Stuart S. Janney III: Dr. Rick Arthur and Alan Foreman are board members of the Racing Medication and Testing Consortium. They are here today to report on very important progress from the RMTC and its Drug Testing Initiative.
Rick is going to start us off …
Dr. Rick Arthur: Thank you, Stuart, Dinny.
Good Morning. It’s a pleasure to be here. Even though this would be a cold winter rain at Santa Anita, yesterday was beautiful.
Over the next few minutes Alan Foreman and I are going to be discussing several of the RMTC’s recent efforts. The Racing Medication and Testing Consortium was formed in 2003. Their purpose was to encourage national uniform medication policies and to promote industry cooperation on drug testing and related issues.
One of the RMTC’s first recommendations was a 5 micrograms/milliliter (ug/ml) threshold in blood for phenylbutazone. Phenylbutazone is ubiquitously known as “bute.” It is a non-steroidal anti-inflammatory drug commonly used in racehorses in the U.S. Phenylbutazone is not allowed in international racing competition under IFHA rules. If I slip and say bute, I am referring to phenylbutazone.
Was there are scientific basis for the 5ug/ml level? No. It was a political calculation of what could be accomplished at the time — and it worked. About a third of the states had 2ug/ml, most of the rest were 5ug/ml and some states were virtually unregulated. In the end, horse racing had as close to a national uniform medication policy for phenylbutazone as for any medication.
The RMTC is now recommending the permitted phenylbutazone level be reduced to 2ug/ml across the country. What’s changed since 2003?
Barbaro, Eight Belles, and an industry and public who are paying attention.
The NTRA Safety Alliance, The Jockey Club Safety Committee, the Grayson-Jockey Club Welfare and Safety Summit, and other initiatives have been undertaken to enhance and refine our safety and animal welfare programs. This has not been PR posturing, but substantive efforts.
With all the review of our safety procedures what is clear is pre-race examination is a key safety check, if not the key safety check, for our horses. Pre-race examinations are challenging under the best circumstances, but let me go right to the heart of the issue: our examining veterinarians have expressed concern our current medication policies compromise their ability to properly evaluate the soundness of in-today horses.
California has an extensive necropsy program. All horses dying within CHRB enclosures are necropsied — that’s autopsied — by pathologists associated with the UC-Davis School of Veterinary Medicine. That’s over 5,000 necropsies since the program began less than 20 years ago, a sobering number by any measure. What is clear and has been clear for some time is that 90% of all horses suffering fatal musculoskeletal injuries have pre-existing pathology at the site of their fatal injury.
This is important so let me repeat: 90% of all horses suffering fatal musculoskeletal injuries racing or training have pre-existing pathology — a prior injury — at the site of their fatal injury.
Why are our examining veterinarians missing those pre-existing injuries? That is the question.
The examining veterinarians are concerned with two classes of drugs commonly used in racing in the U.S.: corticosteroids and non-steroidal anti-inflammatory drugs. Both are anti-inflammatories. Corticosteroids are cortisone drugs; phenylbutazone and other non-steroidal anti-inflammatories are drugs like Advil and Tylenol. The public knows non-steroidal anti-inflammatories as painkillers. That’s how they are advertised to the public, because they are painkillers. Obviously, our horses can’t talk. Veterinarians — trainers and jockeys for that matter — evaluate a horse’s well-being and soundness by clinical signs, signs that are masked by analgesics, that’s painkillers, and anti-inflammatories. These drugs are not allowed in IFHA rules in places like Ireland, England, France, Dubai, Australia, Hong Kong, Japan, and other countries, but they are allowed in the U.S.
Racing fatality rates in the U.S. are two- to three-times higher than other major racing countries that don’t allow phenylbutazone and other drugs. My international colleagues have no doubt our medication policies, especially in phenylbutazone, are the cause of this disparity. I’m not convinced it is that simple, but there is no question medication regulation is the most glaring difference between U.S. and other major racing countries.
