Dr. Rick Arthur: CHRB

[image url="http://cdn.bloodhorse.com/images/content/rarthur_large.jpg"]Dr. Rick Arthur[/image]

Dr. Rick Arthur, world-renowned expert in the field of veterinary medicine and advocate for equine health and welfare issues for more than 20 years who currently serves as equine medical director for the California Horse Racing Board, is our guest on a very special edition of Talkin' Horses this Tuesday, December 19, at Noon (ET/ 9 a.m. PT).

Actively involved in racehorse medication and drug-testing issues at the state, national, and international levels for many years, Dr. Arthur has been a member of  the CHRB Medication Advisory Committee since the mid-’80s, chaired the Racing Committee of the American Association of Equine Practitioners, and served on the Quality Assurance Program of the Racing Commissioners International, where he is a member of  the Executive Committee.

Dr. Arthur, who has stated that he believes as much as 80 per cent of drug positives reported today are simple mistakes with no malicious intent that prevent the CHRB from concentrating its time and resources on addressing more serous issues facing the industry, will be answering your questions about these and other issues.

Mundelein, IL:
I am a sophomore in high school, hoping to pursue a career in veterinary medicine, preferably with an equine concentration. Do you have any advice for me or any other student who is wanting to become a vet?

Dr. Arthur: Your number one goal must be to have an exceptional academic record. I have sat on admission committees and can tell you grades are the number one consideration. Most top veterinary schools can fill their classes with 4.0 students, and I’ve seen wonderful candidates with good but not exceptional grades not make the first cut. After grades you need to make sure you know what veterinary medicine is about and the commitment it requires. Equine practice entails a special life-style commitment.

Reston, VA:
If 80% of drug positives are mistakes, what should we do about the other 20%? It seems that a trainer can be caught time after time and receive no penalty other than time away from his horses, still collecting fees and purses. It seems like the punishment amounts to a paid vacation.

Dr. Arthur:
This question is more complicated than one would think. The trainer insurer rule in many ways does a disservice to horse racing. There is seldom a real investigation in a case because the trainer is the responsible party. Real investigation, as was done by the FBI in the Gregg Martin milkshaking case, is very rare. As such, with often times only the laboratory findings and the trainer insurer rule pointing to the trainer, the legal system, at least in California, is reluctant to take a person’s livelihood away for what the non-racing judicial system sees as a technical violation. So you are right, trainers do collect fees and purses and still essentially train the horses from afar. For trainers with multi-state stables, it really isn’t much different than their usual operation.

Alameda, CA:
What is your opinion on taking away of some stalls from trainers for drug violations involving drugs totally banned on race day?

Dr. Arthur:
This is the way it was done in the past. Too bad it still isn’t true today. In the old days, the tracks would not give a trainer stalls or tell him to get his horses off the grounds for any reason. Today, that approach doesn’t work. Just putting Doug O’Neill in the detention barn for a high TCO2 at Hollywood Park brought lawsuit threats from his attorney, court hearings, and legal fees.

Arcadia, CA:
In a recent column in The Blood-HorseBarry Irwin called racing "corrupt to its core" regarding medication. Do you believe this to be the case or an exaggeration?

Dr. Arthur:
If Barry used a word other than corrupt I may have agreed with him. Misguided is a better word. The only justification for any medication is to benefit the health and welfare of the horse. Unfortunately, benefit, health, and welfare seem to be a matter of interpretation. There is too much emphasis in horse racing today on veterinary services and medication. This has led to a rather perverted system where no owner or trainer wants to be left behind. There are stables today where the vet bill is larger than the training bill. In some ways it could be described as an “arms race.” Dr. Jack Robbins and I took care of John Henry from late in his 3YO year until the horse retired. At the time, I estimated his vet bill totaled less than $1000 over 5 years or about $20/month.

The RMTC has taken the approach no horse should race under the influence of medication with the lone exception of bleeder medication for the very real problem of EIPH. Even with regards to EIPH (bleeding), all treatment is banned on race day in all other major racing jurisdictions around the world, and they still have a winner in every race.

