COMMENTS ON LASIX
RULEMAKING
Submitted by
New York
Thoroughbred Horsemen’s Association
May 14, 2012
TABLE OF CONTENTS
Introduction 1
I.
The
Case for Lasix 2
A.
Lasix
is not like other medications 3
B.
The
vast majority of horses bleed; it’s inhumane
to
withhold therapeutic medication 5
C.
Lasix
does not mask the presence of other medications 5
D.
Horse
racing already has the strictest medication rules of
any
sport 6
E.
The
use of Lasix does not have a significant effect
on the
marketability of North American-bred horses 8
II.
Cost-Benefit
Analysis of Lasix Use 10
A.
The
annual cost of Lasix usage 10
B.
The
costs of alternatives to Lasix 11
C.
The
impact of racing without Lasix on horses and on
fan
perception. 13
III.
How
could a Lasix ban be introduced? 14
A.
Two-year-olds
only 15
B.
Beginning
with foals of a specified year 15
C.
Stakes
races 16
D.
Reduction
in allowable dosage levels 16
E.
“Grandfathering”
in horses currently racing on Lasix 17
F.
Alternatives
for proven bleeders 17
IV.
The
costs of a Lasix ban 18
V.
Lasix
and two-year-olds: the prophylactic effect of
early
Lasix administration. 18
VI.
Racing
fans’ perceptions of Lasix and other medication use 18
VII.
Likely
trainer reaction to a Lasix ban 19
A.
Medication
alternatives 19
B.
Non-medication
alternatives; withholding water and
nutrition 19
C.
Ease
of detection for Lasix alternatives 20
VIII.
Beyond
Lasix: recommendations on overall medication policy 20
A.
NYTHA’s
position on recommended changes 20
B.
Owner
and breeder responsibility for violations 22
C.
Mandatory
recovery periods 22
D.
Use
of painkillers during training 23
Conclusion 23
Introduction
On April 30, 2012, the New York State
Racing and Wagering Board (the “Board”) requested comments regarding the use of
furosemide (marketed for equine use under the trade name Salix, but generally
referred to in the industry as “Lasix”) for racehorses and on equine medication
policy in general.[1]
Specifically, the Board issued an advance notice of proposed rulemaking
regarding Lasix and seeking comment on seven specific questions about Lasix in
particular and equine medication policy in general.[2]
Briefly, the Board’s questions address the following issues:
1.
Cost-benefit
analysis of Lasix use;
2.
Possibilities
for introducing a ban on Lasix without causing major hardship;
3.
Costs
of a ban or limitation on Lasix, and who should bear those costs;
4.
Prophylactic
effects of Lasix use;
5.
Impact
of Lasix use on racing fan support;
6.
Possible
trainer reaction to a Lasix ban and likely substitutes for Lasix; and
7.
Other
medication policy changes that might be implemented.
The New York Thoroughbred Horsemen’s
Association (“NYTHA”) is the officially designated representative of Thoroughbred
owners and trainers racing at tracks operated by the New York Racing
Association (“NYRA”). This submission represents the official view of the
horsemen and women who race at Aqueduct, Belmont and Saratoga and who provide
the product on which New York’s reputation as the premier racing jurisdiction
in the United States is based.
We urge the Board to consider the
views of the members of the industry with the utmost seriousness, and to take
into account the wealth of scientific evidence attached to this submission,
documenting the therapeutic benefits of Lasix use, the significant negative
impact of a ban on Lasix, and the other medication policies that the Board
could adopt to improve racing’s image as well as the fairness of racing, while
at the same time attending to the welfare of the horse.
Not all medications are the same. The
call for “drug-free” racing misses the point. What we should be seeking is
racing that is safe, for both horses and riders, that is fair, and in which no
one has the opportunity to gain an advantage through the use of illegal,
performance-enhancing medications. By all means, the Board should go after the
cheaters, but it should not harm the horse in the process.
In fact, NYTHA itself has put forward
a plan for further curtailing the use of true performance-enhancing drugs on
the racetrack. In our letter of April 13th, 2012,[3]
addressed to NYSRWB Chairman Sabini, we advocated three new rules limiting the
use of painkillers, clenbuterol and corticosteroids. We also advocated
codifying the existing practices of having Lasix administered on raceday only
by veterinarians employed by the racetrack or the State and continuing to ban
all “adjunct” bleeder medications, permitting only Lasix. These proposals
address real issues to protect the health and welfare of the horse and to
reduce the use of artificial performance-enhancing medications.
The Case for Lasix
Race horses bleed. We’ve known this
since at least the early 18th century, when a brother of the
foundation stallion Flying Childers was given the nickname “Bleeding Childers”
because of his propensity to bleed from the nose after exercise.[4] And
they bleed without regard to geography; bleeding is not limited to North
America.[5] Without
Lasix, some amount of bleeding occurs in a minimum of nearly four out of five
horses.[6]
Other studies put the percentage of horses showing evidence of bleeding after
exercise at 90% or more.[7] Some
investigators put the percentage of horses that will show some evidence of EIPH
over their careers at virtually 100%.[8] With
Lasix, the percentage of horses showing even slight bleeding drops to 57%, and
the severity of bleeding decreases in virtually all cases, reducing the
likelihood that bleeding will prevent a horse from performing to the best of
its natural ability and that severe bleeding will prove fatal to the horse.[9]
More specifically, bleeding, or
exercise-induced pulmonary hemorrhage (“EIPH”), interferes with oxygen exchange
between a horse’s respiratory system and its bloodstream. Decreased oxygenation
of the horse’s blood can result in decreased oxygen supply to various organs
and contribute to fatigue, organ damage, metabolic disturbances and,
ultimately, breakdowns on the racetrack, when fatigued muscles can no longer
cushion and absorb the shock that is increasingly placed on the tendons,
ligaments and musculo-skeletal system of the horse.[10]
It’s not just Thoroughbred racehorses.
Bleeding affects quarter horses, standardbreds, barrel racers, in short, any
horse that is asked for short-term extreme performance. A Thoroughbred,
especially when racing more than six furlongs, goes into “oxygen debt” as the
race progresses. In these circumstances, even minor pulmonary bleeding can
substantially interfere with a horse’s ability to run its race.
A.
Lasix is not like other medications
Lasix works. According to the
definitive South African Study,[11]
horses that were treated with a placebo (saline solution) were 7 to 11 times
more likely to exhibit Grade 2, 3 or 4 EIPH than horses treated with Lasix.
