The Breeders’ Cup Forum: Lasix – A Racetrack Practitioner’s Perspective

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Dr. Don Shields has been a Southern California racetrack practitioner for more than 25 years since his graduation from the University of California-Davis School of Veterinary Medicine in 1987.

While he has specialty training in diagnostic ultrasound and has performed numerous stem-cell and platelet rich plasma treatments to injured tendons and ligaments of horse, Dr. Shields is a staunch advocate for the use of furosemide, or Lasix, to treat exercise-induced pulmonary hemorrhage in horses.

He provided the following answers via email to questions on EIPH and methods to control it.

From your perspective as a racetrack equine practitioner, why do you think furosemide is the best way to treat exercise-induced pulmonary hemorrhage?
As with all professional sports, horse racing is a very strenuous activity.  Exercise induced pulmonary hemorrhage (EIPH), or bleeding, is a common occurrence caused by the stresses encountered by our magnificent equine athletes during training and racing.  Furosemide is currently the only medication which has been scientifically proven to decrease both the incidence and severity of EIPH.  This beneficial effect of furosemide was clearly demonstrated in the landmark 2009 study by Drs. Hinchcliff, Morley and Guthrie.

While rest may allow the damaged lung time to heal the acute injury caused during EIPH, it has never been demonstrated to prevent future episodes of EIPH.

There are a number of adjunct medications that have been utilized in conjunction with furosemide in an attempt to further reduce EIPH.  These adjuncts include medications such as conjugated estrogens, aminocaproic acid, tranexamic acid and carbazochrome.  While numerous trainers and veterinarians believe they have seen a clinical effect with some of these adjuncts, none of these medications has yet been scientifically proven to be efficacious at decreasing EIPH.  This fact does not mean these medications do not work.  It must be noted that no adjunct medication has ever been tested in the same manner and utilizing the same study design that was employed by Drs. Hinchcliff, Morley and Guthrie, which clearly proved the efficacy of furosemide.

Hypothetically, if furosemide is banned on race-day, what would the possible results be?
We do not need to guess at what the possible impact to our equine athletes might be.  The study by Drs. Hinchcliff, Morley and Guthrie clearly demonstrates that more horses will bleed more severely without the administration of furosemide.  In this study, twice as many horses did not bleed at all when they were treated with furosemide.  There were also no EIPH grades of 3 or 4 “bad bleeders” when horses were treated with furosemide; however, without furosemide bad bleeding (grades 3 & 4) occurred in about 12% of the horses.

Here is a chart demonstrating the grades of EIPH encountered during this study when horses raced with and without furosemide.  The same 152 horses were examined endoscopically after racing once with furosemide and once without the administration of furosemide.  The study is available online.

EIPH in furosemide treated horses    EIPH in non-treated horses

GRADE    Horses    %         GRADE    Horses    %

Grade 0    65        43        Grade 0    32        21
Grade 1    75        49        Grade 1    67        44
Grade 2    12          8        Grade 2    35        23
Grade 3      0          0        Grade 3    16        11
Grade 4      0          0        Grade 4      2          1

Studies have demonstrated that approximately 60% of the sudden deaths during racing have been attributed to pulmonary hemorrhage, EIPH grades of 2 or more have been shown to adversely affect racing performance, and EIPH is believed to adversely affect the overall health of racehorses.  We know that EIPH is pathology, an injury to the lung of the horse, and that this injury causes further lung pathology.  In his presentation to the participants at the International Summit on Race Day Medications, Dr. Robinson discussed the pathology caused by EIPH including interstitial fibrosis, septal wall thickening, venous wall remodeling and the infiltration of new blood vessels into the lung tissue.  Studies have also shown that horses with EIPH have more severe exercise-induced hypoxemia (an inadequate level of oxygen in the blood) as compared to normal horses, suggesting that horses with EIPH have impaired lung function.

The administration of furosemide greatly reduces both the incidence and severity of significant bleeding.  Significant bleeding is considered to occur with EIPH of grades of 2, 3 or 4 because these grades of EIPH negatively affect performance.  Grade 1 EIPH has not been shown to have any negative effect on performance.

Do you have any estimates on the percentage of horses you endoscopically examine post-race (treated with furosemide) that show some signs of EIPH?
Lung function seems to be minimally affected or unaffected by small quantities of blood; however, quantities of blood above this low level negatively affect both lung function and racing performance as well as create lung pathology.  It is far more accurate to discuss the levels of bleeding, the actual severity or grades of EIPH found post-race, rather than chatting about whether horses show some signs of EIPH.  The fact that some signs of EIPH may still be evident in a large percentage of the horses treated with furosemide is meaningless without discussing the actual grades of the EIPH detected.

As is stated above, grade 1 EIPH has not been demonstrated to impact performance; however, EIPH of grades 2, 3 and 4 have been proven to negatively impact performance.  Thus it is more important and accurate to discuss significant bleeding (EIPH grades 2 – 4) rather than any and all signs of EIPH no matter how miniscule.  Using the data from the study, it is apparent that 53 of the 152 (35%) horses racing without furosemide bled significantly – a grade 2, 3 or 4.  However, only 12 of the 152 (8%) horses bled a grade 2 when furosemide was administered prior to racing (there were NO grade 3 or 4 bad bleeders following furosemide treatment).

One single dose of furosemide reduced significant, race-affecting EIPH by 77%!  This single administration of furosemide also doubled the number of horses that demonstrated no bleeding whatsoever from 32 of 152 horses (21%) without furosemide to 65 (43%) with it.

