- The Washington Times - Wednesday, February 19, 2003

FORT LAUDERDALE, Fla. A weight-loss drug containing the stimulant ephedrine most likely contributed to the heatstroke death of Baltimore Orioles pitching prospect Steve Bechler, Broward County's chief medical examiner said yesterday.
Bechler's death was deemed multi-system organ failure due to heatstroke. Dr. Joshua Perper, the medical examiner, said a bottle of supplements taken from Bechler's locker after the incident was the medication Xenadrine RFA-1, an over-the-counter weight-loss supplement made by Cytodyne Technologies.
Xenadrine is a thermogenic drug that increases the body temperature and is designed to result in the faster burning of fat. It also contains a derivative of the herb ephedra, which has been linked to the deaths of several athletes in recent years, including that of Minnesota Vikings lineman Korey Stringer in 2001.
Perper said after consulting "reliable sources" from the Orioles, he almost certainly can determine that Bechler, 23, had taken three Xenadrine pills the normal dose on Sunday. The Washington Times first reported Bechler had taken ephedrine recently before he became ill at about 11:30 Sunday morning and that a bottle of supplements was taken from Bechler's locker. Also, as reported in The Times on Monday, the bottle of supplements, after it was shown to paramedics, was indeed thrown in the clubhouse trash and later recovered. The same bottle was provided to the medical examiner, Orioles officials said yesterday.
Perper will not be able to conclude absolutely whether Bechler, a minor league pitcher who was not expected to make the Orioles' roster this spring, had taken an ephedra-based product on the day of his death until toxicology tests are returned with the final results of the autopsy in two to three weeks.
After performing the autopsy, Perper also stated a list of other known factors that he believes contributed to Bechler's death. Among them:
Borderline hypertension. Perper said Bechler had a history of consistently high blood pressure that was detected but left untreated when he underwent his physical examination at the spring training complex Friday. Bechler had a blood pressure of 140 or 145 over 95, slightly above normal, Perper said.
Poor diet. Perper said he concluded Bechler was on some type of diet, because he had very little solid food in his digestive tract.
Liver abnormality. Perper said tests in the last couple years indicated that Bechler had an unspecified liver abnormality. However, Perper didn't think there was a final diagnosis made, that "there were some theories but nothing really final."
Other factors, in some capacity, included Bechler experiencing a sudden change in climate, coming to sunny and humid South Florida from wintry Laurel, where he spent his offseason.
However, as Perper said, the key factor in Bechler's death could have been the presence of ephedrine in his system.
"It's our opinion that all those factors converged together and resulted in the fatal heatstroke," Perper said. "And the [Xenadrine] label says very clearly that individuals who have heart problems, hypertension or liver problems should not take this kind of medication or should be very careful in taking it."
According to the Web site of Cytodyne Technologies, Xenadrine RFA-1 is the "#1 diet supplement in America" and "is the one diet supplement clinically proven to dramatically increase the rate of fat-loss significantly more than diet and exercise alone."
Perper said that during Bechler's physical Friday, the pitcher weighed 249 pounds, or 10 pounds more than his listed weight last season. According to numerous accounts, Bechler did not work out often in the Orioles training program this offseason in Baltimore and had struggled to control his weight throughout his minor league career.
According to Perper the derivative ephedrine, but not the herb ephedra, is banned by the Food and Drug Administration from being in weight-loss medications. The difference is essentially a technicality, but Perper said the FDA has taken no action toward banning ephedra. Ephedrine is banned by the NFL, NCAA and International Olympic Committee but not by Major League Baseball.
Perper said as far as he can tell, Bechler's situation was handled properly by the Orioles. Bechler became ill at approximately 11:30 Sunday morning, was transported to the clubhouse less than five minutes later and emergency medical staff arrived at Fort Lauderdale Stadium before noon. Bechler was carried on a stretcher to an ambulance at about 12:10p.m. and transported to North Ridge Medical Center.
"I cannot point to any medical mistakes," Perper said. "They responded promptly to his collapse, they tried to cool him as much as they could … and they immediately called the 911, so I think from this point, they responded fast.
"I have not reviewed the hospital notes yet in sufficient depth, but I saw nothing there which was improper. Unfortunately, this was a situation in which he came in with a very high fever of 106, then he was unconscious and his condition deteriorated very fast and he died, unfortunately, very rapidly."
Given the likelihood that Bechler had taken Xenadrine on the day of his death and it contributed to heatstroke, Perper echoed what Orioles team physician William Goldiner had said on Monday: He would like to see ephedra banned by Major League Baseball and sees no reason it should be available over the counter to the public.
"Some people are not aware of their own risk factors, and others take [ephedrine products] in spite of them," Perper said. "And athletes who involve themselves with strenuous activity, and especially when they combine this with their diet and the drug, really put themselves at significant risk. And that's the reason why not only the Olympic commission, but the [American Medical Association] and a host of athletic organizations have said 'no.'"

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