That represents a very significant increase in the likelihood that, without
Lasix, a horse will not be able to perform up to its natural ability. In New
York, episodes of external bleeding have declined by more than 76% since Lasix
was introduced in 1995.
Lasix does not artificially improve a
horse’s performance above what the horse could naturally accomplish. Rather,
the use of Lasix permits a horse to perform to the best of its natural ability
– not to perform above that ability. “No amount of Lasix can make a horse run
faster than its natural ability,” according to Dr. Scott Palmer, speaking at
the “Lasix Summit” at Belmont Park in June, 2011.
The use of Lasix actually benefits a
horse’s health and its improves potential for a longer career on the racetrack.
As detailed below, the effect of EIPH is almost certainly cumulative. Each
episode of bleeding both creates scar tissue, reducing the horse’s
oxygen-carrying ability, and increases the risk of future bleeding. With each
rupture of the capillaries in a horse’s lungs, scar tissue forms, rendering the
horse more exercise intolerant and more and more likely to bleed with each
successive exertion. Thus, a horse treated with Lasix from the beginning of its
career will necessarily have a greater chance of running more races than either
a horse that is never treated with Lasix or one that is not treated with Lasix
until it has shown clinical signs of bleeding.[12]
The question of whether a particular
medication is therapeutic (i.e., treats a physical condition) or
performance-enhancing (i.e., makes a horse run faster or further) is
misleading. The answer is almost always – both. Science has shown that horses
suffering Grade 2 EIPH can have their performance impaired by 2.3 to 6.1
lengths compared to those running without bleeding. Thus, if the use of Lasix
reduces the level of EIPH from Grade 2 to Grade 1, as the South African study
shows it can, the horse is likely to run several lengths faster than when it
raced and bled without Lasix. It is clear that the use of Lasix is
performance-enabling, not performance enhancing. Horses don’t run faster
because of Lasix; they run slower due to bleeding
Except for narcotics and other
substances possessing no therapeutic value whatsoever, the dichotomy of
“therapeutic” vs. “performance-enhancing” is a false one. Racing regulators,
relying on the best available scientific findings and advice, must find an
appropriate balance between preserving a horse’s health and facilitating that
horse’s ability to safely compete. Generally, in North America, that balance
has been found by permitting raceday Lasix and banning raceday painkillers. We
believe that is the right balance.
Lasix does improve the performance of
horses; it alleviates EIPH, which then allows the horse to run to its full
potential.
B.
The vast majority of horses bleed;
it’s inhumane to withhold therapeutic
medication.
As indicated above, the vast majority
of Thoroughbred racehorses bleed as a result of exercise at or near their physical
limits. When a horse bleeds to even a moderate degree, well short of epistaxis
or visible bleeding from the nose, it will suffer internal distress, struggling
to get sufficient oxygen. In extreme cases, horses have been shown to die from
EIPH[13] –
deaths that can be averted through the use of Lasix. When a horse dies on the
track, the incident endangers its jockey as well as other horses and riders in
the race; with Lasix, that danger is effectively eliminated. In the
“gold-standard” Jockey Club-sponsored South African study cited earlier,[14]
not a single horse that received Lasix before racing showed visible evidence of
Stage 3 or 4 EIPH, the levels that are generally considered to represent
immediate danger to the horse. In New York, since raceday Lasix use was
approved in 1995, the incidence of epistaxis, or visible bleeding, has declined
by 76%.
In the light of the proven discomfort
to the horse and the proven link between extreme EIPH and equine mortality, the
use of Lasix represents a compassionate response to the needs of most horses.
To withhold a proven therapeutic remedy could well be seen as cruelty to
animals. The leading North American organization of equine veterinarians, the
American Association of Equine Practitioners (“AAEP”) fully accepts this
reasoning, and has adopted an official position supporting the use of raceday
Lasix.
C.
Lasix does not mask the presence of
other medications
In the past, critics of Lasix use
have argued that Lasix hides or masks the presence of other medications in a
horse’s system, thereby compromising post-race drug testing. While this may
have been true at the time that Lasix use was first introduced in North
American racing in the 1980s, such is not the case today. Leading veterinary
testing experts now agree that the sensitivity of modern testing methods has
increased enormously. As Dr. Thomas Tobin, one of America’s most distinguished pharmacologists
and toxicologists, stated in a letter to NYTHA President Richard Violette,
“Lasix does not in any way interfere with plasma concentrations of drugs, and
as such does not in any way interfere with the testing process in blood.”
Moreover, even in those jurisdictions that test only urine, not blood or
plasma, Dr. Tobin notes that “under the Lasix [testing] protocols in place
today, there is no significant interference whatsoever with urine testing for
drugs.”[15]
With the strict guidelines for
administration of Lasix that are now in place – Lasix is administered only by
NYRA veterinarians and not closer than four hours to race time – there is no
possibility that Lasix will “mask” or interfere with testing for other
substances.
D.
Horse racing already has the
strictest medication rules of any sport
In the major racing jurisdictions
like New York, equine testing labs analyze samples from the racetrack for the
presence of more than 900 separate chemical compounds. With advanced
technology, such as the spectrometer that NYTHA paid for and donated to the
state’s official testing lab, run by Dr. George Maylin, toxicologists can now identify
virtually all known performance-enhancing drugs. As Dr. Tobin noted, there is no interference
with such drug testing as a result of Lasix use. The challenge for equine
toxicologists today is not to detect other medications despite the presence of
Lasix; that’s already been accomplished. Rather, the challenge is to develop
tests for emerging new drugs, such as synthetic EPO, gene therapy and the like.
To focus on Lasix as a testing problem would be to ignore the very real issues
in contemporary drug use. Like the Board, NYTHA wants to eliminate the cheaters
in racing. But the way to do that has nothing whatsoever to do with Lasix.
Rather, as noted below, it turns on developing scientifically valid testing
protocols, adapting regulations to the actual science, and then adopting firm,
consistent enforcement guidelines.
A recent report by the Association of
Racing Commissioners International (RCI)[16]
makes the point that Thoroughbred racing in North America is already subject to
the most aggressive drug testing program of ANY professional sport, testing for
more substances, with greater sensitivity, than baseball, football, or even the
often-praised World Anti-Doping Agency standards for international athletics.
Yes, Lasix is not permitted in many other sports, but those sports are
contested by humans, not horses. The difference in physiology thoroughly
justifies a difference in medication classification.[17]
Compared to New York, which tests for
over 900 different substances, post-race drug testing in Europe and elsewhere
is rudimentary. The European Scientific Committee’s list of prohibited raceday
medications and detection times[18]
includes barely two dozen drugs, compared to the 900-plus that New York tests
for. To claim that European racing is “drug-free” misstates the reality, which
is that European and other international racing, with a few exceptions, is
largely test-free.