If we simply looked at any signs of post-race EIPH (grades 1 – 4), the study showed that 79% of horses racing without furosemide had evidence of EIPH and yet with furosemide 57% still had some evidence of EIPH.  However, of that 57% that were treated with furosemide and still demonstrated some signs of EIPH, 86% of these bled a grade 1 and thus were likely unaffected by this low level of bleeding.  This is why we need to be clear about what we are discussing and should focus on the grades of EIPH that have been shown to injure our equine athletes and affect their performance.

Have you found any difference in the percentage of Thoroughbreds that exhibit EIPH among top-class stakes horses and lower-level claiming horses?
I currently do not have enough of these top-class horses in my practice to provide statistics on this issue.  If these class horses are worked and raced less often, their lungs may be less affected by previous bleeding episodes.  Many other variables may also affect this statistic.  The general veterinary care for these horses may be better, works may be longer but at a slower speed, furosemide may have been utilized preventatively more often, etc.  Comparisons like these must take numerous variables into account to provide valid results.

In Europe and elsewhere, horses may train on furosemide but there is a withdrawal time and it is not permitted on race-day. Do you think that would work in the United States?
There are those who state that furosemide enhances performance, while others state that no amount of furosemide will allow a horse to run above its capabilities.  It has been my experience that people training on furosemide are not trying to enhance the performance of their horse during a workout.  Furosemide is being utilized because it has been proven to decrease both the incidence and severity of EIPH and thus to decrease or prevent injury to the lungs of the training horses.  I must assume this fact is why horses may train on furosemide elsewhere.

If furosemide is medically beneficial to a horse during training, is it not just as medically beneficial during racing?  Why is it morally, ethically and medically justifiable to allow injury to occur to our magnificent equine athletes when we know how to significantly lessen or prevent that injury?  Millions of Americans take blood pressure medications daily and millions more take low-dose aspirin tablets to lessen or prevent the occurrence of numerous health issues including heart attacks and strokes.  Medically speaking, it is far better to prevent injury and pathology than to try to heal it.  We know how to greatly reduce the incidence and severity of EIPH and the attendant injury it causes.  I believe it is unconscionable to allow injury to increase in incidence and severity when we know how to prevent this from happening.

It must also be acknowledged that diagnosing the incidence or severity of EIPH by looking for blood at the nostrils (epistaxis) is malpractice.  The incidence of blood at the nostrils post-race has been published and is generally considered to be less than 1% of the racing population.  As you would expect, the vast majority of horses suffering EIPH that results in epistaxis have bled badly (EIPH grades 3 or 4).  According to the study above, roughly 12% of horses racing without furosemide will bleed badly (a grade 3 or 4).  That means that looking for epistaxis to determine if a horse bled badly detects only 8% of the horses that actually did bleed badly, and yet this is often how regulatory sanctions are dispensed.  Looking for epistaxis is simply an unfair way to dispense mandated rest and is never a medically sound way to diagnose the incidence or severity of EIPH.

As far as the betting public is concerned, working horses on furosemide and then racing without it may be providing very misleading information.  If the study statistics hold, only 8% of horses racing on furosemide will suffer performance-affecting EIPH (grades 2 – 4) while 35% will race off-form due to significant EIPH when racing without furosemide.  Which horses will bleed significantly and suffer form reversals in a particular race is anyone’s guess, but referencing data from works with furosemide will further confuse the issue when racing without it.

Has your practice evolved philosophically regarding furosemide (i.e., initially prescribing furosemide to horses that scoped with some signs of EIPH in training, evolving to using it as a preventative medicine)? If so, why?
I have always believed that furosemide should be employed preventatively.  We know that the vast majority of horses will suffer EIPH to some degree during their careers.  In fact, the prevalence of EIPH in Thoroughbred and Standardbred racehorses approaches 80 – 100%.  Although evidence of EIPH is not present following every race, when horses are scoped successively following several races, most have evidence of some level of pulmonary hemorrhage.  We simply do not know which horses will bleed or how badly they’ll bleed during any given race.

I firmly believe that it is medically sound and ethically preferable to lessen or prevent the injury to the horse’s lungs caused by EIPH by administering furosemide.

What do you think may be the biggest misperception about furosemide?
Perhaps the biggest misconception is what continues to drive this entire issue.  Is there really a medical question that still needs to be answered?  I have spent quite some time providing you and your readers with scientific facts and medical knowledge regarding furosemide usage.  What I have provided are exactly that, facts.  The debate over whether furosemide greatly lessens the incidence and severity of EIPH and the attendant lung injury it causes has been settled.  We have proof that furosemide works and works very well…and yet the controversy continues.

By administering furosemide to working and racing equine athletes we are lessening or preventing injury to their lungs.  Is there a moral, ethical or medical debate over whether lessening or preventing injury to our equine athletes is the right thing to do?  Can horses work and race without furosemide?  Of course they can, they’ll just suffer more injury and pathology than they would have if furosemide had been administered.  People certainly can also stop taking low-dose aspirin and their blood pressure medications.  The result in humans will also be an increase in injury and pathology.  The utilization of therapeutic medications in a preventative fashion is intended to lessen or prevent injury and pathology.  The pre-work/race administration of furosemide does exactly this by decreasing the incidence and severity of EIPH.

According to the study, horses racing without furosemide are likely to suffer performance-affecting EIPH roughly 35% of the time.  Providing data from workouts utilizing furosemide while preventing its administration for racing should certainly further increase the number of horses racing off-form during any particular race.  Thus furosemide administration is not only in the best interest of the horse as concerns its health, but its use also provides a consistency to the data provided to the betting public.