Plantation, FL:
What is your opinion regarding the use of anabolic steroids like Winstrol in horse racing? Do you feel they truly have a reasonable therapeutic use or are more often applied simply to build muscle mass?

Dr. Arthur:
The RMTC recommendation would not prevent therapeutic use of anabolic steroids as long as they were not used 30-60 days before racing. This would allow the legitimate use to help horses recover from serious illnesses or if a horse falls off after gelding (castration) which happens from time to time. The real use of anabolic steroids is not to put on muscle mass but to allow the horses to stay “focused” and maintain an appetite in face of hard training.

La Verne, CA:
Is Adequan safe to use in 2-year-olds? How often should it be used? My trainer uses it like water. What is it?

Dr. Arthur:
Adequan is polysulfated glycosamineglycan. I considerer it a very beneficial drug which acts to maintain the integrity of the articular cartilage. The manufacturer recommends 7 treatments at 4 days apart. I used to recommend Adequan weekly for extended periods for certain horses. It is expensive. You should be able to find a website that would better explain the action.

Guaynabo, Puerto Rico: 
In my country, the bleeding problem is present on 98% of the horses. Lasix does not work on 90% of the horse and additional medication is used to minimize it such as Vitamin K, Amilcar, Dicynone, etc. The hemoglobin, HCT and MVC is lowered at levels with hydration of the horse. Still the problem persists. What is the reason the drug test does not show positive and trainer get away with illegal drugs and intervention with the horses within the 48 hours pre-race, even though the horses still bleed?

Dr. Arthur:
Ancillary bleeder treatments are allowed in many jurisdictions. I don’t know the rules in Puerto Rico or the testing protocols. Regardless, 50% of the horses show some bleeding even with Lasix.

Bleeding or EIPH is an interesting phenomenon. Historically, you can go back to the grandsire of Eclipse, Bartlett’s Childers (aka Bleeding Childers) who never started because he was such a bad bleeder. Eclipse by tail-male line goes back to 90% of all Thoroughbreds. Herod, another foundation sire of the Thoroughbred breed, was a notorious in and outer. In a race at York, he “burst a vessel” and was beaten off. There are some very interesting physiological theories for bleeding which are too technical to explain here. We do know pulmonary arterial pressure in the running horse is very high, and Lasix lowers pulmonary arterial blood pressure.

Owensboro, KY: 
Do you believe that metabolism of particular drugs vary from horse to horse and leads to some of the positive test results? As a current veterinary student, I'm being taught that there is a particular half-life and time for clearance of medications in general. Could these positive tests come from horses that have slower or prolonged clearance times of these drugs? What can be done to remedy a positive test for these animals?

Dr. Arthur:
This depends on the drug and how it is used, but the general answer is yes. Take flunixin (Banamine) as an example. The RMTC adopted a flunixin threshold based on a certain group of states' recommendation. Problems arose during a phase-in period in California where we were seeing a 5% violation rate. When we went back, the recommendation was based on 3 unexercised horses. Subsequently, we administered flunixin to nearly 30 exercised horses mostly in race training, applied a statistical approach used for drug residue withdrawal times in the meat and milk industries, and developed a recommendation in California. We know we will not call a positive if someone treats a horse within our guidelines, and we know we can prevent the race day administration of flunixin, a primary goal.

Virtually no other commonly used medication has similar data with statistical evaluations. When there is data, there are few numbers and no statistical analysis. For the most part, trainers and practitioners are guessing where the boundaries are in any jurisdiction. The RMTC is trying to address this deficiency by conducting similar studies on other drugs so scientifically based withdrawal times or threshold levels are available. With good information, trainers and veterinarians can avoid unnecessary violations which waste so much of everyone’s time and resources.

Another issue is lack of laboratory standards. Very few labs in the US are accredited to AALA ISO 17025 standards as required of top racing labs such as Hong Kong, HFL in England, or France - which are light-years ahead on many U.S. labs. Many positives over the years occur because labs change their methodology without warning. That is fine for prohibited drugs but shows a lack of comprehension of what we are about for recognized, legitimate therapeutic drugs.