According to the RCI, "In 2010, 324,215 biological samples
were taken and tested. Lab results show that 99.5% of those samples were found
to contain no foreign or prohibited substance. In other words, only 1/2 of 1%
of samples tested was found to have contained a substance in violation of the
rules. An examination of racing commission data also reveals that, in those
relatively rare instances when a violation of a medication rule does occur,
most were associated with a legal substance administered in the normal course
of equine care by a licensed veterinarian and cannot be characterized as 'horse
doping' or as indicative of a 'drugging.' Those substances that could
legitimately be construed as a 'horse doping' (RCI Classification Categories I
and II) represent just 47 instances out of 324,215 samples tested in 2010. That
represents 0.015% of all samples tested. The use of terms like 'rampant,'
'endemic,' 'widespread,' 'chemical warfare,' or 'racing's drug addiction' do
the sport and the tens of thousands of families who rely on it a great disservice."
"Horse racing's anti-doping program tests for more
substances at deeper levels than any other professional sport. These facts are
inexplicably ignored by many who wish to opine on this matter and have been
successful in drawing attention to their assertions by spinning negative
headlines about the sport. The perception created is not consistent with the
facts."[19]
The US racing industry as a whole
spends more on drug testing -- $35 million annually – than the entire worldwide
budget of WADA ($26 million). And these efforts have paid off. Despite ever
more sensitive testing, medication violations declined by 20% from 2001 to
2010. Racing regulators and test laboratories are doing an ever better job of
catching the cheaters. Forcing the labs to focus on Lasix would represent a
step backward in racing’s real war on drugs.
E. The
use of Lasix Does Not have a significant effect on the marketability of North
American-bred horses
The Board’s Notice of Advance Rulemaking included the
following statement;
Some
owners and breeders oppose race day Lasix. Heredity is a factor in EIPH. Lasix
keeps horses from being culled from the breeding pool. A single stallion can
have a large impact on the breeding pool. The market for race horses is
becoming more international than ever. With increasing financial rewards for
New York State breeders as a result of VLTs at Aqueduct, the marketability of
New York horses is important, and there is worry that American horses are
losing their standing and value in the international market.
Contrary to the implications of this
statement, North American-bred horses continue to do well. Prices at the
recently completed “select” sales of two-year-olds in training were up
substantially this year, returning to peaks not seen since the collapse of
international financial markets in 2008. While it is true that the quality of
stallions standing overseas has improved in the past three decades, that
improvement is largely the result of sustained buying of North American-bred
stallion prospects by deep-pocketed foreign buyers such as the Coolmore group
in Ireland, the royal family of Dubai, and buyers associated with the Japan
Racing Association. After 30 years of raiding the American market, these buyers
have understandably improved their own stallions and breeding operations.
Nonetheless, they continue to buy at the North American sales and, to an
increasing extent, to race their horses in North America.
One would expect that, if foreign
buyers were shunning North American sales because of the Lasix issue, the
effects would be seen most clearly at the annual sales of Thoroughbred breeding
stock. But, in fact, foreign buyers continue to be the mainstays of those sales.
Lasix has been permitted for raceday use everywhere in North America since 1995,
but US exports of Thoroughbreds continue to rise well into the 21st
century, right up to the present, with a decline in 2008 that was clearly due
to the global economic crisis, not to the presence of Lasix.
Thoroughbred exports to Europe
increased 54.3% from 2003 to 2007. While overall volume declined in 2008 and
thereafter for a time (early results of 2012 sales indicate the market is
returning to its pre-crash levels), the leading sales in the US continue to
draw foreign buyers. In 2008, five of the top 10 buyers at the premier
Keeneland November bloodstock sale were from outside the US: one from Dubai,
two from Japan and two from Saudi Arabia. In 2009, once again, five of the top
10 buyers at the sale were foreigners: one from Ireland, two from France, and
two from Australia. And in 2010, again, five of the top 10 buyers were foreign:
two from Japan, two from Australia and one from England. At the Keeneland
November sale in 2011, two French buyers, two Japanese, one Australian and one
Irish buyer all spent more than $1 million for US bloodstock. The continued
presence of foreign buyers at the top end of the US bloodstock market, long
after US breeding has come to be based almost entirely on horses that raced on
Lasix, offers powerful evidence that Lasix use is not an impediment to the
commercial breeding industry in North America.
This conclusion is even stronger in
the case of breeders based in New York. These breeders have never had a
significant presence in the international marketplace. For a variety of
reasons, including the incentives provided to race New York-breds in New York,
New York-breds appeal primarily to New York and other East Coast horsemen.
Also, there are few, if any, proven turf sires standing in New York, and
European and Japanese buyers are primarily interested in turf racing; hence,
few New York stallions, Lasix or no Lasix, would draw international attention.
Europeans have not, in fact, been
supporting their own breeding industry since the start of the global economic
crisis. The foal crop in England and Ireland dropped by almost 40% between 2007
and 2010, from a peak of 18,472 in 2007 to 12,253 in 2010, with a further drop
to 11,300 estimated for 2011. In a presentation at the Tattersall’s sales
company in June, 2011, Weatherby’s executive director Paul Greeves stated that
“the speed and quantity of the reduction in numbers [of English and Irish foal
crops] is unprecedented in modern times.” He added that there had not yet been
a parallel drop in the number of broodmares, but that breeders were, for the
time being, choosing not to breed their mares, as no market existed for the
foals.
Thus, comments that European buyers
are shunning North American bloodstock because of Lasix use in North America
miss the mark. The declines in European foals crops, evidently, were due to
fundamental economic conditions and had nothing to do with the use of Lasix in
some jurisdictions. If Lasix had been a factor, one would have expected that
European breeders and owners would have relied more on their own bloodstock,
rather than, as they did, continuing their historic ratios of North American to
home-grown horses.
Moreover, there is no scientific
evidence to support the claim that susceptibility to EIPH is a condition that
is being bred into horses, or that horses that have run on Lasix shouldn’t be
allowed to go to the breeding shed.[20]
II. Cost-Benefit
Analysis of Lasix Use
A.
