When is a scientific study not a scientific study? That was a question posed by several panelists during a two-hour session on medication Jan. 25 during the National Horsemen's Benevolent and Protective Association winter convention in Pasadena, Calif.
Panelists and audience members suggested that questionable studies might be the basis for medication policies that affect horsemen and racehorses.
Kent Stirling, chair of the National HBPA medication committee and the executive director of the Florida HBPA, moderated the panel. He began by questioning a study done at the 2013 Breeders' Cup on furosemide by way of introducing Dr. Hugh Townsend, an expert in study design and affiliated with Western College of Veterinary Medicine and the University of Saskatchewan.
Townsend analyzed a Breeders' Cup furosemide study that examined 2-year-olds competing in the 2-year-old Breeders' Cup races as well as those in the Golden State Juvenile and Juvenile Fillies, two non-Breeders' Cup races conducted during the same two days at Santa Anita Park. The study concluded that horses treated with furosemide (also called Salix or Lasix) were more likely to bleed, and bleed more severely than non-treated horses.
Townsend called the study "fatally flawed" and said that "no meaningful conclusions could be drawn" because it did not follow proper study protocol. He noted that the horses were not chosen randomly, it wasn't a blind study, and it didn't include an adequate number of horses.
The rest of the medication session focused on the efforts of the Racing Medication and Testing Consortium to establish a national uniform medication policy. The National HBPA asked for clarification regarding whether the current 24 medications on which the RMTC has established thresholds are the only medications that will be allowed.
"We'd just like to know exactly what the rules are," Stirling said. "Right now we don't know because they seem to be all over the place."
Dr. Dionne Benson, executive director and chief executive officer of the RMTC, explained that the list of 24 medications is not a set list. "There is a lot of misinformation about this list," she said. "We are not stopping at 24."
Benson said she expects other medications to be added to the list as the RMTC develops thresholds for them. Available funding is a limiting factor as to how quickly this could happen.
The question arose as to how each regulatory jurisdiction would handle those medications not on the list. Benson acknowledged that jurisdictions were handling them differently, some going to a zero-tolerance policy and others keeping current regional thresholds in place.
Dr. Thomas Tobin of the University of Kentucky made presentations on behalf of himself and Dr. Steven Barker of Louisiana State University. Barker could not attend the conference due to bad weather in Louisiana.
Barker titled his presentation: "RMTC: Regulating Medications Through Conjecture, Where Did the Science Go?" The paper said regulation of medication should be based on good science and "should permit adequate therapeutic treatment of horses, not limited to the use of effective drugs based on public opinion, emotion, hyperbole, uniformed speculation, and mythology."
Tobin's presentation went further to take specific issue with some of the studies the RMTC has used to establish threshold levels, singling out those on acepromazine and phenylbutazone. Tobin, a medication adviser to the National HBPA, suggested that a Pennsylvania analysis of the RMTC data suggests that the two-microgram level of phenylbutazone the RMTC now recommends would result in an 8% overage rate.
Panelist Dr. Don Shields, a California veterinarian who operates the Winner's Circle Ranch lay-up facility, raised questions about medications not on the RMTC list and others for which tests aren't being performed.
These things need to be spelled out," Shields said. "Uniform medication must allow for quality veterinary care. At the same time, the idea is to protect trainers and veterinarians from inadvertent positives when you're racing across the country. The 24 medications is an excellent start. I am happy to see that this list will be amended from time to time."
After the session Benson spoke about Tobin's criticisms of the RMTC's thresholds on acepromazine and phenylbutazone.
"These are based on significant research," Benson said. "As far as phenylbutazone, it is a threshold that has been in several states for a long time. We've actually had fewer violations with the two-microgram rule than with five micrograms."
She noted that the RMTC is continually trying to get the message out that the number of medications will change as thresholds are developed.
"I have been to probably 15 states in the last year, and I will continue to talk to them and tell them that it is a living document," Benson said. "Obviously, we have very little control over what they choose to do, but we will continue to help.
"The (Association of Racing Commissioners International) is expecting additions. The hard part is that some of these jurisdictions certainly take longer to pass their regulations. That is no fault of their own. They each have a different process.
"Change is hard and it's scary. We don't want people to get trapped by these regulations, but paramount is the safety of the horse and rider."