industry, despite carefully cultivated political support and millions of consumer adherents across the country, is under fire as never before after several high-profile public relations disasters in recent years.
Cytodyne is a defendant in a lawsuit filed by Northwestern University following the death of football player Rashidi Wheeler during summer workouts in 2001.
The NFL banned ephedra products after Minnesota Vikings offensive lineman Korey Stringer collapsed in camp and died of heatstroke in 2001. Stringer had used an ephedra product, although an autopsy found no traces of it in his system.
The Army and Air Force also banned the sale of ephedra products on bases last year, following similar action taken by the Marine Corps in 2001. The NCAA, the U.S. Olympic Committee and the International Olympic Committee banned ephedra long ago as a performance-enhancing drug.
"The unfortunate thing is that it usually takes an incident like this for the issue to be brought up," said Orioles pitcher Rick Helling, a member of the Major League Players Association's executive sub-committee.
Helling said Bechler's death was likely to make the union take a long look at the NFL's and NCAA's policies. Baseball instituted its first drug-testing program for illegal steroids this season, but players are only tested at prescribed times and the results carry no threat of punishment.
"I think things are starting to turn around because of the groundswell from the media and the general public," said Oakland lawyer Christopher Grell, who is active in an informal organization of attorneys known as the Ephedra Litigation Group. "Just because this stuff is being promoted as all-natural doesn't mean it's safe. People are starting to change their attitudes."
The supplement industry has lost or settled a large number of lawsuits in recent years, including one jury verdict that awarded $13.3 million to an Alaska woman who had a debilitating stroke while taking ephedra products.
"That one's the 100-pound gorilla," said John Hathcock, a vice president for the Council on Responsible Nutrition, an industry organization. "There is substantial difficulty getting product liability insurance, and if you can't get it, you have to rethink the business."
Bruce Silverglade, director of legal affairs for the Center for Science in the Public Interest, a longtime opponent of ephedra, said several companies have stopped selling ephedra, but it won't disappear altogether until the Food and Drug Administration takes action.
The FDA and the supplement industry have fought a prolonged battle over ephedra since passage of the 1994 Dietary Supplement Health and Education Act, which allows companies to market supplements without pre-screening -- like vitamins or chewing gum.
Last June, responding in part to the fallout from the Stringer and Wheeler cases, the Bush administration ordered the Rand Corp. to review the literature on the safety and effectiveness of ephedra and make recommendations -- a move decried as a stall by ephedra opponents. Results of the study are due next month.
"You don't need another study," said drug safety specialist and ephedra opponent Raymond L. Woosley, vice president for health sciences at the University of Arizona. "Stop this game, and call these ephedra products what they are -- drugs without any proven value that kill people."
FDA Commissioner Mark McClellan said the agency is monitoring the Bechler case, and when the Rand study is completed, "you can expect some prompt action." He did not rule out banning ephedra.
Known in China as Ma Huang, ephedra was used in the United States in the 1960s as an asthma remedy, but in the early 1990s mail-order companies began marketing it to young people as a legal "high." Ephedra, and its synthetic equivalent ephedrine, are stimulants and close cousins of the illegal drug methamphetamine.
For the last 10 years, ephedra accelerated in popularity, winning mainstream acceptance as a weight-loss supplement and as a workout enhancer. But while the FDA gathered reports about serious problems and deaths associated with it, the companies successfully resisted all attempts at regulation. The industry is a generous contributor to political campaigns and counts powerful friends in Congress.
Late in 2000, the New England Journal of Medicine published a paper implicating ephedra in 54 deaths and around 1,000 serious illnesses. Next came the deaths of Stringer, Wheeler and Florida State football player Devaughan Darling, who collapsed with a seizure after taking ephedra supplements.
Yesterday, Rep. Henry A. Waxman (D-Calif.), a critic of dietary supplements, sent a letter to Major League Baseball Commissioner Bud Selig urging baseball to stiffen its policies: "Baseball needs to face up to the dangers of ephedra immediately."
Shipley reported from Fort Lauderdale, Fla. Staff writer Dave Sheinin contributed from Fort Lauderdale.