Lasix: Fact and Myth

I’m not sure what compromise solves the Lasix issue for horseracing. The pro-Lasix side is mostly horsemen and vets who believe it is a necessary part of allowing a horse to run to the best of his ability. The Water, Hay, Oats Alliance is in the forefront of the effort to ban the use of Lasix, and performance enhancing drugs by appointing an independent anti-doping program run by the U.S.  Anti-Doping Agency. The motives of the WHOA are to

  • solve the problem of widespread drug use in American racing;
  • put the U.S. in step with international standards.

According to the WHOA, doping destroys public confidence in racing, defrauds the betting fan, weakens the genetic pool and, most importantly, puts the life and limb of horses and their jockeys at risk. They also insist that the various jurisdictions cannot police themselves. The are careful not to call out Lasix by name, but considering it is the only allowable raceday medication…..well, you figure it out.

If you search the WHOA website, you might expect that they would be documenting their position with statistics. But you’d be wrong. Instead, theirs is a populist movement, and the lineup of folks on the WHOA team is pretty impressive.  Instead of dull statistics, their argument is, all these people must have a point. For example, John Koenig, Two Rivers Racing Stable, Owner/Farm Owner says

I think we are at a tipping point. The time for arguing “therapeutic” medications and permissible drugs is over. Regardless of our opinions, the public will never believe running horses on drugs is humane. Further, as we all know, it truly is “chemical warfare” at the racetrack. This has created a crazy arms race that no one can win – expensive in both owners dollars and horses health. At the same time, the industry is dying. This is due to many reasons, but a drug-riddled image is certainly among them. We currently use many legal medications in our stable. Real change would effect us and the way we operate, forcing us to possibly retire or rest horses more frequently. I say good. If outfits like ours are forced to change or disappear because they cannot, so be it. I believe it is the only way racing will survive.

I picked this one because it had some of the common “evidence” for why we need to ban medications and drugs.

  • the public will never believe running horses on drugs is humane. Notice the carefully constructed language. It does not say running horses on drugs is inhumane. It says the public doesn’t believe it is humane. Remember last week’s blog, Opinion and Fact? What is the fact? Drugs are not humane or drugs are humane and we just can’t find a way for the public to believe it?
  • As we all know, it is truly chemical warfare at the track. As we all know? Chemical warfare? The language is inflammatory and pejortive, but certainly not instructional. As they say on law dramas, assumes facts not in evidence. But it does fit nicely with the WHOA agenda where we need an independent and universal drug testing agency.

Here’s another good one from Andrew Kessler, Slingshot Solutions LLC, Substance Abuse Expert

As an advocate working in Washington, D.C. on the subject of substance abuse treatment and prevention, I see every day the damage that drugs can do to a life, to a family, and to a business. As a lifelong racing fan, I am witnessing a collision of my professional expertise and one of my greatest passions. While the policy I work on pertains to human health, I have developed an expertise on what damage unregulated drugs can to do a body. Whether we are human or equine, we deserve to live a life that is free from the destruction caused by illegal drugs, or even legal drugs administered in unsafe dosages. Substance abuse does not damage only those who ingest drugs and narcotics. Amongst people, drug use causes severe economic damage, stemming from increased health care costs, lost economic productivity, and a plethora of other problems. The difference between humans and equines in this regard is negligible. Drugging of horses leads not only to bodily damage, but to economic damage as well, in the form of increased medical costs, and shortened careers. Nothing should be more paramount to the Sport of Kings than the safety of its participants. Every other sport- football, hockey, baseball, etc- are taking part in a movement to place participant safety at a level never before seen. Thoroughbred racing must join in this movement.

I’m going to ask a general question. What the hell does most of this have to do with drugs in horseracing? The damage drugs do to a life, a family, and to a business? Try not to forget there is exactly ONE drug allowed on raceday and that’s Lasix. I don’t know – are horses spending all their pocket money on drugs, keeping their families from having an idyllic life? And then he has the audacity to mention football, hockey, baseball, and leaders in limiting drug use. Are you kidding me? Here are some of baseball’s enlightened standards

Drug Initial Test Level (ng/mL)              Confirmation Test Level (ng/mL)

Cocaine Metabolites                           300                                                 150
Opiates/Metabolites                        2000                                               2000
Phencyclicdine (PCP)                             25                                                     25
Cannabinoids                                             50                                                      15

You know what the standards are for these substances in horseracing? Zero. The presence of a stimulant in baseball is considered a positive only if the level exceeds 250 ng/ml. That would be 250,000 picograms/mL. Remember Kellen Gorder was nailed with a 49 picogram positive for meth. I wonder how many baseball, football or basketball players could pass post-race testing after a game?