The last issue is the lack of uniformity in medication rules between states. Why does isoxsuprine, an innocuous but easy for labs to find drug, have withdrawal times that vary by weeks between jurisdictions?

Duarte, CA:
Why do we race horses year round? Other major sports have seasons and time off. Wouldn't horses benefit more from a vacation than continued action?

Dr. Arthur:
Horses would benefit from time off. There is good information for this from analysis the relationship between fatalities and training intensity from the California necropsy program. Good trainers give horses time off from time to time as a matter of course

Malibu, CA:
Do you ever think there will be ANY infraction committed against a horse serious enough to ban someone from racing for life?

Dr. Arthur:
Yes, blocking an injury with a local anesthetic to race a horse so the horse won’t feel the pain. Even if you don’t care about the horse, remember almost every dead or paralyzed jockey was involved in an accident where a horse broke down. This may be what it takes. Even though there is no evidence to my knowledge this was anyway related to the Dutrow, Asmussen, Pletcher, and pending Mullins mepivicaine positives, it is the reasons racing jurisdictions must be so unforgiving with such cases.

Nor would I have any qualms about banning anyone from racing for life where there is proof by legal standards a race was fixed. I would be hesitant relying on the trainer insurer rule without corroborating evidence.

To obtain a life-time ban we may have to be willing to include the criminal system. We tried to interest the FBI in the Cole Norman milkshaking case with Top Commander in the 2005 Bing Crosby Handicap. Interestingly, preliminary rulings in the Gregg Martin milkshaking case in New York make clear a U.S. attorney could take a case most anywhere in the US when interstate wagering has taken place within his district.

Cambridge, MA:
People are suggesting we are breeding inferior horses than 30+ years ago. You hear the same story, they raced more, had less injuries, had no problem racing on dirt, etc. Do you believe this is a case that when people look back they remember the good times? Do you think breeding quality is cyclical, sometimes you have great patches sometimes you have rough patches? Do you believe any regulation into breeding standards is needed?

Dr. Arthur:
This is an interesting question. But like everyone else, I am opinion rich and fact poor. My impression is that horses are not as hardy as they were 30 years ago. Having said that, I also believe training patterns have changed. When I was young veterinary student (early 70’s), I was working at the track when Charlie Whittingham worked Cougar II in 1:11 and change. We all talked about it. This last Del Mar there was an unraced two year old worked 1:10 and change twice ( He didn’t win at Del Mar and I don’t know if he is still around). There is less emphasis on horsemanship today and more on medication, veterinary care, and trainer salesmanship.

Cranford, NJ:
Can you explain to the casual observer what is meant by the term 'unsoundness' and how this could destroy the industry in North America?

Dr. Arthur:
Unsoundness means the horse has a musculoskeletal problem which prevents the horse from performing. Most horses are retired because of some unsoundness problem of one degree or another. The best evidence of an unsoundness problem in the Thoroughbred is a 40% reduction in starts per starter in the last 40 years (35 down to 20). Unsoundness is a problem from two directions. One is the economic issue of fewer starts per horse the other is the perception of a sport abusive to the horse. Barbaro and Pine Island would be examples of the latter to the general public even though all of us in horse racing would be confident their connections had sent sound horses into their races.

Richmond, VA:
Should there be a national standard of drugs that are allowed? It is my understanding that each state has a different sent of rules now.

Dr. Arthur:
Yes. The RMTC is working in that direction and the ARCI, a national group, has classified drugs for years by their potential for abuse to influence a race. As of now every state has a little bit different set of rules and how they are enforced.

Paris, KY: 
How realistic is it to have a uniform on-track reporting system for equine injuries? Do you honestly believe trainers will go for this? What do you feel would be the best way to implement such a change: Jockey Club, Breeders' Cup, a new entity?

Dr. Arthur:
There are several approaches that may work. Dr. Mary Scollay from Florida has been working on a format for several years and the Jockey Club has expressed interest in moving that along. There is also the possibility of piggybacking on a jockey injury study with federal funding. Just like everything else in horse racing, there is no entity to make this work. The leaders just have to convince everyone it is a good idea and hope they come along.

