Should Racehorses Be Medicated?

There will be the usual excitement for the Belmont Stakes in New York this weekend — the third and final event of horse racing's Triple Crown.

But the sport still is clouded by the recent deaths of more than two dozen thoroughbreds at Santa Anita Park in Southern California. The fatalities have renewed calls for reform and rekindled a long-running debate – should racehorses be medicated with a bevy of drugs?

Chemical horses

On a sunny April day at Santa Anita, Kathy Guillermo looked out at the famed race track, aware that many who work there, consider her the enemy.

In their eyes, she wants to end horse racing.

But Guillermo, a senior vice president with PETA – People for the Ethical Treatment of Animals – says she doesn't. After 11 year of working to reform racing, and the cluster of 26 horse deaths at Santa Anita, Guillermo says it's time to right the sport's wrongs. Especially, the issue of medication.

"As a veterinarian I know once said, race horse is not a diagnosis," says Guillermo. "And yet that's the way these animals are treated. Meaning, that just by virtue of being a thoroughbred on a racetrack, you are medicated."

The Racing Medication and Testing Consortium currently lists 30 approved therapeutic medications, including sedatives, pain killers, muscle relaxants. Nearly all horses that race today take the two most popular substances — Lasix, to combat bleeding, and the pain-relieving anti-inflammatory, Phenylbutazone, or "bute."

Investigations continue into the causes of the spike of fatalities at Santa Anita, but according to a prominent veterinarian Dr. Rick Arthur, medications did not play a major role.

"Having reviewed all of the cases so far, medication is not a big factor," Arthur said in April, referring to the initial cluster of 23 horse deaths. "There certainly are a few glaring exceptions to that, but that didn't cause this particular problem."

Arthur has been based at Santa Anita for more than 40 years. He's the equine medical director at the University of California Davis School of Veterinary Medicine, and a full time adviser to the California Horse Racing Board.

Many blame the injuries on bad weather affecting track conditions. Arthur agrees "[the cluster of deaths] is really related to the type of surface we've had." He also believes there was a larger, philosophical issue, of horses being forced to race when they shouldn't have.

Still, Arthur believes there is an "issue" with medication that has to be addressed in the sport.

"Horse racing has to be perceived to be drug free," he says.

For that to happen, racing has to reverse a long history. What Guillermo calls today's "chemical horse," had its origins hundreds of years ago.

Racing on heroin

Racing historian Mary Simon says a book in the 1500s "had a chapter in it about the different types of medicines used to improve a racehorse's performance and improve [its] breathing."

The award-winning Simon adds, "Charles the 2nd also had someone write a treatise on medications used to benefit racehorses."

Not all medications were beneficial. The publication Bloodhorse chronicled the use of stimulants, cocaine and even heroin in horses. Then a moment in 1968 reminded the public that beloved racehorses were not just running on water, hay and oats. Dancer's Image was disqualified as the winner of the Kentucky Derby after tests revealed the presence of bute, which was illegal in 1968 .

Since then, bute and many other medications have become legal. Including Lasix.

Humans use Lasix to control blood pressure. But it's become the single most controversial medication in racing. It's used on race day, in the U.S. and Canada, to control horse's bleeding in the lungs. But outside of North America, it's widely banned on race days. As a diuretic, Lasix causes horses to drop a significant amount of weight due to fluid loss. As a result, they race lighter. That's led to charges that Lasix is a performance-enhancer. There's also a theory that horses continuously losing fluids, and then, post-race, rebounding from that dehydration, has led to less robust horses.

"In 1950, the average racehorse started 44 times in his career," says historian Simon, adding, "by 2010, that [average] was 11 starts."

Going without

John Ed Anthony has owned racehorses for nearly 50 years. He's been one of the few to resist using Lasix with his younger horses.

"That puts us at a distinct disadvantage, no doubt," says Anthony.

It didn't used to. Anthony's Arkansas stables have produced some great horses. Including Triple Crown race winners. In 1980, his thoroughbred Temperence Hill won the Belmont Stakes; in 1992 and 1993, Anthony won back-to-back Preakness Stakes with Pine Bluff and Prairie Bayou. All three won without Lasix. Even though he says he's at a disadvantage now, competing against horses on Lasix, Anthony continues the policy of keeping his 2-year-old thoroughbreds and most of his 3-year-olds, off the race day medication.

"For the long term benefit of the horse," he says, "we're better off with a healthy developed horse without having his fluids drained, consistently, than we are otherwise."

Tragically, Prairie Bayou, Anthony's 1993 Preakness winner, broke his leg in the final Triple Crown race that year, the '93 Belmont, and had to be euthanized.

"Let me emphasize that this was an absolutely sound horse," Anthony said after Prairie Bayou's injury. "Perhaps the soundest horse in the barn. Galloping along at a very slow pace, in the back of the pack well within himself. Doing what he's always done, under no stress, not in a drive, in the first half of the race. It's something you can't explain."