So if the medical questions of the efficacy of furosemide as well as its use in preventing or decreasing injuries sustained by our equine athletes have been definitively answered, then what is this controversy about?  Perhaps it all boils down to money?  There are those who believe that European and other world buyers will pay significantly higher prices for our horses if they are not running on furosemide.  Is it moral, ethical, medically sound or even a good business practice to trade increased pulmonary injury and pathology to the lungs of our racehorses for the imagined increased profits to be reaped in the sales ring?

We certainly can race without furosemide, as long as we don’t mind mandating an increase in the injury and pathology to be suffered by our equine athletes.  For the record, I do mind and don’t believe this course of action would be in the best interest of the horse.

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  • Tveazey

    thanks for the info.  The horses health is and should be our main concern.  If furosemide can prevent lung damage, bleeding out and possibly death, then please put the horse and it’s health first and foremost .

  • mike

    What will anti-lasix loon Barry Irwin say?

    • Donna B.

      Irwin is not “anti-lasix”, he’s only committed to not using it on their two-year-olds.  Some of his older horses actually race on Lasix and, in fact, at 2012 Keeneland Fall meet Team Valor ran a horse, off of a long layoff, racing for the first time in the United States ON Lasix.

  • Bob Lunny

    The largest majority of race horses are cheap claimers. Its safe to say 90%+ run with anti-bleeding medication. If they were not allowed to run on this medication a large majority would retire from horse racing, thus reducing the number of horses available to run, especially at small race tracks. Those tracks, small stables & owners would than have to leave the industry. The worse is these horses would be released and hopefully end up on some rescue farm which would be strained beyound their ability to house these horses. The only solution would then be to ship them to Mexico to be slaughtered for food.

    • http://twitter.com/Cangamble Cangamble

       I believe that there might be some horses who won’t be able to run, but by getting rid of the drug culture in the backstretch, horses that don’t bleed will be able to race more, just like they did in the 60′s and 70′s. The reality is that field size would probably go up.  Lasix and other drugs drain horses more than anything that was used legally and ahem illegally in the 60′s and 70′s. 

      • Takethat

        Indeed. Look at what happened in NY. The whole reasoning behind the use of Lasix was utterly bogus.

        “The original rigid scopes gave way to flexible endoscopes in the early 1980’s. Once minute amounts of blood could be detected, trainers could argue that their horse deserved to race on Lasix. Nowadays, every jurisdiction affords Lasix, no proof required.
        New York held out until September 1995. Fearful of losing horses, it made a business decision to legalize it. Ted Hill, formerly the chief veterinarian for the New York Racing Association and now a steward at NYRA, had collected data on the number of bleeders from 1976 until its introduction. The highest number of visual bleeders in one year was 70, or 0.3 percent of starters, and the low was 24, less than 0.1 percent. Since Lasix was introduced on raceday in New York, the range has gone from 5 to 18.
        Lasix made a significant difference by reducing the number of horses observed bleeding on the track. But there weren’t many to begin with, Hill said”
        “Personally, I was never convinced it was really something we needed,” he said. “Of course, the fiber-optic endoscope changed how we diagnosed EIPH, and the rest is history.”

        Lasix: Demystifying the drug, methods of training without it …

      • Bob Lunny

        I do remember the 60′s & 70′s. When did lasix become approved, and was the reason because  the horse population was declining? The BC 2 yr old race was run with claimers. Has the breeding been hurt with use of lasix that horses can longer run without it? If so, than how long will it take with the banning of lasix, to get the stock back to horses that were fitter in the 60′s & 70′s?

        • http://twitter.com/Cangamble Cangamble

           Lasix became legalized in the mid 90′s.  The average starts per year in the 60′s was over 11.  Now it is just over 6.  It declined every year since 1992 until a slight uptick in 2010.  If drugs are the main reason for this decline, I’m guessing it would take something like 3 or 4 generations of breeding (around 15-20 years) to get the breed back to where it was in the 60′s.  But there would be improvement every year. Problem is that for the horse racing industry, worrying about where the industry will be 6 months months from now is considered long term thinking.

          • Bristling

            The reason field sizes are is because there is much more racing now not because of lasix.

          • Randyp

            That is certainly not true in so many ways!!!!!!!

          • Mark

            The commercial market is just as much to blame for fewer starts.  Badly performed and conformed fillies and mares suddenly had a place in the breeding shed.  Looking at the size of the foal crop next to the Yearling Sales averages tells the story.

          • Randyp

            the use of medication over the last 30 years has allowed horses with bad genes or taits to be introduced into the gene pool, arguabaly weakening the breed.

  • http://www.facebook.com/MaureenTierney51 Maureen Tierney

    I would still like the true CAUSE of bleeding to be ascertained.  Science seems to be completely ignoring the fact that using Lasix days before a race is still effective, when the diuretic effect of Lasix only lasts hours.  Is it, in fact, the diuretic effect that prevents bleeding, or is it something else?  Why does no one seem to care?  Why is the easy “symptom” reliever used without concern for the actual cause?    I agree Lasix should be used, but I believe even more strongly that it’s just a poor substitute for a true solution, since Lasix does have negative side effects.

    • Bristling

      Well said

    • Janet delcastillo

      There are many reasons why a horse may bleed…it is just a symptom of a problem. Wouldnt it make more sense to understand why …maybe something as curable as a lung infection …very common in young horses especially in their two year old year when they leave the farm and goto track…like children who start school..

  • William Koester

    There are a few questions that I believe should have been asked to Dr. Shields, that were not. With all due respect
    Graduating from vet school in 1987, it would seem that you have little or no experience dealing with horses before lasix was permitted ?
    Have you ever practiced or assisted in a country that runs drug free and see how they do it ?
    Since graduating, how much of your income has made administering lasix ?
    Do you believe it’s a level playing field if some horses race on drugs and some don’t ?
    Do you believe that every country that races without lasix, are treating their horses inhumanly?