Newmarket, England:
What are, in your opinion, the challenges for equine vets in 2007? Can we anticipate any significant advances in technology and treatment methods?

Dr. Arthur:
Veterinarians have become the whipping boys in horse racing in the US. The vast majority of veterinarians do superb work but they end up getting tarred with the same brush as the few problem veterinarians. Trainers are in the same boat and, just like with veterinarians, the same small group of individuals cause the same problems year after year.

On a positive note, advances in diagnostic imaging are very exciting. MRI especially has great promise. Biomarkers to predict impending unsoundness is another promising frontier. There are also advances in track design and maintenance as well as relating biomechanics to track surfaces. If we can put this entire picture together the horse will be the greatest beneficiary. The productivity of the veterinary researchers with support from organizations such as the Grayson-Jockey Club Research Foundation will continue to advance veterinary medicine. In many ways, the success to date of Barbaro’s treatment is the culmination of years of work. This is true from the Kimzey Brace which was placed on his injured leg before he was put in the specially designed horse ambulance on through his treatment to date at New Bolton.

Waco, TX:
Won't geldings be at a disadvantage if steroids are eliminated because of their lower level of naturally produced testosterone?

Dr. Arthur:
John Henry never had anabolic steroids while he was in Ron McAnally’s barn in California. The horses he ran against were the ones at a disadvantage.

I would not be surprised if gelding racehorses became less popular once anabolic steroids become regulated.

Del Mar, CA:
Do you agree with the position of the AAEP opposing federal legislation that would end slaughter?

Dr. Arthur:
As policy, yes; as politics and public relations, no. I told the leadership of the AAEP their arguments were too technical and academic to be effectively explained to the public. I was right. The real impact of this legislation will not be on racehorses. Contrary to what the supporters of the bill say, ex-racehorses are a small number of horses slaughtered.

The horse slaughter issue is really an unwanted horse issue. The question is whether slaughter is an acceptable solution. The cost of euthanasia and disposing of the carcass can be several hundreds of dollars to over thousands of dollars, depending on location plus euthanasia costs. I definitely believe slaughter is more humane than abandonment. Unlike dogs and cats, horses need human care to survive in all but a few areas of free range in the West. To put equine slaughter in perspective, approximately the same numbers of horses are processed for food each year in this country as unwanted dogs and cats euthanized in Los Angeles County, roughly 65,000.

While I personally find the thought repugnant, I have no objection to someone else wanting to eat horse meat. In reality most horse carcasses are processed for either food or fertilizer. I doubt the people eating horse meat are going to be eating broccoli if horse meat is unavailable. From an animaltarian perspective, the slaughter of 65,000 unwanted horses would save 50,000 cattle, 100,000 swine, 300,000 sheep, or several million chickens. Which animal is more important?

FYI-there are more cattle processed every day than horses for the entire year.

The AAEP worked very hard to pass federal legislation to make sure, if horses are to be slaughtered, they be transported and cared for in a humane manner. I made numerous trips to Washington, D.C. myself on this legislation. That was ten years ago and just now the regulations are being implemented. As a practical matter, horses are going to continue to be shipped to Mexico and Canada outside of even those regulations. They are already. California has already outlawed horse slaughter, but rest assured California horses are ending up in slaughter plants as long as there is profit somewhere.

The key issue for racing is to develop rehabilitation programs for ex-racehorses. A number of groups are already doing this, and we need more. It can be expensive. I spent over $10,000 rehabilitating an ex-racehorse of mine to be a riding horse, but it was worth it.

Palatine, IL:
Why did you decide to end your private practice? I assume you took a sizable pay cut to work for the public interest.

Dr. Arthur:
I consider this to be a personal and professional challenge. I have been critical of the way horse racing has been regulated for many years, and this is an opportunity to see if I could do better. I must admit a number of industry leaders lobbied me to take the position.

Most people, even in California, don’t realize the Equine Medical Director is a position within the School of Veterinary Medicine at the University of California at Davis. This was important for me even to consider the job. A key requirement I made before I accepted the position was a research budget. This had not been available to my predecessors and opens up opportunities to investigate a number of critical problems for California.

