The road to hell is paved with good intentions. With time, we can often see the wisdom in this familiar axiom. As we reflect on events in racing in recent years, an image of misdirection becomes clear: the supporters of therapeutic medication had only the best of intentions when they started down that road. At the time, it all seemed neatly justified and relatively benign. Racing on dirt surfaces and in extreme weather conditions placed physical demands on American horses far beyond those experienced by their international counterparts. American horses raced more often and the resultant musculo-skeletal injuries were preventing them from performing to their inherent ability. Non-steroidal anti-inflammatory drugs such as phenylbutazone and Banamine, and some prednisone or similar steroid to reduce inflammation in aching joints, tendons, and ligaments, the supporters argued, would simply help horses withstand the rigors of frequent racing. Eventually, muscle relaxers, bronchodilators, and even tranquilizers found their way onto the growing list of approved therapeutics. Furosemide, a diuretic known now as Salix, may be the quintessential example of good intentions gone awry with therapeutic medications. Salix was believed to alleviate or prevent bleeding (exercise-induced pulmonary hemorrhage), and it quickly became the accepted race-day treatment throughout the country. New York, in fact, was the final jurisdiction to permit it in September 1995. Again, the pro-medication argument from some corners seemed strong enough at the time. Research had demonstrated that most Thoroughbreds bleed at some point in their careers, even if the amount is quite small (based on endoscopic examinations). Horses were bypassing New York to race in states that allowed race-day Salix. Management would benefit from increased field sizes and overall handle; the horsemen and veterinarians would be satisfied; and of course, the horse would benefit. Approximately 90% of all starters at New York Racing Association tracks now race with Salix. The costs associated with its regulation are substantial, yet its value as a race-day medication remains questionable. If the research and recommendations in support of Salix are valid, one must wonder how so many horses managed without it in New York for so long. Since its legalization, the average field size has not increased, nor have the number of starts per year or total career starts. Ultimately, we must ensure the integrity of racing, and many within our industry agree that therapeutic medications must be strictly regulated. But therein lies the rub: there has never been agreement on how to effectively achieve this control on a uniform and national basis. Testing methods and so-called "acceptable drug concentrations" (without effect on performance) varied; there were disagreements among racing commissions and laboratories. With little scientific support and limited resources, jurisdictions with rather permissive policies found it practical to look less critically at each sample. In some jurisdictions, the use of liberal combinations and amounts of these "therapeutic" drugs became de facto standard treatment. There was little or no consequence--except to the horse. Who was hurt by this pervasive movement toward more medication in the guise of therapeutics? The racing public and the industry as a whole have been damaged, but the real loser has been the horse. Certainly, the intentions were only to help the horse and industry, but here we are nonetheless. It took years to reach this point, and it will take many more to correct our course. A comprehensive effort by the Racing Medication and Testing Consortium is under way to define and provide informed direction for the use and control of medications in the racehorse. Though well-entrenched beliefs, resistance to change, and limited scientific information may slow progress at times, even initial, small accomplishments will significantly benefit the industry. The success of the consortium is paramount, not only for the health and well-being of horses racing today but also for the long-term future of the breed. Hopefully, this effort will pave a road that goes in the proper direction.DR. TED HILL is The Jockey Club steward at NYRA tracks and a member of the Racing Medication and Testing Consortium.