Here’s another part of the baseball drug policy. If a doctor says a drug is a medical necessity (say testosterone for all you A-Rod fans) it is allowable. Does that policy sound like anything in racing? I’ll give you a clue. Lasix. And let’s not even get into football. Anyone remember Tony Romo getting painkiller injections in his ribs in four straight games? Anyone remember the outcry from fans of the game? Me neither.

Now before you say Romo could consent, but a horse can’t, sure that’s a legitimate point. But that totally understates the issue that comes up in horseracing – that performance enhancing substances are affecting the outcomes of events. Did the fact that Romo was able to play instead of some backup affect the outcome of the event? I’m sure we all have an opinion on that.

I’ve had the WHOA and HANA people take shots at me, saying things like horseracing is more “wholesome” without Lasix, or why do horses need drugs for something they were bred to do? Honestly, if wholesomeness is your best argument, you really aren’t making a positive case. As for breeding, as we’ll see in a moment 300 years of breeding has left the breed with an undeniable defect. They bleed under racing stress. Somehow it is supposed to be a truism that withdrawal of Lasix will be in the best interest of the horse, and although WHOA is a little thin with the details, this really translates as no horse in less than perfect health gets to run. Sort of the Olympic equivalent of asthmatics should stay home. And what this really translates to is there may not be nearly enough horses to run at the hundred or so race tracks operating in North America. Smaller tracks will be driven out of business, and whether WHOA is on board with this, there are organizations that think this can fix one of racings really big problems – too many tracks and too many marginal tracks running marginal racehorses. I didn’t make this up – horsemen who have talked with me all believe this is an agenda.

Exercise Induced Pulmonary Hemorrhage (EIPH) refers to the rupturing of blood vessels in the lungs during racing or training. EIPH is measured numerically on a scale from 0 to 4, where 4 represents a horse with blood covering the entire trachea.

Let’s talk Myths and Facts.

Myth: The only bleeders of concern are those that show epistaxis, or discharge of blood from the nostrils.

Fact: Prior to the perfection of the fiberoptic endoscope, the only visible symptom of bleeding was epitaxis. However the endoscope proved that the bleeding starts in the lungs. The great majority of racehorses will show some level of bleeding in their careers. Dr. Ken Hinchcliff, a major force in EIPH research, proved EIPH affects the majority of racehorses, with 50-70% confirmed bleeders. If you scope a horse after three successive strenuous workouts, nearly 100% will show signs of EIPH. And as a horse ages, the potential for bleeding increases. In essence, if a horse races long enough he’ll probably bleed at some point.

Myth: Lasix is a performance enhancing drug and as such should be banned on raceday.

Fact: Horses that suffer bleeding cannot breathe properly and most certainly performance will suffer. In fact, even a grade 2 EIPH is likely to affect performance. If the inferrence is that Lasix is performance enhancing in the same way say amphetamines would be, it doesn’t really make physiological sense. Lasix allows a horse to run to the level of his ability because their breathing is not going to be impaired. If a study shows a horse runs faster on Lasix than without, I believe the scientific explanation is, DUH! Lasix does lead to the elimination of excess fluids, which once again allows the horse to run to the peak of his own ability. Lasix is not like Popeye’s spinach, where gulping a can turned him into a super sailor. It is not a stimulant. The alternative to Lasix is denying food and water for 48 hours. That has the same effect as using a diuretic – weight loss due to the elimination of water weight. If you think some trainers won’t deny food and water if Lasix is banned. you’re dead wrong. And if you think PETA won’t replace WHOA as the voice of cruelty to race horses (HEADLINE: TRAINERS STARVE RACEHORSES), well you don’t know PETA either,

Myth: If Hong Kong, Europe, Japan and Dubai can race without Lasix, so can we.