  • James Staples

    ALL that come on the PAULICK REPORT NEED to READ this…IT SPEAKS FOR ITSELF!!!…So lets move on & RID “THE GAME” of THE REAL PROBLEM…THE CHEATS/REPETES/HORSE/JOCKEY/GAMBLER ABUSERS before the FED STEPS IN & DOES IT fore U…GET BUSY!!!…TY a TON for THE FACTS Ray!!!…

    • Danny Gonzalez

      If you want to rid the games of the CHEATS   start in the front office then work your way down. This Entire lasix issue is being pushed so a small group of individuals can make a small fortune. But as always   Racing people have no idea what is really going on because they are being led by the nose  in a certain direction. 

    • Bristling

      Wow I finally agree with you on something.

  • Philo

    Low dose aspirin and BP med comparison is a week
    argument. Humans make lifestyle choices that may necessitate drug use, horses don’t. It wasn’t that long ago that New York and I think KY didn’t allow lasix.

    And they used to show mud marks in the PPs, nevermind.

  • Nick Kling

    The South African study Dr. Shields referenced indicates lasix was beneficial for the group of 152 horses used in the study.  However, that was 1 study on 1 small group of horses.

    Anyone with any training in the scientific method knows (including Dr. Shields, I assume) that no single study is definitive proof of anything.  Scientific testing requires two or more studies which replicate the results in a manner which confirms or repudiates a theory.

    I don’t question the results of the South African trial.  What I do question is what the results would be if 5 similar tests were conducted in different locations with different horses.  Then, and only then, would we have something resembling proof.

    Until additional testing is done it is disingenuous for scientists like Dr. Shields, or anyone else for that matter, to conclude that raceday lasix has been confirmed as beneficial for Thoroughbreds in regards to prevention of EIPH.

    If pro-lasix folks are going to pin their belief in its use on “science” they should be willing to support (and fund) further research to determine just what the science says.

    • Mike C

      Nick, as an obvious proponent of “no lasix” please explain how the game will be better off,handle will rise, and racetracks will have larger crowds.

      What good is lasix off, there will be negatives to players,owners, the animals.
      Thanks,Mike C, a fan of yours.

      • http://twitter.com/Cangamble Cangamble

         I believe that lasix can mask certain concoctions, despite the claims that if you use certain administering times it won’t.  I don’t believe it for a second.  So elimination of lasix may reduce super trainers, whose presence I believe hurts both handle and the integrity of the game.  Also, lasix and other drugs drain horses to the point they can’t race as much as they used to.  Starts per horse by year are down by more than 50% from the 60′s and 70′s.  So if say 10% of horse can’t race if lasix is gone, those who can race can do so twice as much, and that will have a good effect on field size, which attracts bettors. 

        And then there is the question of whether the drug culture weakens the breed.  I believe there are quite a few factors which include a rush to the breeding shed, frail shooting star horses that injure themselves early able to breed their frailness, etc., however,  it only makes sense that if our best horses could be having their performance enhanced by lasix and other drugs, and that these horses are relatively weaker without the drugs and poorer choices for the breeding sheds compared to the sires and dams of the 50′s, 60′s and early 70′s.

        • RayPaulick

          You’ve brought up an important issue here: super trainer. Whether an overlap in the era of super trainers and the almost universal use of Lasix is coincidence or is somehow related can not be proven, but I think it’s hard to dispute that overlap exists. In the last 20 years there has also been widespread cheating in human sports (or longer ago if you go back to the Soviet bloc Olympians), so it’s possible the evolution of the super trainer is more pegged to that phenomenon: EPO, HGH, etc.

          • kyle

            I don’t think it’s too big a leap to assume training 200 plus horses would be more difficult without one’s lynchpin chemical.

          • Takethat

            They wanted to be able to race half fit horses and Lasix use allowed them to do so. It was all about shortchanging the owners. They want to spend the minimum amount of time possible on each horse. Without Lasix their business model would disintergrate.

          • James Staples

            Ty Cobb was on DRUGS so it goes back more than twenty years!!!…ty…

        • Mike C

          Respectfully,there are legit ways to move a horse up. As Nick pointed out there are TONS of legal medications used in concert with hyperbolic chambers, accupuncture, super jugs, pointed massages and much more which is the MO of many”super trainers” very expensive, very legal. Too many have no knowledge of what is legal and what is disallowed under any circumstance.An assualt on the ILLEGAL stuff is all that is necessary to calen this up, cost money, states/venues unwwilling to front the cash.There is no question that there are a samll percentage of thieves inside the game!

          Racing has done a horrific job of defending itself and being transparent. The stewards of racing have brought about the present disconnect/suspicion between those that wager $11 billion per annum and themselves.

          Around the game 40 years, the single greatest problem is the the lords of racing in their fifedoms and the politically appointed who lack the overall business acumen to be in charge.

      • Nick Kling

         Mike,

        Illegal drug use and improper use of legal drugs is a bigger issue than legal raceday lasix. I have no problem with that argument.

        However, the future of pari-mutuel racing will be decided by people who are not fans of the sport.  The single most frequent question I get asked is some variation of this: “Why do horses need to be drugged to do something they were born to do?”

        I have no answer for that question, particularly given the knowledge that 300 years of racing history, and most of the racing world today, operate without it.

        Handle and attendance may or may not rise if raceday lasix is banned.  Unless we act proactively, inevitably the game will be banned or severely curtailed by a general public to whom we can give no answers, and who believe racing is a cruel sport.

        You and I may know that is baloney, but we are in the minority.

