NEW YORK -- Arielle Newman was a high school track star who suffered from the typical aches and pains that result from a grueling training regimen. To soothe the aches, she covered her legs with large amounts of muscle cream.
The 17-year-old girl suddenly died on April 3, and authorities now say the sports creams caused her death.
The New York City medical examiner's office ruled last week that Newman accidentally overdosed on methyl salicylate, the wintergreen-scented ingredient found in liniments like BenGay, Icy Hot and Tiger Balm.
Following Newman's death, experts said such products should be labeled more clearly to warn consumers of potential risks. They say the clearer warnings are especially necessary given the fact that muscle creams have become such a staple in locker rooms around the country.
"There has to be a heightened awareness that these products are something that needs to be used under medical supervision," said Dr. Gerard Varlotta, director of sports rehabilitation at the Rusk Institute of Rehabilitation Medicine at New York University Medical Center.
Experts say they have never heard of a death resulting from the application of muscle cream, although no clear documentation on the subject exists. The death of Newman, a cross-country runner from Notre Dame Academy on Staten Island, was the first recorded death in New York City to be attributed to products containing methyl salicylate.
Ellen Borakove, a spokeswoman for the medical examiner, said that Newman put the muscle cream on her legs between track meets and also used adhesive pads containing the anti-inflammatory, plus an unspecified third product.
"There were multiple products, used to great excess, and that's how she ended up with high levels," Borakove said. The products were used and the chemical absorbed over time, rather than from a single instance of overuse, she said.
But health authorities said the products, whose active ingredient is the same thing that's in aspirin, carry risks that should be taken seriously.
"Everywhere you go in every training room, you see these containers of Icy Hot," Varlotta said. "Any type of cream that has an anti-inflammatory product in it does get into the system and can cause problems."
Johnson & Johnson, the maker of BenGay, expressed sympathy to the Newman family and said in a statement that the product "is safe and effective when used as directed to provide relief from minor arthritis pain, sore, aching and strained muscles and backaches."
Chattem Inc., the maker of Icy Hot, did not immediately return a call seeking comment.
The labels on both products say to stop using them if "condition worsens or symptoms persist for more than 7 days."
The labels also say to keep the products out of the reach of children.
"It's on my one-swallow-to-kill list for kids," said Dr. Thomas Kearney, who directs a poison control center and is a professor of pharmacy at the University of California at San Francisco.
Kearney said topical application of methyl salicylate can be hazardous as well, if it is smeared over 40 percent of the body or if someone has a skin condition or is taking another medication that interacted negatively with the products.
Varlotta said some consumers, including those with asthma, may have a sensitivity to aspirin, and he said the labels on BenGay and Icy Hot should spell out the fact that they contain aspirin.
"There are warnings but I don't think they're strong enough. I don't think they're direct enough," he said. "There's nothing here that says 'contains an aspirin product."'
He said the U.S. Food and Drug Administration should mandate clearer warning labels.
Kimberley Rawlings, a spokeswoman for the FDA, said the agency is aware of Newman's death. "We are looking into it," she said. She would not say whether the labeling requirements for methyl salicylate products might be changed.
Methyl salicylate is not the only common pain reliever that can be dangerous if used improperly.
Accidental poisonings from acetaminophen, best known by the Tylenol brand, are the nation's leading cause of acute liver failure.
Rebecca Burkholder, vice president for health policy at the National Consumers League, said a major problem is that people don't read warning labels on over-the-counter drugs.
A 2002 Harris survey the group commissioned found that 44 percent of adults admitted to exceeding the recommended dosage of pain relievers and just 16 percent said they read the entire label.
"People are thinking if it's on the shelf at their local drugstore that it's harmless," Burkholder said. "And they're going to take as much as they need to make the pain go away."
(Copyright 2007 by The Associated Press. All Rights Reserved.)
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