The Annual Cost of Lasix
Pre-race Lasix administration at NYRA
tracks is performed by NYRA veterinarians. NYRA charges the horse owner $20 per
injection. In addition, most trainers use Lasix before a scheduled timed
workout, or “breeze.” Lasix for breezes is generally administered by
private-practice veterinarians, who bill the owner or trainer directly, usually
at $25 per dose. Horses will generally breeze about once a week while in
training at the track, skipping a week or two after a race. Assume that the
average horse starts seven times a year, and that it breezes another 14 times a
year. That makes the total cost of Lasix administration approximately $500 per
year per horse. In contrast, the total cost of keeping a horse in training at
NYRA tracks, even allowing for some time off during the year, is on the order
of $35,000-$40,000 per year.[21] To
earn even a modest profit on the annual training cost, once one takes into
account the trainer’s and jockey’s fees and other costs of racing,[22] a
horse needs to earn about $60,000 per year in gross purses.[23]
Against this overall cost of
ownership, the actual cost of Lasix is insignificant. $500 per year represents
from 1.2%-1.4% of total training costs, much less than the costs of a farrier
(perhaps $1,400 per year, and much more if a horse needs glue-ons or other
special shoes) or of the non-Lasix charges of veterinarians, which are
conservatively estimated at upwards of $3,000 per year and can be much, much
higher.[24]
The annual cost of Lasix is less, in fact, than the cost of transporting a
horse from Belmont to Saratoga and back once a year for the Saratoga meet.
The fact that Lasix is so universally
favored by trainers, many of whom are part- or full owners of their horses, is
in itself convincing evidence that Lasix is a cost-effective solution to the
bleeding issue.
B.
The Cost of Alternatives to Lasix
If Lasix is not permitted on raceday,
horsemen would have only three options: (1) find other medications or training
techniques that help prevent EIPH; (2) retire those horses that prove unable to
compete because of EIPH – estimated at anywhere from 2-5% of all horses; and
(3) give horses additional time off between races. None of these are adequate
solutions, and all of them impose additional costs on owners, trainers, racetracks
and the state, whose income from pari-mutuel wagering would decline as fewer
races are run with fewer horses.
First, the training options. At
present, some jurisdictions permit “adjunct” medication, such as tranexamic
acid or aminocaproic acid, to be administered in addition to Lasix on raceday. If
Lasix were banned, presumably such adjunct medications would also be banned. In
any event, even if trainers were allowed to use adjunct medications, none of
these have proved nearly as effective as Lasix in preventing and reducing the
severity of EIPH, nor have a variety of homeopathic remedies that have been
used in the past. In contrast to Lasix, none of these homeopathic or so-called
“natural” treatments have been proven effective in any scientific test. That
leaves these options: First, a trainer could withhold water, and perhaps food,
from a horse for 24 hours or more before a race. Before Lasix use was
permitted, many trainers did just that, with the result that their horses
arrived in the paddock looking “drawn up.” Surely everyone would agree that
withholding water and food is an inhumane practice, but, denied recourse to a
safe and effective therapeutic medication, trainers might feel they had no
choice. Alternatively, a small minority
of trainers would search for some substance that, while banned for use on
raceday, might somehow go undetected in post-race samples. In contrast to the
proven effectiveness of Lasix, any such unproven substance is certain to be
less effective, more dangerous to horses, and more problematic for post-race
testing.[25] And,
because such substances would be used only by a few cheaters, the relatively
level playing field that now characterizes racing at major-league tracks such
as NYRA’s would be tilted in favor of the rule breakers.
It is impossible to estimate the costs
of these training alternatives. Since we don’t know what alternative medications
trainers would turn to, we cannot put a price on them. But they would cost
something, and, given the low cost of Lasix use, it is unlikely that the cost
of Lasix alternatives could be significantly less than the $500 or so that it
now costs to use Lasix. And, because trainers would be unable to use the
“public option” of having Lasix administered by NYRA veterinarians on raceday,
it is quite possible that higher costs for owners, resulting from greater use
of private vets, could be incurred.
In addition, trainers would
undoubtedly need to use post-race therapy, including antibiotics and hyperbaric
chambers, for horses that bled during races. These therapies would involve significant,
if unmeasurable, costs.
The second cost of banning Lasix
would be the forced retirement of a certain number of race horses who could not
perform effectively without the medication. No one knows how many they might
be, or which horses they might be; the forced retirees could include $7,500
claimers or Grade I-winning stakes stars.
In Hong Kong, where Lasix use is not permitted, from 1-2% of horses are
retired annually because of bleeds,[26]
but Hong Kong treats as bleeders only those horses that present with epitaxis
(visible bleeding from the nose) or with serious (Stage 3 and 4) tracheal
bleeding. And, in fact, the number of horses reported as bleeding in Hong Kong,
even with this limited definition, is far higher than in New York: 6.4% of all
starters, compared to 1% in New York, with Lasix use. Hong Kong and Singapore,
both non-Lasix jurisdictions, report the highest rates of bleeding of any major
racing venues. Remember that, in New York, there has been a 76% reduction in
epistaxis (horses bleeding through the nose) since raceday administration of
Lasix was first permitted.
Third, horsemen would be forced to
drop their horses that bleed to lower competitive levels (e.g., from allowances
to claiming races) so that those horses could be competitive while they were
bleeding.
C.
The impact of racing without Lasix on
horses and on fan perception
When horses race without Lasix, they
bleed more. When horses bleed, they are more likely to bleed severely, to the
point where they bleed visibly and, on too many occasions, die on the racetrack
from bleeding.[27] As Hall
of Fame jockey Jerry Bailey noted on this year’s Kentucky Derby telecast, “I’ve
never had a horse break down in a race because of Lasix.” The impact on the
horse of racing is simple: more horses will bleed, they will bleed more
severely, and some of them will die.
The impact on fan perception is
hardly more complicated. Most surveys of racing fans’ view of Lasix are marked
by seriously flawed methodology. For example, a McKinsey & Co. Thoroughbred
racing consumer survey in 2011,[28]
commissioned by The Jockey Club, found that only 36% of racing fans thought
that “medication is one of the top three issues facing racing,” and that 38%
“would bet more if they knew horses were not being given drugs.” Similarly, in
a 2009 survey by the Horseplayers Association of North America (“HANA”), only
59% of those surveyed reported that they were “extremely concerned” with the
use of illegal medication and drugs.” And in a 2008 survey by the National
Thoroughbred Racing Association (“NTRA”), the top three concerns of racing fans
were reported as being (1) the health and safety of horses; (2)
performance-enhancing medications; and (3) therapeutic overages.
