Stimulant Response

Yesterday Broward County, Florida, Medical Examiner Joshua Perper released a toxicology report showing that Baltimore Orioles pitcher Steve Bechler had "significant amounts of ephedrine" in his system when he collapsed and died of heatstroke in February. Bechler had been taking a dietary supplement containing the herbal stimulant ephedra, which the Food and Drug Administration has indicated it may ban for safety reasons.

"It is my professional opinion that the toxicity of ephedra played a significant role in the death of Mr. Bechler," Perper said, "although it's impossible to define mathematically the contribution of each one of the factors in his unfortunate death due to heatstroke."

Here are some of the other factors: Bechler was overweight, had high blood pressure and abnormal liver function, and was excerising hard in hot, humid Florida weather to which he was not acclimated. "I am not saying [ephedra] was the triggering factor," Pepper said, "because I cannot identify the triggering factor. You have here a constellation of factors working together."

But if ephedra was not the "triggering factor," Bechler would still be dead even if he hadn't consumed the herbal stimulant. And even if ephedra played a role in his death, this is not the sort of case from which you can judge its safety in ordinary use. On that question, the governmment's numbers indicate that ephedra is safer than over-the-counter drugs such as Benadryl, Tylenol, and aspirin.

Yet Perper insists ephedra should be available only by prescription. Could that position have influenced his judgment about Bechler's death?