Fact: I’ve been through the explanation of why we aren’t Hong Kong (860 races a year) or Dubai (23 racing days per year) numerous times. North America runs more races in a month than those jurisdictions run in a year. Some jurisdictions will allow Lasix but only after evidence of epistaxis, which is evidence of serious crisis. Trainers in both Australia and Europe will use Lasix during training regularly. Do I need to repeat that?  Lasix is not banned in Europe for training. If you think European horses don’t bleed, think again. They do, pretty much at the same rate as the breed in general. And lest you think the Euros are above racing on Lasix, plenty of them show up in the U.S. and race on Lasix when they do.

Myth: Racing is underfunded to test for drugs and medications, unlike the Anti-Doping Agency.

Fact: According to RCI’s own statistics, over 324,000 blood and urine tests are done each year on racehorses. Racing jurisdictions spend $35 million a year on testing. The Anti-Doping Agency spends $1.6 million on testing. So the WHOA idea is to pass $35 or so million dollars to an agency completely ill-equiped at the moment to take on something of the maginitude of racehorse testing in 38 jurisdictions. And where does WHOA think all the testing is going on? At a lab far superior some of the high level testing labs (like LSU or UC Davis)? Like most of the WHOA plan, we’ll worry about the details later. RCI statistics show almost 99.6% of the horses test clean. Out of the 324,000 plus tests, 47 revealed a positive for a Class 1 or 2 substance. In 2014 the current heinous drug, cobalt, showed up positive in only six tests. TCO2, the standard for milkshaking, showed positive in 14 cases in 2014, and most of them were not milkshaking but, feed, dehydration or a Lasix bump. The only explanations are that either compliance is high and the testing program is having a discouraging effect on illegal drug use, or horsemen are pulling a fast one on testers. I’ve had people insist the trainers are drugging away, and the reason they are getting away with it is that labs aren’t testing for those substances. As I’ve noted, it’s a small community and it would be hard to keep that secret from the authorities for long. Under any definition of the term “chemical warfare” those statistics are not supportive.

Myth: Lasix masks other medications.

Fact: Rick Sams, who directs HFL Sport Science Inc. in Lexington, KY said, “That concern is largely eliminatied when [Lasix] is administered in a tightly controlled environment, as it is in the United States. It’s impact on past-race testing is not very significant.” In other words, Lasix given four hours before a race at 10cc or less isn’t a masking agent, especially considering the sensitivity of modern tesing equipment.

Myth: Lasix weakens the breed.

Fact: I believe this is in part the epigenetic argument, which I wrote about in this blog  The other part has to do with the average number of starts per horse per year. The argument goes something like, since Lasix has been an approved drug, starts have decreased. This may be a spurious correlation. It could be specifically related to changes in trainer behavior. Not that long ago, trainers raced their horses into condition, and now they put them on the track race ready. Many owners select trainers based on win percentage, and if you are giving your horse two or three races to get in shape, your percentage is not looking good. However, if the presence of Lasix has created a situation where horses are not strong enough to start less, then we should see horses in Europe or Australia averaging more starts per year than the U.S., but it’s not the case. Average number of starts per year per horse in the U.S. is slightly over 6. That compares to 3.77 in Ireland, 4.82 in Germany, 5.01 in France, 5.33 in England, and 5.64 in New Zealand. Only Australia is comparable to the U.S. with 6.14. If absence of Lasix made the breed stronger, wouldn’t this show up in the statistics for places that ban raceday Lasix? The point is that the average number of starts is more likely correlated to trainer behavior and the significant drop in foals born than Lasix. It’s misdirection.

Myth: The public is anti-Lasix.

Fact: A lot of people believe exactly that, although I don’t know how many of them are die-hard horseplayers. But Lasix is not steroids and it is not amphetamines and it is not a Class 1 controlled substance. It is a therapeutic medication given to horses with a condition called EIPH. If it is a performance enhancing drug, it is only in the sense that a horse runs better when it isn’t suffering through pulmonary bleeding. It does not cause a horse to run beyond its natural ability.

I’d like to think that the vast majority of horseplayers see Lasix for what it is, and considering 98% of horses are on it, which horse is gaining an advantage? In my opinion, only the one who would be without a job if it couldn’t have its EIPH controlled. I’d ask some different questions before deciding what to do with Lasix.

  • What impact will it have on the treatment of horses to ban Lasix? Is Lasix actually more humane than the alternatives?
  • Will racing suffer with even smaller fields?
  • Will the number of available race horses decrease to the point where many smaller tracks are run out of business?
  • Is there not room for compromise as I proposed in my blog, To Lasix or Not to Lasix?