But none of these surveys, nor any
others that have been reported in the press, distinguish between illegal medications,
or illegal levels of permitted medications, on the one hand, and legal dosages
of Lasix on the other. When fans respond to such surveys, explicitly in the
case of the McKinsey Report that referred only to illegal drugs (i.e., not
Lasix), and implicitly in the case of other studies that just referred to
“drugs” without specifying which ones, they are simply not being asked to take
a position on Lasix. Thus, the fan surveys relied on by opponents of Lasix
prove -- absolutely nothing.
The McKinsey & Co. survey asked
questions about drug use in a number of different ways,[29]
yet none of its questions differentiated between Lasix and other medications.
Without such differentiation, its conclusions are essentially meaningless in
the context of a discussion of Lasix alone.
Racing fans and bettors do take drug
use seriously. Dedicated handicappers don’t want illegal drug use to interfere
with their handicapping. They want the race to be run fairly and transparently.
Lasix is not a problem for them; its use is regulated through independent
third-party administration of the medication, and the fact that it is being
used is available in the racing program and all online handicapping sites. Of
far more concern to the bettors is the hidden use of illegal performance
enhancers. Serious and consistent enforcement of medication rules already in
effect, plus the changes suggested in NYTHA’s five-point plan,[30]
would allay the concerns of both serious bettors and casual racing fans. Lasix
has nothing to do with their perceptions.
III. How
could a Lasix ban be introduced?
The Board’s Notice of Proposed
Rulemaking asked for comment on how a ban on Lasix might be introduced,
offering a variety of alternatives.[31]
NYTHA believes that any ban on Lasix would be detrimental to horses and to the
sport of Thoroughbred racing. Nonetheless, we offer the following comments on
the various options offered by the Board.
A. Two-year-olds
only
The effect of EIPH is cumulative; the
more times a horse bleeds, the more likely it is to suffer pulmonary scarring
and to bleed again. It has been conclusively proven that the incidence of EIPH
increases with age.[32]
The reason appears to be that pathologic changes resulting from EIPH start with
mild symptoms at the very back of the lung, then gradually become more severe
and affect more of the lung with each new episode.[33]
While some foreign jurisdictions
claim that their horses “are not bleeders,” that claim is based on a very
different definition of bleeding than the one used in the South African study.
A definition that classifies a horse as a bleeder only when it bleeds through
the nose (epistaxis) will always result in a very small number of horses being
classified as bleeders. This is archaic and barbaric: waiting for a horse to
bleed visibly, in crisis, is irresponsible.
Banning Lasix for two-year-olds only
would merely expose those horses to additional bleeding episodes, thus
increasing the likelihood, and the severity, of bleeding in future years. There
seems to be no logic behind a ban on Lasix only for a horse’s two-year-old
season; the likely effect would be that fewer horses would race at age two.
Since two-year-old racing is a major part of NYRA’s program, especially with
the two-year-old graded stakes at the Saratoga meet, such a ban would
negatively impact both the quality and the revenue-generating ability of NYRA’s
racing program.
B. Beginning
with foals of a specified year
One of the most common proposals for
restricting Lasix use involves a rolling ban, starting with foals of a given
year (e.g., two-year-olds of 2013). In each successive year, an additional
class of foals would be covered by the ban.
Such a proposal has two major problems.
First, for races that are designated
as “three-year-old and up” or “four-year-old and up,” the proposal would
eventually result in younger horses running without Lasix against older horses
running with Lasix. It is still common
to see nine-year-olds running, and running well, at NYRA tracks, so it would be
many years before all races were, in fact, Lasix-free. In the interim, one can
be certain that trainers would be reluctant to run their non-Lasix horses
against older horses. Again, this would reduce field size and, consequently,
revenue to the state, NYRA and horsemen.
Second, the rolling ban only deals
with Lasix, and not with the reality of EIPH. The horses will not magically
stop bleeding because we stop giving them Lasix; the will bleed more.
C. Stakes
Races
A Lasix ban applicable only to stakes races would require
trainers to adapt their practices if they merely thought a horse might qualify
for stakes company. Currently, if you take a horse off Lasix, you can't run
back on Lasix for a minimum of 30 days. Trainers often enter stakes-level
horses in allowance races at some point in the season; should they run in the
allowance race with or without Lasix? Should they risk letting the horse bleed?
How would horseplayers react to a horse that was running on
Lasix one month and off Lasix the next? This certainly would create more
guesswork and frustration for a fan base already shrinking due to competition
for the gambling dollar.
Because all trainers have the option of using raceday Lasix, it
creates a level playing field that will no longer exist if a ban is enacted. As
its use and administration is strictly regulated by the NYSRWB, it ensures the
welfare of the animal, and the integrity of the race for all competitors and
for the betting public. This is important in every race, especially the graded
events that are so vital to the breeding industry.
D. Reduction
in Allowable Dosage Studies
The default Lasix dosage in New York
is 5 cc, although trainers may specify the dosage in a range going up to a
maximum of 10 cc. Generally, the ideal dosage for fillies tends to be somewhat
lower than for males. In the South African Study, all horses receiving Lasix
were given a dosage of 10 cc.
If Lasix is allowed at all, there
would seem to be no point in reducing existing dosage levels. Trainers are the
best judges of which dosage level works for their horse; too much will, as a
result of Lasix’s diuretic effect, remove too much water from the horse’s
system, thus impairing its racing ability. Too little will merely be ineffective
in preventing EIPH. This is a case where a little Lasix may be more dangerous
than just the right amount.
E. “Grandfathering” in horses currently racing on
Lasix
This proposal is essentially the same
as the rolling ban, beginning with a specific foal crop, discussed above. The
only difference is that a few unraced two- and three-year-olds would be unable
to use Lasix, even though their age peers that have already raced would be
allowed to continue on Lasix. For the same reasons discussed above with respect
to the rolling ban, this is an impractical idea.
F. Alternatives
for proven bleeders
Since virtually all horses bleed, the
meaning of “proven bleeders” needs to be defined before one can discuss
alternatives for them. In many jurisdictions that impose mandatory rest periods
or that bar horses that “bleed,” the term essentially means horses that display
epistaxis, or visible bleeding from the nose. If that definition is applied,
then anywhere from 1% to 6% (the latter figure reported in Lasix-free Hong Kong)
are classified as bleeders. If Lasix is used, then there are virtually no
“bleeders” in that sense.[34]
In the absence of a clear
classification, then discussing alternatives for “proven bleeders” makes little
sense.
IV.
The costs of a Lasix ban
This topic is fully discussed above,
at pp. 11-13. To summarize, there would be substantial additional costs, both
in the health of the horse and in dollars spent by owners and trainers, all of
which would be unnecessary if raceday Lasix use is permitted to continue.