Lasix advocates point to moments like this, where a prominent Lasix-free thoroughbred broke down, to bolster their assertion that Lasix itself doesn't lead to catastrophic injuries. They also point out that while nearly all racehorse are on Lasix, last year's rate of fatal injuries in this country was only 1.68 per 1,000 starts.

Why shouldn't we use it

While the 80-year-old Anthony has watched medication use grow during his long career, Dale Romans has never known anything else.

Romans, 52, is one of the country's top thoroughbred trainers. He's based at legendary Churchill Downs, home of the Kentucky Derby. Romans says Lasix always has made sense to him.

"[Lasix] is a blood pressure medication," Romans says. "And it's been proven over time to help horses from hemorrhaging into their lungs. Which is a problem for horses. And if we have something we can use that's a $20 medication, four hours out [from the start of a race], that's used on people, people take on a daily basis and it's proven effective ... then why shouldn't we use it?"

"[Former Pittsburgh Steelers running back] Jerome Bettis couldn't have played in the Super Bowl if he couldn't have used his inhaler for asthma," Romans adds, "and why shouldn't we allow a racehorse to do the same?"

The debate over Lasix heats up though when talking about pulmonary bleeding being a "problem" for horses. Lasix advocates, like Romans, maintain the problem is widespread.

"Bleeding is not a problem you see as a casual fan in the grandstands," he says. "It's something you see when you get back to the barn. When you stick a scope in a horse's nose and you can tell that it has some blood in his lungs. We see the effect of that and we have to clean them up and get them healthy again before they run back. So why not use the medication is always my question?"

But opponents say that reasoning shows why Lasix is over-used, potentially to the detriment of horses.

Using a scope on a horse can show even the smallest traces of blood in the lungs, when anti-bleeding medication isn't needed. Lasix is necessary for horses with serious bleeding, when you can see blood coming from the nostrils.

And those horses, opponents say, are the exception.

The Jockey Club is the breed registry for thoroughbreds in the U.S., Canada and Puerto Rico. A recent research paper by the 125-year-old organization notes "somewhat less than 10% of the [racehorse] population is actually adversely affected by exercise induced pulmonary hemorrhage (EPIH), whereas approximately 95% of all racehorses are treated with Lasix."

In light of Santa Anita and overall scrutiny of the racing industry, the debate over Lasix appears to be leaning in the opponents' favor.

"Internationally horses race very successfully under those conditions," says Dr. Rick Arthur, referring to no race-day Lasix. "What we're trying to do is race horses that have no effective drugs on them at the time they run."

In mid-April, a coalition of leading thoroughbred racing associations, and major racing tracks, unveiled a plan to start phasing out Lasix use starting next year.

All the rest

Beyond the controversy over race day Lasix, Dale Romans, who stables 40 horses, bristles at the notion of a "chemical horse," pumped full of different meds that potentially mask injury. Asked whether horses can run, medication-free, like more of them did decades ago, Romans says they can.

"But is it going to be the best and healthiest way for a horse?" he asks. "I don't think it is. I think we have responsibility to horses, if they have any ailment, that we make them comfortable and as safe as possible."

"It gets mixed up on medication," Romans adds. "[The] cause of injury, or preventing injury? I'm a believer that properly used, [medications] will prevent injuries."

There seems to be some agreement on the issue.

"It's like the NFL or NBA — all athletes have aches and pains," says John Ed Anthony, who opposes Lasix. "So a number of horses benefit from a little bit of [medication]. Bute, in my definition, is more like aspirin or Tylenol or something like that than it is a stimulant. [It can] make an old boy more comfortable running."

Asked whether racing should be completely drug-free, Dr. Arthur says, "do you want to eliminate all health care?"

But is there a risk of over use? Of stacking too many medications in a horse that could mask aches and pains to the point that small injuries turn catastrophic?

"Yes," says Anthony.

In mid-March, when Santa Anita was in crisis mode, track owners the Stronach Group proposed changes that included reducing therapeutic medications — an acknowledgement that too much is not good.

Watching public opinion

Last week, Dale Romans led a visitor on a late morning tour of his Churchill Downs barns. He stops next to a young thoroughbred named Fight Fight Fight.

"Look at this horse," Romans says, "how much happier can an animal be? Look how shiny the coat is, how healthy this horse is. It's got a beautiful bed to sleep on. Hay imported from 2,000 miles away because [it's] the most nutritional. And eats three times a day."

Romans says more people should tour his barns, like this, and see how well his thoroughbreds are treated. He knows the Santa Anita deaths, whether or not tied to medication, have turned public opinion against racing.

And that opinion can be powerful.

In the early 1900's, moral outrage about gambling and corruption in the sport led to the shut down of tracks across the country.

The questions now are, where will the public's concern about dying horses lead?

And, if racing survives its latest crisis, will medication continue to be as controversial as it has been for many decades? [Copyright 2019 NPR]