To most Americans, ephedra was just another mysterious herb with dubious health benefits -- sold to athletes from the shelves of health-food stores under names such as "Ripped Fuel" and to truck drivers in small packets late at night at convenience-store counters -- until high-profile football players began to die.
Florida State linebacker Devaughan Darling died of a heart attack, Minnesota Vikings offensive lineman Korey Stringer died of heatstroke, Northwestern University safety Rashidi Wheeler of exercise-induced asthma -- all in 2001.
However, while all had been using ephedra, none of their deaths was traced directly to it. The NFL and NCAA moved quickly to ban ephedra, but it remained on shelves and counters nationwide.
It took the death of a baseball player, Baltimore Orioles pitcher Steve Bechler, on a cool February morning last spring to thrust ephedra deep into the public consciousness -- a process that concluded yesterday with the Bush administration announcing a federal ban on the controversial stimulant.
"I believe that this very unfortunate death of Mr. Bechler had some kind of an echo," said Joshua Perper, the Broward County (Fla.) medical examiner. "This was not the first incident that pointed to the danger of providing over-the-counter access to this drug. But I think it brought it into focus."
Within days of Bechler's death at age 23, Perper singled out ephedra as contributing to his death -- and Perper took the additional, and perhaps peculiar, step of pleading for a ban on the substance.
"I think Steve's unfortunate death," said Orioles physician William Goldiner, "was far and away the catalyst for pushing this forward. And the real reason Steve's death was such a catalyst was because of Dr. Perper. The difference between Steve's case and the others is that you had a medical examiner with the courage to speak up."
Within weeks of Bechler's death, momentum was building in Congress and the FDA toward a federal ban on ephedra. During congressional hearings on ephedra in July, Bechler's parents, Ernie and Pat Bechler, spoke, telling the nation, "Don't let my son die in vain."
"I think the attention was on him because he was an up-and-coming young pitcher," Pat Bechler said yesterday. "If it wasn't for who he was, no one would have noticed. . . . This [federal ban] happened quite fast compared to what we thought it would be. We thought it would be state to state. But to have the federal government ban ephedra is very good news."
However, it is unclear to what extent the deaths of Stringer, Wheeler, Darling and Bechler hastened the federal government's ban on ephedra. The FDA had been pushing for restrictions on its use as far back as 1997, and at yesterday's announcement Health and Human Services Secretary Tommy Thompson made only general references to the dangers of athletes using the supplements.
But undoubtedly the athletes' deaths, especially Bechler's, drew massive public attention to the issue of ephedra use. And nothing speeds the political process like massive public attention.
Orioles Vice President of Baseball Operations Mike Flanagan remembers telling Kiley Bechler, Steve Bechler's widow, after her husband's death that there would be a "silver lining" to the ordeal.
"She agreed that if it led to the banning of ephedra, then [Steve's death] would not have been in vain," Flanagan said yesterday. "I think this news is terrific."
Kiley Bechler declined a request for an interview, citing the advice of her lawyer. However, the lawyer, David J. Meiselman, said in a statement: "We are pleased but not surprised that ephedra has become the first supplement ever to be banned by the federal government. The scientific evidence is so overwhelming and yet the ephedra cartel still refuses to accept responsibility. Now we must go after the pushers of these products that poison and kill us."
In July, Kiley Bechler filed a $600 million wrongful death suit against the manufacturers and marketers of Xenadrine-RFA1, which Steve Bechler was using when he died February 17 in Fort Lauderdale, Fla., a day after collapsing during the Orioles' morning workout.
In December, the manufacturer, Nutraquest Inc. (previously known as Cytodyne Technologies), filed a motion in U.S. District court in Miami seeking to bring the Orioles into the suit as a third-party defendant.
A spokesman for Nutraquest did not return telephone messages yesterday. However, at yesterday's announcement, FDA Commissioner Mark B. McClellan said the government is anticipating legal challenges to the ban.
While Kiley Bechler sued the manufacturer but not the Orioles, the families of Stringer and Wheeler have taken the opposite approach. Stringer's widow, Kelci, has a lawsuit pending against the NFL; Wheeler's mother has an ongoing suit against Northwestern University, but she dropped her claims against the manufacturers of the supplements her son was using at the time of his death.
Among the major sports governing bodies, Major League Baseball remains the most notable without a ban on ephedra, despite the attention brought on by Bechler's death. Yesterday's news is unlikely to hasten a change in baseball's drug policy, according to industry sources, since any drug testing must be bargained with the players' association.
Commissioner of Baseball Bud Selig did not return a telephone message yesterday.
In the midst of the public outcry from Bechler's death, the Major League Baseball Players' Association resisted a ban on ephedra as long as it could be purchased legally over the counter by all citizens. However, Donald Fehr, executive director of the players' association, in a letter sent to all players last spring, also took the step of advising players not to take the supplement.
"We've gone out of our way to encourage both Congress and the FDA to take a long look at this and to make whatever judgments they felt were appropriate," he said. "If the government feels there is a serious health and safety issue, then this action is something everyone should welcome."
The NFL, in contrast, was concerned about ephedra even before the death of Stringer in August 2001. In December 2000, John Lombardo, the league's steroid adviser, sent a health bulletin to players informing them of the dangers associated with ephedra. It said: "If you are using any products containing ephedra, I strongly urge you to stop immediately. If you are unsure, contact your team doctor, trainer or nutritionist."
On Sept 27, 2001, the NFL announced that ephedra would be added to the league's list of banned substances, and in July 2002 the league began testing and disciplining for ephedra use under the league's steroid and banned substance procedures.
The announcement of the federal ban on ephedra came more than three years after the NFL first warned players of its risk, and the league praised the government's action.
"Our office and the NFL Players Association have consistently taken the position that ephedra is a dangerous stimulant and that more federal regulation is needed in this area," Harold Henderson, the NFL's executive vice president of labor relations, said in a statement. "The FDA's announcement today is a very positive step toward protecting the health of all athletes and the general public."
Staff writer Len Shapiro and staff researcher Julie Tate contributed to this report.