        • Lollipop

          The future of pari-mutual racing will absolutely be decided by people who are “fans” of the sport. Anyone who believes different is crazy. The business is floundering because of a lack of effective leadership, greed, laziness and to borrow a word from the anti-Lasix zealots the craven attitude of racing in general towards its customers. The future of the business isn’t up to congress, PETA or any other enemy of the game. The future of the game will be decided by the customers who provide the horses to bet on and those who do the betting. The entire lasix issue is just another example of misguided people stumping on soapboxes while the customers walk out the door.

          • Nick Kling

             Lollipop,

            You raise a valid point, so I’ll rephrase.

            If racing’s so-called leadership doesn’t kill the game, the ill-informed righteous public will kill it for us, unless we take pro-active measures.

        • James Staples

          One More Time Nick…98% of AMERCIANS don’t know a damn thing about about T-Bred Horse Racing…Its the Best Kept Secert in North Amercia…Used to be a National Treasure!!!…ty…

    • Stanley inman

      Nick,
      Your “reasoned” analysis makes lots of sense.
      Yet whenever I approach this subject it is laddled
      With passion.
      If you have ever mainlines a horse;
      Witnessed his eyes tracking you
      As you pull back and push ever so slowly.
      One quickly
      if he cares about the horse
      Knows they would not do this unless is was necessary to save his life.
      It’s easy to discuss
      Lasix in the abstract
      Doin it reminds me of
      how wrong it is to the horse.
      That feeling trumps everything I know from reading about it’s merits.

  • Tinky

    This type of interview is very useful, Ray. You should balance it with a similar one with either or vet or trainer associated with a major yard in the UK.

    With regard to the substance of Dr. Shields comments, there are some problems worth noting. It is also worth noting at the outset that he apparently was not practicing before Lasix became legal at racetracks in the U.S., which, like trainers who fall into the same category, both limits his perspective, and makes him subject to fear of the unknown.

    His comments pertaining to Lasix as a performance enhancer suggest either an unfortunate bias, or stunning ignorance. He likes to emphasize “facts” when arguing his case, but conveniently implies that there is a question about whether Lasix enhances performance. There is NO question. It is an unassailable fact, and I have explained why on many previous occasions on this site. For a vet who claims to rely on science to suggest otherwise raises serious questions about his other claims.

    There is an interesting inconsistency in that he first suggests that rest can heal damage from bleeding episodes, then trots out the predictably scary suggestion that the “disease” is debilitatingly progressive. Well, which is it? And if, when pressed, he would claim the latter, as most Lasix proponents do, then how would he explain why a good percentage of the two-thirds of the horses racing around the world without Lasix aren’t retired earlier than their American counterparts, or do not suffer notable declines in form as older runners?

    It is deeply disingenuous to emphasize that in some study Lasix prevented bad bleeding episodes (i.e. “there were NO grade 3 or 4 bad bleeders”). The fact is that horses do have grade 3 and 4 episodes while racing on Lasix. Dr. Shields knows this FACT very well, yet attempts to obscure it. Why? Because he is clearly biased.

    That bias was again in evidence when he suggested disingenuously that trainers overseas don’t scope horses, but rather judge bleeding on the basis of visible blood in the nostrils. That is simply false, and major yards in the U.K., France, Ireland, Australia, Hong Kong, etc. do plenty of scoping.

    To be fair, Ray does characterize him as a “staunch advocate” for Lasix use, so there apparently was no pretense that he would be balanced in his opinions.

    The main, though perhaps most subtle problem with the interview, is what what left unasked and unanswered. If Lasix is so necessary for the health and well-being of racehorses, how is it possible that they averaged over 30 starts in their careers prior to its widespread use in the U.S., and now average less than 11? If it is so obviously necessary in order to prevent bleeding, and keep horses from suffering, how is it that two-thirds of the worlds’ owners, trainers, breeders are comfortable with the status quo of no medication on race days? Why haven’t there been grass-roots movements to make Lasix legal on race days? Are these people all ignorant and insensitive? 

    Also, implied in his responses is the unfortunate mindset that the answer to the Lasix question is binary. Either we keep the status quo, or ban Lasix and keep everything else the same. That is the greatest illustration of bias, as anyone truly interested in the welfare of horses, and truly interested in objective science, would look at ALL of the related variables before arriving at a conclusion. In other words, if Lasix were to be banned, what might be done to help prevent the condition WITHOUT having to resort to race day medication? Why does John Gosden report that only 5% of his runners are “unmanageable” without the drug? What is he doing that his American counterparts aren’t?

    Finally, I can’t help but wonder whether or not Dr. Shields has any children, and whether he was inclined to treat them with pharmaceuticals when they were young as a preventive measure? 

    • Circusticket

      Don’t you think it’s much harder to build a fan base when the horses’ careers don’t last as long as they used to?

  • Stanley inman

    Ray,
    What do we learn
    From this piece?
    Ans. The subtle yet preponderant
    Conflict of interest
    in our sport.

    The definitive judgement
    On this topic
    seems often tied
    To those who have an economic interest.
    If you don’t believe in Breast augmentation
    Don’t go to a plastic surgeon for advice.

  • kyle

    Truth is greater than the sum of a few selected “facts.”

  • thevoiceoftruth69

    With all due respect, asking a racetrack vet to comment on Lasix is no different than asking Wayne LaPierre to comment on the benefits of guns.   What this vet doesn’t get is that horses can compete without Lasix and maybe THOSE horses should be the one’s that compete.  He completely ducked the question when asked about eliminating Lasix.   What a waste of time to read this hogwash !

    • Hossracergp

      Oh please….some of you are so entrenched in your delusions about lasix that no amount of facts could persuade you to believe other wise.

