In the Furosemide Wars of 2019, the first battle in Kentucky goes to furosemide proponents.
The Kentucky Equine Drug Research Council (EDRC) met Monday morning to consider a spate of medication rules changes brought forward by council member Mike Ziegler in July on behalf of Churchill Downs and Keeneland, including a phaseout of furosemide. Ziegler said that since he first proposed the changes, all other Kentucky racetracks – including Standardbred tracks – have privately agreed to support the measures.
The proposed furosemide phaseout rule before the EDRC Monday called for no furosemide in 2-year-olds beginning in 2020 and no furosemide in stakes races in 2021. Ziegler explained to the council that this proposal represented a compromise between proponents and opponents of furosemide use. Removing the option to use the drug in 2-year-olds would mean that any bleeders would have an opportunity to recover and come back as 3-year-olds with the drug, while removing it from stakes races would work to slowly curb its influence on the Thoroughbred gene pool. The proposed rule would still allow for furosemide use in 87 percent of Churchill races.
Veterinarians and industry representatives expressed skepticism about the intent behind the rule, calling it a “knee-jerk reaction” to the problem of fatal breakdowns in racing. The most outspoken opponents to the rule on the council were Drs. Andy Roberts and Mark Cheney. Cheney pointed out the high incidence of lower airway inflammation in racehorses and expressed concern that those infections damage the airways and predispose a horse to exercise-induced pulmonary hemorrhage (EIPH).
Roberts emphasized that furosemide is a therapeutic drug which is good at accomplishing its goals to reduce EIPH.
“Lasix is therapeutic and it's good for the horse,” said Roberts. “We've made a lot of changes in the industry, like taking the administration of Lasix out of the practitioners' hands and putting it in the regulators' hands for the impression there is a greater safety margin … this is not the last domino in this thing to fall. When we gave up the adjuncts, we were promised that was it, Lasix was staying, we just didn't have any evidence that adjuncts work, so I voted for that.”
Roberts suggested that if Churchill wanted the Kentucky Derby to be furosemide-free, it could put that provision in the condition book.
Representatives of several industry groups were on hand for the meeting and spoke against the furosemide phaseout, including Rick Hiles, president of the Kentucky Horsemen's Benevolent and Protective Association and Eric Hamelback, CEO of the National HBPA. Hiles questioned whether a phase-out would negatively impact sales prices when sellers realized their investments couldn't run until age three if they turned out to be bad bleeders.
“If I could just get everyone to think about the hypocrisy of removing Lasix, even if it's a phaseout for certain ages,” said Hamelback. “We just spent quite a while talking about horses breaking down. If you do this at any level, whether it's 2-year-olds, graded stakes, or stakes, you've guaranteed one more dead horse. It's a proven fact.”
The Racing Medication and Testing Consortium has furosemide on its controlled therapeutic substances list, and provides guidelines on dosage and withdrawal. The organization's standpoint is that horses may be managed safely and successfully with or without the drug.
Kentucky Sen. Damon Thayer, member of the EDRC spoke up in favor of the measure, saying he believes the only way to avoid federal intervention in horse racing is if state racing commissions voluntarily scale back medication – including furosemide on race day.
“We've got to pull our heads out of the sand, people,” said Thayer. “If you're not willing to make reforms, you probably need to go home and take a look in the mirror, decide whether you should be on this council or not.”
In the end, the furosemide rule failed, with five EDRC members (Drs. Cheney, Michael Kilgore, Jim Morehead, Andy Roberts, and Johnny Mac Smith) voting against and three members (Thayer, Ziegler, and chair Dr. Stuart Brown) voting for it. Art Zubrod, representative of Standardbred breeders, was not present for the meeting.
After the vote, Thayer pointed out that the Kentucky Horse Racing Commission is not prohibited from considering and voting upon the furosemide phaseout just because the EDRC did not approve it. Roberts questioned whether this was technically permissible, and Thayer maintained it was. The commission previously voted to phase out furosemide in 2012 but officials did not file the regulation with the Legislative Research Commission as they waited to see other states follow with similar phaseout plans. This time could be different, however, as The Stronach Group and the California Horse Racing Board are already considering more broad measures to eliminate use of the drug.
Other reforms brought forward by the racetracks fared better, however – a proposed rule to back up administration of non-steroidal anti-inflammatories (NSAIDs) from 24 hours pre-race to 48 hours pre-race passed. Regulatory veterinarians had expressed concern that NSAIDs given 24 hours out from a race wound up being given much closer to pre-race soundness exams, particularly for night cards. Backing the drugs up further should remove their ability to impact those exams, according to KHRC equine medical director Dr. Bruce Howard.
The EDRC also passed a rule eliminating the use of bisphosphonates in horses four years old and younger.
The NHBPA's Hamelback expressed concern about the use of bisphosphonates in younger horses.
“In my opinion, I think there are trainers/owners that get a substandard product that may have been abused and subsequently ends up on the Equine Injury Database for something that occurs at a much younger age,” said Hamaelback.
One proposed rule that generated some debate was an extension of withdrawal time for intra-articular corticosteroids from seven days to 14 days – a change that has already been implemented privately by The Stronach Group and which was passed by the New York State Gaming Commission during a meeting Monday afternoon. Here, there was again a clear division among EDRC members that is representative of much industry discussion about medication reform: Cheney and Roberts said additional restrictions would make it more challenging for them to treat horses in need of treatment, while proponents questioned the optics of needing to medicate a horse within a week of a race. Cheney and Roberts both agreed that some corticosteroids have been shown to improve joint health when used appropriately.
“We're talking about medicating horses to get them to a race,” said Thayer. “Well if they're sore, shouldn't we be medicating them to get them sound before we get them to a race?”
Cheney and Roberts objected to that characterization, noting they wanted both joint repair and rest before a race but saying the current timeframe already allows this. Roberts said after the meeting that many corticosteroids can do their work to improve joint health in a matter of 48 hours, during which the horse is not worked.
“We have other problems that are causing breakdowns, and bringing up a bunch of ancillary things that are unrelated doesn't help,” he said. “If somebody can show me data that says the horses at Santa Anita died because they had corticosteroid injections eight days out, then I'll go for that. But our racing fatality rates were lower here 25 years ago when we had a lot more medication than we do now. I'm not saying that's right, I'm one of the people who fought to remove a lot of those medications, but going further and further down a rat hole that's not yielding any results is not the thing to do.
“I don't want to do things that are window dressing. I want to do things that will help the situation.”
The proposed rule advanced 6-2, with Roberts and Cheney voicing objections. The rule does not address the use of intra-articular applications of other substances, like Adequan or IRAP.
Additional rules approved by the EDRC Monday a requirement that 14 days of medical records be provided to KHRC at the time of a horse's entry, with the notion that these would be transferred to a claimant if a horse is claimed. The committee also signed off on a rule eliminating electronic therapeutic treatments (minus nebulizers) on race day, including vibration plates and sheets and PEMF.
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