Tuesday, June 30, 2009

Lasix works: No cheerleading necessary

A groundbreaking study proves that furosemide (often known by the brand name Lasix) does just what its proponents always touted: It enhances the racing performance of thoroughbreds by reducing the incidence of exercise-induced pulmonary hemorrhage.

That's more like what the lead paragraph should be of a story reporting that study's findings at The Blood-Horse online. Instead, the magazine/Web site adds a phrase to its lead for which there is no claim made by the study and little or no actual evidence from the study to support: "furosemide does more than enhance performance in thoroughbred racehorses; it also has beneficial effects on the health and welfare of those horses."

I will go on record as being a fence-rider at this stage on the subject of Lasix. I'm not against it outright and I'm certainly not among those who fear that Lasix is the hidden factor that is leading to fragile bones in thoroughbreds. But I do believe it would be best for horses and for the sport if there were some way to race without any race-day meds. (And they do race without meds in virtually every jurisdiction other than the U.S. and Canada.)

But The Blood-Horse's lead paragraph reads to me -- and I do this for a living -- like someone plugging for the drug's use and not the work of a publication that is simply trying to factually report the study's findings. And maybe that isn't surprising, considering The Blood-Horse is operated by the Thoroughbred Owners and Breeders Association, whose board of directors has considerable membership and influence from the The Jockey Club. And, the Grayson-Jockey Club Research Foundation was among the contributors that financed the study; small degrees of separation that should be noted for readers when The Blood-Horse reports on the study's results.

The Daily Racing Form's reporting of the study -- which is more thorough and objective (The Blood-Horse calls its unbylined piece an "edited press release") -- goes into the study's specifics in greater detail. The headlines on the two are also an interesting contrast. The Form is direct and factual: "Study finds that Lasix reduces bleeding." The Blood-Horse's headline is considerably less specific, open-ended and reads more like a drug company wrote it: "Study shows furosemide has beneficial effects."

This is not to say that the research is flawed or offers fraudulent information. That appears not to be the case.

I've read the study as it will be printed in the Journal of American Veterinary Medicine myself, as you can online.

For the first time, researchers set out to specifically study whether furosemide had the intended beneficial effects of controlling pulmonary bleeding (which some horses suffer under extreme exertion) on a controlled population of racehorses, when administered on race day.

And it did.

Researchers included: Kenneth Hinchcliff, professor and dean of the faculty of veterinary science at The University of Melbourne; Paul Morley of Colorado State University (who undertook earlier research of furosemide's effects by simply reviewing past-performances of horses on- and off-Lasix); and Alan Guthrie of the University of Pretoria in South Africa.

The study used 167 thoroughbreds racing in South Africa. Each horse was raced twice, in fields ranging in size from nine to 16 competitors, once using furosemide and once without. And researchers determined that "horses were substantially more likely to develop EIPH" when racing without the furosemide than they were when administered the drug.

Case closed, at least in the debate of whether administering Lasix helps EIPH-prone horses -- known as "bleeders" -- perform better when racing.

But where is the evidence -- as The Blood-Horse's story reads -- of having "beneficial effects on the health and welfare of the horse?" ... It isn't there, certainly not in so many words. And such claim was in no substantial way inferred by the authors of the study. (How their press release, received by The Blood-Horse and not by me, happened to be phrased, I don't know.)

If The Blood-Horse reports that "furosemide does more than enhance performance in Thoroughbred racehorses; it also has beneficial effects on the health and welfare of those horses," I need to see evidence in the study of precisely that.

To me, that passage reads as though there was some additional, surprising finding in the study, perhaps that furosemide unexpectedly protected horses from some airborne contagion or healed them of a seemingly unrelated malady. That isn't the case.

In fact, the term "welfare" appears nowhere in the entire study, and the word "health" only appears once, when researchers state that "EIPH is believed to adversely affect the overall health of racehorses." I suppose it is not, then, a quantum leap to say that treating a racehorse with furosemide for his propensity to suffer EIPH is better for the health of that racehorse. And from there, the next hop, skip and jump apparently lands the writers on the words "and welfare" as tagalongs for "health."

Treating a racehorse for his EIPH is good for the health and welfare of that horse.

But you know what foreign jurisdictions have found is also beneficial to the health and welfare of the racehorse who happens to be a bleeder?

They don't race bleeders.