    • Lasixistherapeutic

       If not the actual licensed horse doctor that prescribed the therapeutic medicine,  who should we ask for expert opinion????

  • Trotnwin

    What about Standardbreds? Here we are being aliened with the thoroughbreds and we are almost completely different… race almost every week, a mile is our standard, two legs on the ground (less breakdowns) at one time (gaited-trot or pace) and more cold blooded, but that is evolving. Everyone is united in the unity call, my concern is that the Standardbred horseman did not have enough input and there is not enough  leeway of our significant differences in the breeds and racing techniques.

    • Bristling

      Because standardbreds take a backseat to thoroughbreds.

  • Grarick

    Lies, damn lies and statistics. The South African study has been misunderstood and misquoted since the day it was published. As others have suggested, several more pieces of research are needed. But until then, there are some glaring holes in Dr. Sheilds’s comments. He glosses over the question of other jurisdictions that don’t use lasix by assuming everyone trains on it and then ignoring the question with a backhanded accusation of animal cruelty in 90 percent of the world. Also, no question was asked about side effects, which are clearly a major issue – horses in the United States run far less frequently than they did in the days before legalized lasix. I, too, hope you follow up this story, Ray, with another Q@A with a European or Asian vet.

  • SteveG

    “I have spent quite some time providing you and your readers with scientific facts and medical knowledge regarding furosemide usage.”

    And not a single word on negative side-effects, contraindicated drug interactions, or an iota of concern about long-term use in otherwise healthy racehorses.

    Selected “scientific facts.”

    In and of itself, that failure to acknowledge, even glancingly, the downside of the drug calls into question the good doctor’s motives, despite the “ethical” protestations to the contrary.

    • Janet delcastillo

      Remember, training on Lasix with young horses weaken bones…how can that be good for the horses? Does anyone look at the negative side effects?

  • Q6ranch

    Easily the most thought provoking presentation of the pros and cons of “Lasix” use. No mention, however, of the influence on the gene pool of the American Tb as we move “forward”.

  • Randyp

    Would love to see the same questions answered by a vet in Australia, Japan, Hong Kong, England, France and perhaps Germany………….

  • Jgeills

    As a gambler, I do not like the idea of vets in the stalls with needles on race day. Blocking, doping all occur prior to the race when a “vet” is in the stall. Only state vets, in a race day quarantine barn, giving LASIK, would make me start to wager more. The trainers winning at 40% clips with enormous start numbers
    Proves that shenanigans is going on. This so called sport is in a death spiral, because of rampant cheating.

  • KarinB

    I’m
    inevitably in two minds on the subject.  I do hate for horses to have major
    bleeding episodes, but I also think that we shouldn’t perpetuate genetic lines
    that are bleeders, just because they’re precocious.  We’ve bred for
    precocity and speed to the exclusion of durability too long.

  • Marshall Cassidy

    OK. Dr. Don Shields is a competent practitioner of veterinary medicine and has legitimate opinions regarding the efficacy of furosemide for the treatment of EIPH. No problem: he makes as much sense for the use of this drug as any other protagonist. Furosemide reduces the severity and rate of incidence for EIPH.

    My problem with Dr. Shields’ dissertation resides in his proximity to the subject: Dr. Shields makes his living treating horses in need of treatment. Dr. Shields, as well as other advocates for furosemide, does not address the need to reduce the problem in our horse populations, and he does not address the adverse perception of chronic drug treatment in the public’s eye.

    So long as horses bleed they will need assistance to remain competitive. Will the business die if bleeders are refused at the entry box? 

  • Bryan Langlois (ShelterDoc)

    Very interesting article and perspective from the scientific and vet community.  I also agree that more studies would be needed focusing on US horses in different geographic regions, housing environments, etc.   I think the fact that EIPH is bad for a horse and that lasix does have effects that minimize it has never really been in dispute.  I would like to know how many european horses do show a grade 2-4 of EIPH when racing off lasix but training on it.  I know the stats were there for the South African population, but would like to see them in other jurisdictions as well.  However,  I also think the one question that still does need to be looked at scientifically is what the long term effects of chronic lasix use has on the thoroughbred that races routinely.  As has been mentioned above, starts per year have drastically declined over the last decade or so.  What the cause of this is probably is multi faceted, but still needs to be studied in a scientific way. When we look at humans that take lasix or other drugs for blood pressure, etc., often they have to check in with their physicians 2-4 times a year to have testing done to make sure their electrolytes and other factors stay in balance.  I’m sure enough blood tests have been run on the back side on horses that race and train on lasix to get a statistically significant sample for someone to do a retrospective study on this.  Somewhere there has to be a grad student interested in looking at this for a Thesis.   

  • http://www.facebook.com/ben.vandenbrink.52 Ben van den Brink

    Get an opinion from sources in Hong Kong, (high humidty, high temperatures)

  • http://www.facebook.com/ben.vandenbrink.52 Ben van den Brink

    John Gosden has been given a good answer on this subject.

  • Sara

    Here in Europe Lasix is banned along with steroids, bute and anything else which can mask weakness or injury in a racehorse. Allowing horses to race on Lasix does nothing but breed weakness into the thoroughbred. Only horses which have raced and won free of medication should be in the TB gene pool.

