Toxicology results released Thursday showed Baltimore Oriole pitcher Steve Bechler had significant amounts of ephedra in his system, leading the Broward County (Fla.) medical examiner to conclude "within a reasonable degree of medical certainty" that an over-the-counter supplement prompted Bechler's heatstroke death last month.
The results did not move baseball any closer to joining the NFL, NCAA and International Olympic Committee in banning ephedra-containing supplements.
In a memo that will be sent to players today, union chief Don Fehr stopped far short of that suggestion.
"Such dietary supplements are currently undergoing a more intensive scrutiny by the federal government, and we urge you to avoid supplements containing ephedra pending the results of that effort," Fehr wrote.
A baseball source said the commissioner's office is pushing Fehr and the players for a ban, noting that in a pamphlet distributed to players this spring doctors assigned jointly by management and the union determined ephedra products had potentially harmful effects. Union officials say they are not ready to agree to a ban if the public can still purchase ephedra products over the counter; that its plan is to improve the players' education.
After Bechler's death, baseball Commissioner Bud Selig banned ephedra use by players with minor league contracts.
Dr. Joshua Perper, the Broward County medical examiner, said athletes should avoid ephedra entirely.
"First of all, they all too often don't know if they are at risk -- those with high blood pressure shouldn't use ephedra and high blood pressure is the silent killer," Perper said.
"Second, these athletes, especially the pros, are so committed to succeed, they'll take almost anything that can help them."
Perper noted in his report that Bechler, 23, was overweight and had other health-risk factors, including mild hypertension and abnormal liver function. Bechler, who weighed about 250 pounds -- a little less than 20 pounds more than his ideal playing weight -- was on a liquid diet and wasn't yet accustomed to the warm, humid weather.
"I cannot put a number on the percentage of different factors that contributed to his death, but I do know every factor you add increases your risk and [ephedra use] increased his risk," Perper said.
Perper said ephedra restricts blood vessels in the skin, increases heartbeat and blood pressure, raises body temperature and doesn't allow body heat to normally dissipate.
Bechler collapsed on a spring training practice field Feb. 16 in Florida. He died the next day, after experiencing a 108-degree temperature and organ failure.
Bechler had the ephedra-containing weight-loss supplement Xenadrine RFA-1 in his locker and Perper said the player had the stimulants pseudoephedrine and caffeine in his system, in amounts consistent with that of three tablets of Xenadrine RFA-1. No other drugs were found, other than those used to treat Bechler at the hospital.
An attorney for Kiley Bechler, the pitcher's widow, said she will sue Cytodyne Technologies, maker of Xenadrine RFA-1.
In a conference call that followed the toxicology results, Wes Siegner, general counsel and spokesperson for the Ephedra Education Council, which is partially funded by Cytodyne, said the notion that ephedra caused Bechler's temperature to spike and damage his organs are false; that "what we're saying is the product is safe when used as directed."
Said Siegner: "This is press-driven, not scientific, and there's no clinical data. Heatstroke is a dangerous issue in sports and we're concerned people are pointing fingers at a factor [of ephedra use], but ignoring the real factors: conditioning and screening."
Siegner said the Orioles are specifically accountable for not identifying Bechler's high blood pressure and liver problems and not knowing of his ephedra use.
Beyond that, Shane Freedman, Cytodyne Technologies' chief legal officer, said, "In this case, the medical examiner rushed to judgment and his actions led to this huge frenzy regarding ephedra products."
Perper said he expected criticism of his conclusion in what has become a highly publicized and politicized case.
The Food and Drug Administration, which has said at least 100 deaths have been linked to ephedra use, is considering placing labels warning of heart attacks and strokes on ephedra products. Health and Human Services Secretary Tommy Thompson has advised the public not to use the supplements.
With a spokesman conceding, "Bechler's death clearly triggered our investigation," the House Energy and Commerce Committee sent letters to the four leading manufacturers of ephedra products on Thursday. The committee ordered Starlight International, Twinlab Corporation, EAS and Metabolife International executives to respond to a series of questions that will help determine if their ephedra supplement warning labels are sufficient or if the FDA should be given legal authority to take stronger action.
The independent Consumers Union has called on the federal government to immediately ban the sale of ephedra supplements.
"The press attention does cause me and the industry concern about a ban," Siegner said. "Still, there are many scientists who do not want these products driven off the market because of a case like this. These cases are not science. I still feel confident the FDA will do the right thing on this. They are the science agency."