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No drug is without risks

Here’s a tragic story:

NEW YORK – A medical examiner blamed a 17-year-old track star’s death on the use of too much muscle cream, the kind used to soothe aching legs after exercise.

Arielle Newman, a cross-country runner at Notre Dame Academy on Staten Island, died after her body absorbed high levels of methyl salicylate, an anti-inflammatory found in sports creams such as Bengay and Icy Hot, the New York City medical examiner said Friday.

The medical examiner’s spokeswoman, Ellen Borakove, said the teen used “topical medication to excess.” She said it was the first time that her office had reported a death from using a sports cream.

Newman, who garnered numerous track awards, died April 13. She had gone to a party the night before, then returned home and spent hours talking with her mother.

This is, of course, highly unusual. When Arielle died two months ago while other reports mentioned two boys accosting her in a park, the cause seemed a mystery and speculation was that she had been drinking too much. It turns out that that wasn’t the case. However, chronic use has been associated with problems:

Methyl salicylate poisoning is unusual, and deaths from high levels of the chemical are rare.

“Chronic use is more dangerous than one-time use,” Edward Arsura, chairman of medicine at Richmond University Medical Center, told the Staten Island Advance on Friday. “Exercise and heat can accentuate absorption.”

Dr. Ronald Grelsamer, of Mount Sinai Medical Center, said Newman had a very abnormal amount of methyl salicylate in her body.

“She either lathered herself with it, or used way too much, or she used a normal amount and an abnormal percentage was absorbed into her body,” he said.

Newman’s mother expressed the sentiment that most people probably would have:

Her mother, Alice Newman, said she still couldn’t believe her daughter’s death was caused by a sports cream.

“I am scrupulous about my children’s health,” she told the Advance. “I did not think an over-the-counter product could be unsafe.”

It’s important to remember that the dose makes the poison. It is not described how large Arielle Newman was, but if she were a relatively small, light girl it would take less of any substance to result in poisoning. Also, although these days it is usually chemically synthesized rather than being distilled from plant oils, it’s important to note that methyl salicylate is a natural product, sometimes known as oil of wintergreen after the type of plant from which it has been traditionally isolated. Moreover, methyl salicylate is the most toxic of the salicylates, with doses of less than 1 teaspoon having been fatal in young children. Presumably, Arielle must have slathered quite a bit of the stuff on herself to absorb a fatal dose. It’s also been speculated that using the sports creams on skin warm and moist from heavy workouts could have led to her absorbing more methyl salicylate.

However this happened, it should stand as a sobering reminder that any chemical substance, be it a natural product or a drug, that has a physiologic effect has the potential to cause harm.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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