    • lasixistherapeutic

       Theoretically not a bad idea…but what do we do with the thousands of racehorses that got that “bleeder  gene”  …Easy to say …Retire them all….Not sure if owners/trainers would buy into that….What happens if we stop Lasix and horse bleeds out???  Lasix (furosemide) is a diuretic, it has no stimulant activity or anabolic activity.  Trust me, if it gave advantages to athletes , they would be using it in baseball, football, and cycling!…………………

  • http://www.facebook.com/ben.vandenbrink.52 Ben van den Brink

    So ,when the US trainers go to Dubai, where racing is lasix free, the problem does not exist. It exist only in the US

  • Chartfarm

    The goal in racing is to race drug free.  You can find someone to argue any side of the question.  The rest of the world races drug free, and are very successful in doing so.  It is about time to stop talking this subject to death.  Let’s get on with cleaning up the sport, and revitalizing the fan basis. 

    • Mike C

      Chart,
      Wrong, rest of the world does NOT race drug free,you are misinformed. Who cares about the rest if the world with their mainly Mickey Mouse racing except for a few big days?

      • Matt Clarke

         Please inform us what drugs are used in Europe to race on? Please be specific, you obviously know the “facts”

        • Ike C

          Race day, we use one,lasix,what DRUGS??? As in plural are all of you speaking of?

      • Lorrie

        Please…….You call the Arc de Triomph, the Grand National, the King George VI & Queen Elizabeth Stake. Not to mention the Dubai World Cup, the Melbourne Cup and the richest 2year old race in the world the Golden Slipper “Mickey Mouse” racing? That is the height of American parochialism that makes us a joke to the rest of the world. 

        • Mike C

          We only have have 116 Grade 1 races vs Europe, check the numbers. Europe, the world mainly Boutique meets, not even close to USA

          • Lorrie

            Too many horses and too many races. Maybe we should cut back and improve the sport. To most people racing in the USA is the Kentucky Derby and the Triple Crown.
            No one says that Europe and the rest of the world doesn’t race on drugs but when there’s money involved there will always be those who abuse the system. That’s not confined to racing either and needs more policing. I do feel the battle is going to be lost and at the expense of the horses and those who put their hard earned on them. 

      • Kfminton

        My horses in France do NOT race on drugs.  Nor do I consider their races to be “Mickey Mouse” races.  Their races are as important to me as any Derby races!

  • Dave Parker

    Mr. Paulick, thank you for this column.  Sanity prevails at last !

  • voiceofreason

    Have you found any difference in the percentage of
    Thoroughbreds that exhibit EIPH among top-class stakes horses and
    lower-level claiming horses?

    I currently do not have enough of these top-class horses in my practice to provide statistics on this issue.

    Nuff said.

  • Barry Irwin

    So the rest of the world, which just happens to have nearly every top-rated horse on the planet, has got it wrong, and a racetrack vet in Southern California has got it right? What are the odds of this being the case? Racing is an insiders game and Dr.Shields is so far on the inside he cannot see the forest for the trees. And he is not alone in this regard.

    • Aklanfer

      How many horses have you bought overseas for the sole purpose of running them on lasix in the states…

    • Mike C

      Just about every top rated horse is in the rest of the world??

      In addition to being a disengenuous phony who races on lasix(exc 2 yr olds perhaps) you don’t have a clue comparing the Mickey Mouse racing conducted at the top level,USA vs the world

      • Barry Irwin

        An anonymous poster calling me a liar and calling into question my knowledge of racing around the world? That’s got to be the funniest post of this or any other thread. 

        Let me tell you what a phony is–it is somebody that campaigns to keeps Lasix in all of the Breeders’ Cup races and then scoots off to Dubai to run without the stuff.

        • Mike C

          Nice Try, a phony is one who says one thing but does another, like you running most of your horses on Lasix while trying to stump with a few Elitists breeders.

          • StartUp

            Seems as though you have lost all objectivity assuming you ever had it to begin with.
             
            Any person who has ever been around the racetrack knows Salix is preformance enhancing for most horses. (Here’s a shocker-some horses actually preform better without it, but they are the exception/for another thread.) To attempt to be competitive and try to level the playing field somewhat, 99.999% of trainers appear to use it.  (Here’s a couple questions never discussed in this great debate.  Which trainers use 2ccs and which use 12ccs?  And what exactly does an adverse reaction to Salix look like? LAT?)

            Shanghai Bobby won the Juvenile without Salix. So why has he run before and since with it? Did he just miraculously not bleed in CA?

            Barry is absolutely right.  There is something phony about campaigning to keep Salix in all the BC races and yet take horses to Dubai to run without it.  An objective person would reasonably question if the horses needed it in the first place.

    • John F. Greenhaw

      Mr. Irwin:

      I mean no disrespect, but I just returned from a day at the track, and I can say with absolute certainty that not a Goddamned Person gave a Rat’s Ass whether a horse was running on lasix or not.  What they did care about was whether a 9 yo from SoCal could win a special claiming race at Aqueduct, which he did and paid over $11.00, after the claim by Gary Barber and the shift to Jacobson.

      It appears to me that you, and many others, are not looking out for he life-blood of the sport—THE BETTORS”

      It appears to me, for whatever that’s worth, that the contingent that signed on with the WHOA group, are so full of themselves that they refuse to accept  reality and admit failure with their agenda that now you are siding with European interests as opposed to those that butter your bread.  Please feel free to correct me if by chance I’m incorrect, but your comments do, indeed, tend to smack in the face of those who you take money from!

      • StartUp

        So you are signing on to “the shift to Jacobson” as “looking out for the life blood of the sport”?  Lots of luck with that.

      • Barry Irwin

        John, I believe that the interest of horseplayers would be best served by creating the most level playing field possible and only drug free racing can accomplish this. I sincerely believe that until such time as we stop listening to people that are only interested in what happens today or tomorrow instead of next year and the year after, racing will continue to slide into oblivion.

        Who is it that I am supposed to be smacking in the face that I am taking money from?