Not racing horses who are prone to EIPH (and whose performance suffers greatly as a result) likely has the additional effect of not chemically-inflating the performance of horses who have a significant physical flaw -- the predisposition to bleed in the lungs under exertion. Thus, top runners in Europe, Japan and elsewhere are more likely to be those whose track performance wasn't restricted by their suffering from EIPH. And it isn't much of a stretch, then, to wonder whether that means the horses who are champions and destined for stallion careers overseas are thus not bleeders, and not as prone to passing along to their foals a predisposition to suffer from EIPH.

That should be the next study.

But back to the subject of neutrality in reporting this study.

While The Blood-Horse leads with a phrase implying that furosemide is good for the overall welfare of the horses who take it, the study's "Conclusions and Clinical Relevance" -- in effect, the what you should know about this study part of the document -- does not attempt to make that case.

It reads: "Results indicated that prerace administration of furosemide decreased the incidence and severity of EIPH in Thoroughbreds racing under typical conditions in South Africa."

So furosemide works as-advertised when used as a race-day medication. End of story. Anything else is educated conjecture and the study's authors state it as such, writing that EIPH "is believed" (i.e., not proven by the study) to affect the "overall health of racehorses."

This might seem like picking nits. But to me as both an experienced journalist and a fledgling horseman, it's serious business.

The results of this furosemide study -- performed by a global cast of scientists on a well-documented population of racing thoroughbreds in South Africa -- are important and valuable enough without The Blood-Horse cheerleading those results by phrasing their coverage of the study in terms that go beyond the findings of the study itself.


  1. Excellent summary.

    A further aspect that should be noted is the primary reason why Furosemide is banned in other racing jurisdictions (and for human athletes, btw) in the first place: it makes it impossible to detect certain types of doping. Which also means that the study's conclusion that "its use in racehorses might be justifiable, assuming that other regulatory and policy issues important to the integrity of the sport are adequately addressed." (p. 81) is somewhat eating itself. Furosemide makes it harder to address integrity issues. By extension, this quality may indeed make it one factor in the (not quite that mysterious) "Mystery of the porcelain leg", albeit an indirect one.

    One more point: the study shows that Furosemide considerably lowers the likelihood of suffering from EIPH in THIS race, but it may also mask the existing problem just well enough for the horse not to attract proper veterinary attention before the next start.

  2. My concern (not so much of an objection) with Lasix and all drugs is that trainers seem to give the drugs (and vets enable them) without ever even caring whether or not the drug is actually helping them. Case Study A: Rick Dutrow and Big Brown. When asked about the steriod (yes a legal one), Dutrow admitted he had no idea whether or not it helped.

  3. A great point, Gordon. I'll also never forget that. Dutrow admitted he didn't know what Winstrol really did, nor whether it helped. But he let the vet give it to the horse routinely.

    Lasix is administered to 90 percent of horses raced in the U.S. Some percentage of that -- probably a fairly large percentage -- are connections who simply think, "If your horse is on it, mine needs to be on it."

    Of course they have to be identified as a bleeder, but that doesn't take much.

  4. You've said it much better than I did. A careful read of the study shows it is most effective on SEVERE bleeders, and if 92 percent of U.S. racehorses fall into that category, we're in trouble. Also, it doesn't discuss any possibly negative side effects from repeated lasix use, and it doesn't examine any alternative treatments (like limiting stress and changing the training environment to avoid pollutants).

  5. I think that Gallop France hits the nail on the head - http://www.gallopfrance.com/blog/2009/07/01/about-that-lasix-study/

  6. Here is my problem with the study and how it is being reported by the racing media:

    (1) They think it is some kind of justification for the use of Lasix/Salix;

    (2) One of the participants of the study said, "The results do not diminish other factors"...not a quote, just a summation;

    (3) Peter Lurie (sp?) of HRTV was gushing about this report. (I like him and Race Day America, but...), but he thought it was great news;

    (4) These drugs are diuretics!!!! They bleed the system of water! Tough concept for the athletic body to handle with the necessary hydration needed to compete, perform, etc. Duh!

    (5) Why does no one in the competitive horse world get this? (a) I've got a bleeder, and (b) I'm gonna juice this horse to the point that it won't bleed in the lungs, but also won't have the hydration necessary to compete properly (or ethically). Another Duh!

    Bottom line...your horse needs drugs?...it doesn't need to compete.

  7. Agenda agenda agenda

  8. I'm not sure why university researchers in Australia and South Africa would have an agenda to promote furosemide. Unless you're saying they're on the take from a pharmaceutical company.