Additionally, there would be at least
a short- and medium-term reduction in field size. Because betting handle is
directly proportional to field size, any reduction in field size reduces
betting volume, which in turn reduces the amounts received by Thoroughbred
owners in purses, by NYRA for its operations, and by the State in the form of
taxes.
The most significant cost is the
devaluation of the horse. We already have enough physical issues with
Thoroughbreds; they are very fragile. To add another issue, bleeding, to the
list when we have a scientifically proven remedy does not make sense and will
drive owners away in droves.
V.
Lasix and two-year-olds: the
prophylactic effect of
early Lasix administration
As stated earlier, the effect of EIPH
is cumulative; the more times a horse bleeds, the more likely it is to suffer
pulmonary scarring and to bleed again. The incidence of EIPH increases with
age. The reason appears to be that pathologic changes resulting from EIPH start
with mild symptoms at the very back of the lung, then gradually become more
severe and affect more of the lung with each new episode.
The faster a horse runs, relative to
its natural ability, the more likely it is to suffer the effects of EIPH. Thus,
introducing Lasix from the beginning of a horse’s career is the most effective
way to minimize the incidence and severity of EIPH over the horse’s career.
VI.
Racing fans’ perceptions of Lasix and
other medication use
This topic is also fully discussed
above, at pp. 13-14. Many fans are, quite rightly, concerned with illegal drug
use in racing. But no study has shown that fans or bettors are concerned with
Lasix per se. What we can be sure of, however, is that fans will react
negatively to the sight of a horse lying on the track bleeding to death. And
that’s a sight that can be easily avoided by allowing the continued use of
raceday Lasix.
VII. Likely
trainer reaction to a Lasix ban
Most
trainers play by the rules. As the RCI report on medication violations[35]
indicates, the overwhelming majority of horses that are tested are clean. As
long as the rules are clear and precise, the Board can expect that almost all
trainers will try to comply with them.
A.
Medication alternatives
In most jurisdictions where Lasix is
not permitted on raceday, trainers may still use the medication in between
races. Where Lasix is not permitted on raceday, trainers still use a variety of
other medications. To date, none of these alternative medications have proven
nearly as effective at reasonable cost as Lasix. If a better alternative were
available, one can be sure that trainers would be delighted to adopt it.
Specifically, the most likely
alternatives would be the various “adjunct” medications that are already prohibited
in New York, such as tranexamic acid,
or the already illegal “Kentucky Red”
(Carbazochrome) that was widely used before Lasix was permitted (and is still
used in Dubai, among other jurisdictions).[36]
A ban on raceday Lasix would
undoubtedly trigger a rush to find and use substances that have some effect of
EIPH, but that are not yet the subject of equine toxicology testing. Such medications
would almost certainly be less effective than Lasix while at the same time
imposing additional burdens on the testing labs to develop new test protocols,
thus diverting funds and resources that could be better used to improve the
testing of substances that do have performance-enhancing effects, such as gene
therapy and synthetic EPO.
B.
Non-medication alternatives;
withholding water and
nutrition
Prior to the legalization of Lasix,
many trainers tried to reduce the incidence of EIPH by withholding water, and
sometimes food, from horses scheduled to race in the next 24 to 48 hours. Apart
from the obvious cruelty of such an approach, withholding food and water is
simply less effective than Lasix and usually results in a horse’s being less
able to perform up to the limits of its natural ability.
Another possible approach is the use
of external nasal strips to improve breathing. Scientific evidence of the
impact of such treatment on EIPH is lacking, and the strips are, at the moment,
prohibited in New York. A ban on Lasix would undoubtedly increase pressure for
the use of nasal strips in racing.
C.
Ease of detection for Lasix
alternatives
As noted earlier, the sensitivity of
modern equine toxicology testing is extremely high. Known medications, such as
the “adjunct” medications, are already tested for. The testing problem that
would result from a Lasix ban concerns the unknown medications – new
formulations for which it would be necessary to create new tests. Where an
existing medication – Lasix – is safely administered by track or state
veterinarians and can be easily monitored, it seems counterproductive to invite
a new “arms race” that will require more spending and more staff to police.
VIII. Beyond
Lasix: recommendations on overall medication policy
A.
NYTHA’s position on recommended
changes
While NYTHA strongly believes that
raceday Lasix use should continue to be permitted, we do urge the Board to take
additional steps to further solidify New York’s position as the most drug-free
jurisdiction in the US. As outlined in
our letter of April 13th to NYSRWB Chairman John Sabini,[37]
we advocate three additional rules, in addition to continuing the current ban
on “adjunct” raceday medication and continuing the current NYRA policy of
having third-party administration, by either the racetrack or the State, of
raceday Lasix.
The three new rules that we recommend
are:
1.
Replacing
the current withdrawal-time rule for Bute with a 2 mcg threshold testing level;
2.
Instituting
a 15-day withdrawal time for Depo-Medrol (methylprednisolone acetate) and a
four-day withdrawal time for all other corticosteroids; and
3.
Instituting
a seven-day withdrawal time for clenbuterol.
Bute’s anti-inflammatory effect can
mask the presence of injury that can lead to musculo-skeletal failure and
catastrophic, often fatal, breakdowns. Below certain concentrations, however, Bute
simply will not be effective in masking pain. The proposed 2 mcg threshold
level is well below the level that would materially affect a horse’s
performance and well within current testing capabilities.
Depo-Medrol is a particularly potent and
long-lasting corticosteroid, generally administered by injection as an
anti-inflammatory to address musculoskeletal conditions,
including the pain and lameness associated with acute localized arthritic
conditions and general arthritis. It has also been used to treat equine rheumatoid
arthritis, osteoarthritis, periostitis, synovitis, tenosynovitis, tendinitis
and bursitis. Other corticosteroids, both topical and injectable, are often
used to treat arthritis-type conditions and a wide variety of other conditions.
Because corticosteroids are treatments of
existing medical conditions, rather than preventatives like Lasix, NYTHA
opposes their use on raceday. Generally, a four-day withdrawal period should be
adequate to ensure removal of the medications from a horse’s system, although
the American Quarter Horse Association and the US Equestrian Federation mandate
a seven-day withdrawal period before competing. Because of Depo-Medrol’s
long-lasting effect, we would suggest a 15-day withdrawal period.