        • Milezinni

          Why does it have to be all or nothing? It seems to me the most logical solution is to offer races in the condition books that are “Furosemide Free”…giving every Owner the choice.

          Whichever race fills, is the race they run. 

          As far as Stakes go, have the entry fee be the purse….I believe that’s how Stakes races first started.  

          Every major movement started with that very first step…

          (PS-can’t post with my real name, asks my e-mail addess, and that’s the name it posts under)

    • Lexington 3

      And what does YOUR vet and trainer say, Barry?

      It is more than just “a racetrack vet in Southern California”.  

  • Guest

    In reference to Dr. Shields statements,
    “Which horses will bleed significantly and suffer form reversals in a particular race is anyone’s guess, but referencing data from works with furosemide will further confuse the issue when racing without it.”
    “Providing data from workouts utilizing furosemide while preventing its administration for racing should certainly further increase the number of horses racing off-form during any particular race.  Thus furosemide administration is not only in the best interest of the horse as concerns its health, but its use also provides a consistency to the data provided to the betting public.”
     
    Isn’t this exactly what is happening now? The betting public presently has no idea if  and what drugs a horse is on during a workout, only what the horse is given during a race. The horse could have been given furosemide and bute 15 minutes before the workout or not given anything at all. I see absolutely no consistency to the data under the present system. I would also bet that the majority of trainers, especially with horses at the lower level, do not use furosemide for workouts yet almost all do for races. 

  • JohnfromIreland

    We race horses with the tolerance of the public. In all sport there is and must be an ethical backdrop or we are, to use a new verb word, Lancing ourselves.

    There is no ethics in drugging the performers just so that we can bet today. Yes, there is a short term fix but in time those bleeders will breed more bleeders and it will be manifest in the % serious bleeders in future studies.

    Can I ask anybody who thinks “The entire lasix issue is just another example of misguided people stumping on soapboxes while the customers walk out the door” to consider whether the attitude to drugs including Lasix in the sport may be part of why people are speaking with their feet.

    In time if the sport in USA does not recognise that it is dealing with a declining quality in its horse population it is fooling itself.

    The proof is there for all to see. The world rankings are racing’s equivalent of the golf or tenis world rankings. The top 10 in the last three years tell its own simple tale.
    Yes, you can continue to patch up the bleeders but at a cost. Those who push for change are not the inheritors of racing from a previous generation but rather those minding the sport we love for the next gereration.

    World Rankings

    2012

    Horse (where bred)
    Trainer
    Trained

    1
    140
    FRANKEL
    (GB)
    Sir Henry Cecil
    GB

    2
    131
    CIRRUS DES AIGLES (FR)
    Corine Barande-Barbe
    FR

    3
    130
    BLACK
    CAVIAR (AUS)
    Peter Moody
    AUS

    3
    130
    EXCELEBRATION (IRE)
    Aidan O’Brien
    IRE

    5
    129
    WISE DAN
    (USA)
    Charles Lopresti
    USA

    6
    127
    ORFEVRE (JPN)
    Yasutoshi Ikee
    JPN

    7
    126
    MONTEROSSO
    (GB)
    Mahmoud Al Zarooni
    UAE

    7
    126
    NATHANIEL (IRE)
    John Gosden
    GB

    7
    126
    SO YOU
    THINK (NZ)
    Aidan O’Brien
    IRE

    10
    125
    FORT LARNED (USA)
    Ian Wilkes
    USA

    10
    125
    HAY LIST
    (AUS)
    John McNair
    AUS

    10
    125
    I’LL HAVE ANOTHER (USA)
    Doug O’Neill
    USA

    125
    WISE DAN
    (USA)
    Charles Lopresti
    USA

    2011

    1
    136
    Frankel
    (GB)
    Sir H. Cecil
    GB

    2
    132
    Black Caviar (AUS)
    P.G. Moody
    AUS

    3
    128
    Cirrus
    Des Aigles (FR)
    Mme C. Barbe
    FR

    3
    128
    Danedream (GER)
    P. Schiergen
    GER

    5
    127
    Canford
    Cliffs (IRE)
    R. Hannon
    GB

    5
    127
    Rewilding (GB)
    M. Al Zarooni
    GB

    7
    126
    Dream
    Ahead (USA)
    D. Simcock
    GB

    7
    126
    Excelebration (IRE)
    M. Botti
    GB

    7
    126
    Nathaniel
    (IRE)
    J.H.M. Gosden
    GB

    7
    126
    So You Think (NZ)
    A.P. O’Brien
    IRE

    2010

    1
    135
    Harbinger (GB)
    Sir M. Stoute
    GB

    2
    129
    Blame
    (USA)
    A.M. Stall Jr.
    USA

    3
    128
    Makfi (GB)
    M. Delzangles
    FR

    3
    128
    Quality
    Road (USA)
    T.A. Pletcher
    USA

    3
    128
    Workforce (GB)
    Sir M. Stoute
    GB

    6
    127
    Canford
    Cliffs (IRE)
    R. Hannon
    GB

    6
    127
    Nakayama Festa (JPN)
    Y. Ninomiya
    JPN

    8
    126
    Cape
    Blanco (IRE)
    A.P O’Brien
    IRE

    8
    126
    Rip Van Winkle (IRE)
    A.P. O’Brien
    IRE

    8
    126
    So You
    Think (NZ)
    J.B Cummings
    AUS

  • JohnfromIreland

    Apologies to all the table did not transmit as on the screen. Just look at the rankings for the last three years.

  • patsyann

    One problem not mentioned is that in the USA, horses typically run sprints and in Europe the horses are more likely to be running further distances. For the distance race, the horse builds endurance and for the sprint there is more stress on the lungs

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