The RMTC has been working on corticosteroids for several years. These are a complex group of drugs. Tremendous strides have been made in corticosteroid detection methodology both in the U.S. and internationally — these are a problem for all of us. The consensus of the RMTC’s Scientific Advisory Committee is improved sensitivity is needed before a comprehensive corticosteroid program is ready for the U.S. That improved sensitivity is justaround the corner.
Dr. Larry Soma from the University of Pennsylvania’s New Bolton Center reviewed the scientific literature on phenylbutazone for the RMTC. All members of the Scientific Advisory Committee had input. The bottom line is this:
There is overwhelming scientific evidence that the regulatory veterinarian’s concerns are justified.
I practiced on the racetrack for 30 years. I know something about examining horses. The first thing I would do when I was asked to look at a horse is enquire whether the horse was on bute — or any other medication for that matter. Why? Because bute affects a veterinarian’s — or a trainer’s or a jockey’s — ability to evaluate soundness. Dr. Tom Brokken, a well respected racetrack practitioner from Florida and a member of the RMTC’s Scientific Advisory Committee, stated he thought bute in training was a bigger problem than bute in racing. Why? For the same reason: Trainers don’t know where their horses are at in terms of soundness when they are on bute. Remember: 90% of all fatal musculoskeletalracing andtrainingfatalities have pre-existing pathology at the site of their fatal injury.
Medication issues always raise the blood pressure of horsemen, but the hysteria over this modest reduction is ridiculously overblown. In California 85% of horses already meet the 2ug/ml level under the 5ug/ml rule currently in place. In Kentucky it’s 91%; in Florida it’s 90%. All but a handful of trainers already meet the 2ug/ml level under a 5ug/ml regulation. Do we really want to set policies so a handful of trainers can push the limit — as when they are trying to get a questionable horse past the examining veterinarian? That’s crazy. It’s crazy for the horse and it’s crazy for horse racing.
Don’t let anybody tell you this is a radical move; it isn’t. New York and many other states operated at 2ug/ml for years. Certainly Dr. Soma, who reviewed the science, and Dr. Tom David of the ARCI’s regulatory veterinarian committee, which represents the examining veterinarians, wanted to see a lower level than 2ug/ml. On a purely scientific basis, I have to agree with them; to eliminate all concern, the correct level is that used internationally, and that’s zero.
The professionals we task with the final safety check of our sport tell us they can’t do their job with current regulations. And to be clear, this isn’t just about horses. Since I have been Equine Medical Director in California, I have had a dead jockey, a paralyzed jockey and just last month a jockey with a broken neck but fortunately no paralysis. All were on horses suffering fatal musculoskeletal injuries in races.
The ARCI is taking up the 2ug/ml phenylbutazone regulation next month. Their Drug Testing Standards and Practices committee has already unanimously endorsed the 2ug/ml level. This is an opportunity for the ARCI to demonstrate horse racing can implement a national uniform medication policy.
Moving quickly to the next issue...
The RMTC has directed considerable effort on withdrawal time research for therapeutic medications. Just so everyone knows this same type of research is going on internationally in jurisdictions with IFHA’s no medication rules. Why? For the same reason: positives from therapeutic medications are the most frequent drug violations. We are collaborating with our international colleagues to share information, coordinate research and avoid redundant efforts.
In my four years as Equine Medical Director, excluding TCO2 violations, I can count on one hand, certainly two hands, the positives where trainers have actually tried to take a shot. All but a small number of all drug positives are misunderstandings or management mistakes for routinely used medications with no intention of influencing the outcome of a race.
Most of the headlines for drug violations, the headlines the public and our fans see, are simply mistakes. We spend an inordinate amount of time, effort, money and public goodwill on these unfortunate and unnecessary positives. The purpose of the withdrawal time research is to give horsemen information to help them avoid those positives. We hope to have recommendations on nine of the most problematic medications — as measured by the frequency of drug violations — by this fall and another four within the following six months with other medications to follow on a regular basis. These will be announced and posted on the RMTC website as they become available.