Yes, it is a big pay cut, but I know I can always find a job somewhere if it doesn’t work out.

San Luis Obispo, CA:
It is apparent to me that there are significantly more catastrophic breakdowns than there were 15-20 years ago. What is the cause...too many racing days, drugs, breeding for speed not durability, training techniques, or something else?

Dr. Arthur:
This question could take up the entire session. In fact, it took two days at the Grayson-Jockey Club Welfare Summit. I encourage you to read the strategic plan. All the issues you mention were discussed at the summit and more. There is plenty of blame to go around.

San Juan, Puerto Rico:
There are some pain killers that are mainly eliminated via excrement; do you know of any jurisdiction that are testing the excrement or is the urine and blood testing enough?

Dr. Arthur:
No, but we have discussed this issue. Excretion in feces is true for a number of drugs passed through the bile. Fluphenazine, a long acting tranquilizer, is another example. Fortunately, LC/MS analysis of blood serum gives us an alternative approach to identify these drugs.

Saddle Brook, NJ:
One of my favorite race horses was John Henry, now 31 years old. Can you translate his age into human years?

Dr. Arthur:
Your guess is as good as mine, but he is very old, certainly in his 90’s. Trainer Noble Threewitt is 95 and still at the track every morning. It must be the environment.

Leonardtown, MD:
As somebody who enjoys owning retired TB racehorses, I just want to thank you for all the work you have done and are now continuing to do at a higher level to protect the horses. You are a hero to many thousands of us who will never have an opportunity to express our gratitude to you, but we are out here everywhere, rooting you on and singing your praises.

Dr. Arthur:
Thank you very much for your comments. I try to do what I think is right for the horse and horse racing. I’ve taken the approach my entire career that, if you aren’t willing to take a position, you will never get anything done. I know I stir up controversy at times, but that is fine.

Alexandria, VA:
Congratulations to you and the RMTC on your progress in the area of drug testing for this great industry. Now that you are ready to take on anabolic steroids, would agree that steroid use for horses that go through the public sales ring is a form of fraud? If so, knowing that the AAEP has already recommended a ban on anabolic steroids in sale horses, why doesn't the RMTC issue a public challenge to the top three sales companies to ban steroids use? When does it reach this point in 1,2,3,4 years?

Dr. Arthur:
There are some practical, and political, considerations in this issue. The first is that horse racing has a mechanism for regulating drugs. Sales companies don’t -  or where they do, they aren’t as well developed. Secondly, urine has been the preferred medium to test for anabolic steroids. Getting urines on a large number of horses such as at the Keeneland September Sale would be impractical. There is preliminary work in Uboh & Soma’s lab at the University of Pennsylvania using blood to test for anabolic steroids. This will solve the logistical problem and make testing large numbers of horses practical.

The market place will drive anabolic steroid testing at sales. The first consignor who guarantees their horses are anabolic steroid free and sees good economic results will make the difference. This could happen very soon. I would be surprised if it takes much more than a year.

Truth or Consequences, NM:
It appears that the most common race day injury in our state is to the front fetlocks. What can trainers do to minimize this injury?

Dr. Arthur:
That is also the case in California where fetlock injuries account for one-half of all fatalities. These injuries are related to hard training, and they are on the rise. At Del Mar this summer, all of the fetlock injuries occurred in horses with a disproportionate accumulation of high intensity furlongs. The very few non-fetlock fatalities did not.

Rochester Hills, MI:
What is your opinion on racing 2-year-olds, especially in regards to the Triple Crown trail? It seems that too many horses are injured during their early careers and never recover. What do you feel is an appropriate foundation for a young horse?

Dr. Arthur:
Several years ago, I had the honor of sitting at dinner next to DRF writer Joe Hirsch. He made a comment that it takes a “bold” trainer to win the Kentucky Derby. He is right, but I’m not sure bold is the right word. The trainers who have the Kentucky Derby as their primary goal have to be willing to take causalities, and they do.