A majority of trainers use clenbuterol, which
is not a steroid, but rather a bronchodilator and decongestant, from time to
time in training to ensure that their horses have clean airways. Because clenbuterol, like other medications
that are banned on raceday, treats an existing condition, we support the ban on
its use. We believe, based on the veterinary evidence and discussions with Dr.
George Maylin, that a seven-day withdrawal period would be adequate to ensure
that clenbuterol would have no material effect on raceday.
As these suggestions show, NYTHA fully
supports rational, fact-based efforts to limit medication use on the racetrack
and to assure a level playing field. What we do not support is making
medication decisions based on feelings or intuition that fly in the face of the
scientific evidence.
B.
Owner and breeder responsibility for
violations
Owner responsibility for drug
violations has been suggested at various times as a means of guaranteeing that
owners will not patronize trainers who misuse medications; if an owner suffers
sanctions, so the theory goes, the owner will be more likely to police the
trainer.
We disagree. The owner of a horse
that tests positive for illegal medications already suffers the serious
consequence of losing the purse money for the race. In most cases, that means
the owner will have to dig into his or her pocket, since the positive test
report will come well after the purse money has been made available by the
horsemen’s bookkeeper. To add additional sanctions on top of losing the purse,
such as a suspension of the owner or of the horse, is unlikely to result in any
greater vigilance on the part of owners. If owners were in a position to fully
police medication use, they would have to be in their horses’ barns as much as
the trainers. That is simply unrealistic.
These comments regarding owners apply
with even greater force with respect to breeders, who are far removed from
involvement in the racing careers of horses that they have bred.
NYTHA does, however, support the
concept of having breeders and owners contribute to the safe, healthy
retirement of race horses, perhaps by means of mandatory payments for foal
registration by breeders and payments by each new owner when a horse changes
hands. Such a system would go a long way to address the very real crisis of
thoroughbred retirement.
C.
Mandatory recovery periods
The
horse is the innocent party in any illegal medication incident. While it is
completely appropriate to penalize a trainer for a medication positive,
penalizing the horse – and the owner – by imposing a mandatory recovery period
on the horse in all cases of medication violations seems unnecessary.
Track
veterinarians already have the authority to put horses on the “vet list” when
they see evidence of a physical issue with a horse, and to require that the
horse breeze in the presence of the vet before being entered again. That
solution is the appropriate one, and is more attuned to the specific needs of
each horse. While some jurisdictions, e.g., Hong Kong, impose mandatory
recovery periods for epistaxis, in our view the better solution is to leave the
decision as to whether a horse is fit for racing in the hands of the track
veterinarians.
D.
Use of painkillers during training
Very
few jurisdictions bar the use of painkillers during training. The difficulty in
imposing a blanket ban is that it is entirely appropriate to treat various
injuries with painkillers while the horse remains in the trainer’s barn at the racetrack.
As long as the painkillers are not used to mask injury while the horse is being
asked for maximum exertion, there is no reason to deny the horse the pain
relief offered by medications such as Bute, banamine and certain
corticosteroids. Provided, of course, that in all cases, the medications are
used far enough before raceday so that no significant amounts remain in the
horse’s system at post time.
Conclusion
For
all the reasons stated above, NYTHA strongly supports the continuation of the
current Lasix rules, including mandatory administration of raceday Lasix by
NYRA or State veterinarians at least four hours prior to racing and in dosages
within prescribed limits. To change the rules and bar Lasix would be to inflict
unnecessary harm on the Thoroughbreds that we care for and to impose
unnecessary costs on owners, trainers, NYRA and the State itself.
Respectfully
submitted,
Richard A. Violette, Jr., President
New York Thoroughbred
Horsemen’s Association
INDEX TO EXHIBITS
1.
NYSRWB Cover Letter 4/30/12
2.
NYSRWB Request for Comments 4/30/12
3.
NYTHA Letter to NYSRWB RE: Drug
Policy 4/13/12
4.
Efficacy of furosemide for prevention
of exercise-induced pulmonary hemorrhage in Thoroughbred racehorses
(aka The South African Study – funded by The Jockey Club)
Hinchcliff, Morley and Guthrie. July 1, 2009
- Sudden
death attributable to exercise-induced pulmonary hemorrhage in
racehorses: Nine cases (1981-83)
Gunson, Sweeney and Soma July 1988
- “AAEP” PUTTING THE
HORSE FIRST: VETERINARY RECOMMENDATIONS FOR THE SAFETY AND WELFARE OF THE
THOROUGHBRED RACEHORSE
- “AAEP” CLINICAL
GUIDELINES FOR VETERINARIANS PRACTICING IN A PARI-MUTUEL ENVIRONMENT
8. Overview
of EIPH, Prevalence and Impact on Horse Health
Ed
Robinson/Matilda R. Wilson/College of Veterinary Medicine/Michigan State
University
- TO
RACE OR NOT TO RACE: THE LASIX ETHICAL DILEMMA
Dr. Thomas Tobin DVM
10.
TRANSCRIPT FROM KENTUCKY HORSE RACING
COMMISION HEARING ON NOVEMBER 14, 2011
11.
Exercise –Induced Pulmonary
Hemorrhage
Hinchcliff Kentucky Equine Research 2009
- Exercise-Induced
Pulmonary Hemorrhage in Horses: the Role of Pulmonary Veins
Derksen, Williams & Stack, 2011
13.
Furosemide reduces accumulated oxygen
deficit in horses during brief intense exertion
Hinchcliff, McKeever, Muir and Sams May 1996
14.
Effects of furosemide on the racing
times of Thoroughbreds
Sweeney, Soma, et. al. May 1990
15.
HAVEMEYER FOUNDATION EQUINE WORKSHOP,
March, 2006
16.
Workshop: EIPH Findings, Parts I-III
January 1992
- Letter
from Thomas Tobin, DVM re bone weakening. 12/7/2011
- Fracture
risk in patients treated with loop diuretics
Rejnmark, et. al. November 2005
- Dr.
McNamara Letter to NYSRWB 5/5/12
- Summary
of Bleeder Data from Hong Kong Jockey Club
Dr.
Brian Stewart DVM, June, 2011
- RCI: RACING’S DRUG
“PROBLEM” OVERSTATED
Drugs
in U.S. Racing – 2010/The Facts
22.
WORLD ANTI-DOPING CODE/2011
PROHIBITED LIST/INTERNATIONAL STANDARD
23.
WADA, Therapeutic Use Exemptions
- U.S. ANTI-DOPING
AGENCY: ATHLETE HANDBOOK AND EXAMPLES OF MEDICATIONS
THAT ARE NOT PROHIBITED
25.