  9. Glenn...horses don't talk or pay the bills; the humans that own them do and the other humans involved get the cash from same. Like I said, while the drug may impede bleeding in the lungs (which brings up the fitness and/or genetic debate), the drug(s) seriously impedes hydration and electrolyte balances in the athlete.

    Here's a question (maybe it's in the study and I'll check): Who paid for the study? Look deep and closely because it can be confusing to figure out in the short term or surface.

  10. (Reposted to clean up returns)

    It isn't hard to find at all (with the exception of whomever "private donors" might be). It's at the bottom of page 1.

    "From the Faculty of Veterinary Science, University of Melbourne,Melbourne, VIC 3030, Australia (Hinchcliff); the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523 (Morley); and the Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, Gauteng, Republic of South Africa (Guthrie). All authors contributed equally to this study.

    Supported by the National Horseracing Authority of South Africa, Phumelela Gaming and Leisure (Pty) Ltd, TecMed (Pty) Ltd, Racing South Africa (Pty) Ltd, the Grayson-Jockey Club Research Foundation, the Racing Medication and Testing Consortium, the Thoroughbred Racing Trust of South Africa, and private donors.

    The authors thank Graeme Hawkins, Elvarde van Zyl, Eddie Smith, Rob de Kock, Dr. Duncan MacDonnald, Dr. Dale Wheeler, Dr. Cindy Harper, Dr. Melvyn Quan, Dr. John Grewar, Dr. Patrick Page, Dr. Rosie Gerber, Dr. Cynthia Donnellan, Dr. Robin Moore, Dr. Karin Kruger, Stellest de Villiers, Anette Nel, Ilse Vorster, Roehan Sutherland, Taelo Sibi, Dr. Rick Sams, and Dr. Schalk de Kock for technical, logistic, and administrative assistance.

    Address correspondence to Dr. Hinchcliff.

  11. This story broke my heart (again) as a fan of racing and my love of champions. Yah. I get it, crap happens. Reminds me of Secretariat's demise, laminitas...but honestly, it disturbs me more than the loss of this champion or others to some other level. No, I'm not advocating a smoking gun, but seriously...this just doesn't make sense to me and like Glenn, his (LR) breeding/pedigree was lost too soon. I have three that don't do anything but eat and breathe with similar old line breeding, etc.

    How is it that champions like Secretariat, Lawyer Ron, Alydar get diseases/conditions that are seemingly observable (feeling for heat, off their feed, etc) at some of the premier farms in the US and wind up dead before their time? I'm stupid, but understand that horses can turn on a dime in the wrong direction. Who's watchin' the farm?...literally.

    Yes, crap happens. But I just don't get it. And such a waste for many reasons. Thanks for the memories LR. You will be missed more than many in the racing world will ever understand.

  12. There is just soooo much to respond to and unfortunately, the decline of the thoroughbred/race industry and it's microcosm that is the VA industry can't be resolved with the input of just Craven, Petty and a nobody like me. I'll start with the obvious. There is no way in hell that those in Richmond will willing give that money back (or share, for that matter) to the VA horse industry. Face it. They don't care. Factor in the money required to own a horse, the economy, cost of maintaining rural real estate, tax code and an antiquated blue-law mentality for many reps in Richmond...racing is screwed in VA. A better question for me is, of the top performers (owners, breeders) based in Virginia, what do they think? Better yet, what do they do? I know...they breed and train/race almost entirely out of State. We couldn't even get a license plate in honor of Secretariat because it failed to get the minimum number of advance orders (a measely 300, I think). Isn't the Horse Center in Lexington struggling? As to a Commonwealth Stud, wouldn't that be tied to purses? Wouldn't that require cooperation among adjoining states? Wouldn't that require extending the racing at CD? Sorry, but I don't see that happening. What I'm saying is that you'll find no majority support from Richmond or surrounding racing jurisdictions. It's going to be hard to bring the TB race game with it's associated breeding/ownership with it's former glory back to the Old Dominion for several reasons. Richmond is just one reason. The one thing that has some glimmer of hope is the point-to-point, steeplechase and sport horse area; very user friendly and a good day of sporting for all, albeit low-key.

    Best of luck on your quest.

  13. The above post ended up in the wrong thread, somehow. I'm going to recategorize it into the right one.


I welcome comments, including criticism and debate. But jerks and the vulgar will not be tolerated.