There is a very fine line between too much and too little foundation. I will say you have to have a horse dead fit to win the Derby, and it is a grueling road to get there. You have to start on the road to the Derby as a two-year-old. Someone can check, but I don’t think any horse has won the Derby that didn’t star as a 2YO. The Derby quest costs a lot of good horses. Some trainers can see when they aren’t going to make it, and others are going to keep trying no matter what.

Freehold, NJ:
How is it determined whether to remove a chip from a knee vs. leaving it in as was the case with Skip Away? Do they ever heal without surgery?

Dr. Arthur:
Some very small fractures will heal without surgery, but good clinical evaluation of the progress of the joint is critical.

A key point to remember is that even small fractures can exacerbate degenerative arthritis. Almost all fractures of the knee and ankle would be better off removed arthroscopically and the sooner the better. This is why I had such good success in Dick Mandella's barn with not just arthroscopic surgery but most other problems.

Mt. Gretna, PA: 
Do you believe scientists will eventually find a cure for equine colic? Have there been any recent medical advances in this area?

Dr. Arthur:
Dr. Nat White gave a fabulous Frank Milne Lecture at the AAEP on the advances in our understanding of colic. He made the point that, when he was an intern at UC Davis in the early 70's, they operated 15 horses and lost all of them during a one month period. Today, most horses are operated on uccessfully. There have been tremendous advances, and there will be more.

Unfortunately, the equine gastro-intestinal tract is poorly designed, and we are stuck with it.

Miami Beach, FL:
With regard to the NBA's decision to go back to the old basketball, do you think something similar will happen with the new surfaces we are putting into racetracks across the country? Are we making informed decisions regarding which safer artificial training surfaces to upgrade our tracks to?

Dr. Arthur:
If you are asking whether we are ahead of ourselves with synthetic tracks, I would have to say yes. But what we had, we know wasn't working.

We have been negligent in not obtaining objective engineering and materials data from our traditional racing surfaces. Interestingly, I learned more about Santa Anita and Hollywood Park's turf track when I was in Japan than I ever saw in California. There, trackmen are all graduate engineers.

There is a very good multi-institutional proposal to study the new synthetic tracks in California and possibly elsewhere. We need better research to make informed decisions. I do not believe racing surfaces are the major culprit in the high injury rates. Tracks haven't changed that much in the last 30 years. But the synthetic tracks show tremendous promise. At the just completed Hollywood Park meet, we did not lose one horse during racing on the new Cushion Track! That is impressive and a big step in the right direction.

San Juan, Puerto Rico:
Thank you so much for being with us today and sharing your very valuable expertise. According to your experience, what would be the effect on horses if jockey weights in the U.S. were increased to European standards?

Dr. Arthur:
Force = Mass X Acceleration. I have never seen a horse break down without a rider on him. Admittedly, they will run into fences and other silly things, but the rider weight is a factor.

How much so? It is hard to say. Doing the calculations, it looks to be very little; but the horse is running at the very limit of their physical ability.

Dana Point, CA:
What medications or treatments do you think should be allowed for race horses that currently are not?

Dr. Arthur:
Off the top of my head, I can't think of any that would not be a problem for racing.

We are always trying to balance two issues: what is good for the horse and what is good for horse racing. For example, there would be many horses that would benefit from a very slight amount of tranquilizer before a race, but there is no way that can be allowed or even regulated in a meaningful way.

There will always be new drugs for the horse. If a new bleeder treatment comes along that definitely works, that may be a consideration. FYI- by the RMTC's criteria, Lasix (furosemide) would not be approved for race day use if the drug came up for review today. Why? Horses run faster on Lasix. That is well shown in a number of studies.

Tuscaloosa, AL:
Dr. Arthur, what do you consider to be the number one issue facing the industry today and how do we deal with it?

Dr. Arthur:
Breakdowns are the number one issue. I've always considered them the Achilles Heel of horse racing. The new synthetic track show tremendous promise and there are a number of good ideas which have come out of the Grayson-Jockey Club Welfare Summit.

Without the horse we don't have horse racing.

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