MAJOR LEAGUE BASEBALL’S JOINT DRUG
PREVENTION AND TREATMENT PROGRAM
26.
NATIONAL FOOTBALL LEAGUE’S LIST OF
PROHIBITED SUBSTANCES
27.
UNIFORM CLASSIFICATION GUIDELINES FOR
FOREIGN SUBSTANCES AND RECOMMENDED PENALTIES AND MODEL RULE
28.
FEI 2011 Equine Prohibited Substance
List
29.
EUROPEAN HORSERACE SCIENTIFIC LIAISON
COMMITTEE: Detection times
2011
30.
McKinsey & Co., Consumer
Perceptions About Medication and Integrity, October 2011
31.
Outlawing Lasix won’t stop the
bleeding
6/24/11 by Steven Crist
32.
Brisnet-Handicapping Insights
9/16/11 by Dick Powell
33.
Would medication ban be form of class
warfare?
8/1/11 by Steve Montemarano (posted
on Paulick Report)
34.
Medication Committee Corner: Are We
Winning the War the Lasix War
The Horsemen’s Journal – Fall 2011 –
Kent Stirling
35.
Ignoring scientific research on Salix
could prove costly
Kent Stirling
36.
Banning Lasix is Wrong for the Horses
Chris
Wittstruck, USTA, May, 2012
[1] Open
Letter from NYSRWB, April 30, 2012 (Exhibit 1).
[2] NYSRWB, Advance Notice of Proposed Rulemaking, April
30, 2012 (Exhibit 2).
[3] See
Exhibit 3.
[4] Derksen,
Williams and Stack, Exercise-Induced
Pulmonary Hemorrhage in Horses: the Role of Pulmonary Veins, Vetlearn.com,
Compendium: Continuing Education for Veterinarians, April, 2011 (Exhibit 12).
[5]
Testimony of Dr. Alice Stack, DVM, at Kentucky Horse racing Commission, Race
Day Medication Committee, November 14, 2011, p.8 (Exhibit 10).
[6]
Hinchcliff, Morley & Guthrie, Efficacy
of furosemide for prevention of exercise-induced pulmonary hemorrhage in
thoroughbred racehorses, 235 JAVMA 76 (July 1, 2009) (hereafter, “South
African Study”) (Exhibit 4). This research study, the most complete to date on
the effects of Lasix (furosemide), was sponsored by the Grayson-Jockey Club
Research Foundation and the Racing Medication and Testing Consortium, among
others. It is the first, and thus far the only, study of the effects of Lasix
to adhere to generally accepted scientific methodology based on a comparison of
the effects of a medication (Lasix) with the effects of a placebo. Earlier
studies, using less precise methodologies, had estimated the incidence of EIPH
at anywhere from 44% to 75%. See, e.g.,
Mason, Collins and Watkins, Effects of
bedding on exercise-induced pulmonary hemorrhage in racehorses in Hong Kong, Vet. Rec. 1984; 115: 268-269; Raphel and
Soma, Exercise-Induced pulmonary
hemorrhage in thoroughbreds after racing and breezing, Am. J. Vet. Research
1982:43: 1123-1127.
[7] Derksen,
et al., supra Note 4.
[8] Stack, supra Note 5, at p. 10.
[9] Id. At 80.
[10] Dr.
Brian McNamara, submission to NYSRWB, May 8, 2012. (Exhibit 19).
[11] Supra, Note 6.
[12] Stack, supra Note 5.
[13] See
Exhibit 5.
[14] See
Note 6.
[15] See
Exhibit 5; See also testimony of Dr.
Rick Sams, DVM Kentucky Horse racing Commission, Race Day Medication Committee,
November 14, 2011, p.87 (Exhibit 10).
[16]
Association of Racing Commissioners International, Drugs in U.S. Racing 2010: the Facts, (September 2011). See Exhibit
21.
[17] See,
e.g., the lists of permitted and prohibited substances of WADA (Exhibit 22), WADA’s
standards for “therapeutic use exemptions” (Exhibit 23), US Anti-Doping
Agency athlete handbook (Exhibit 24),
major league baseball’s joint drug treatment and prevention program (Exhibit 25),
the National Football League’s list of prohibited substances (Exhibit 26),
RCI’s Uniform Classification Guidelines for Foreign Substances (Exhibit 27),
European Horserace Scientific Liaison Committee, list of detection times
(Exhibit 29), and the FEI Equine Prohibited Substances List (Exhibit 28).
[18] See
Exhibit 29.
[20] Stack, supra Note 5, at p. 61.
[21] Zorn, Update: the Cost of Thoroughbred Ownership
in New York, Business of Racing blog, March 1, 2012; available at http://businessofracing.blogspot.com/2012/03/update-cost-of-thoroughbred-ownership.html.
[22] In
addition to commissions for the trainer and jockey, and the $20 Lasix
administration fee, NYRA charges owners the following amounts:
A. Backstretch
insurance (BEST): $12.50 per start
B. Jockey
Club: $2.50 per start
C. Jockey
insurance: 0.9% of the purse, plus $840 per owner per year.
D. Backstretch
pension fund: 1.0% of the purse
E. NYTHA:
2.0% of the purse
F. NYSRWB
Fee: $10 per start.
Trainers generally charge
10-13% of all purse money won by a horse, in addition to their “day rate” of
$90 and up. Jockeys are paid 9.167% of the owner’s share of a win purse and 5%
of the owner’s share of the purse for a second or third-place finish. Jockeys
not finishing in the money generally receive $100 per ride.
[23] See
Note 13 above.
[24] Id.
[25] See Nicky Henderson [trainer for Her Majesty
the Queen] tells vets’ inquiry ‘plenty’
used banned drug, The Guardian, 2/15/2011, in response to positive test for
transexamic acid in one of Henderson’s horses.
[26] See
Exhibit 20.
[27] For
visible evidence of epistaxis-related fatalities on the track, see Exhibit 9.
[28]
McKinsey & Co., Consumer perceptions
about medication and integrity, (October 2011). See Exhibit 30.
[29] E.g.,
“which of these statements about raceday medication do you strongly agree
with;” “How has the thoroughbred industry dealt with performance-enhancing
drugs?” “How likely would you be to support federal legislation to end raceday
medication?”
[30] See below,
at page 20.
[31] See
Exhibit 3.
[32] Stack, supra Note 5, at p. 40.
[33] Id.
[34] See
South African Study, supra Note 6.
[35] See
Exhibit 21.
[36] Stack, supra Note 5, at p. 59.
[37] See
Exhibit 3.
