Competition Horse Medication Ethics

Competition horse medication ethics

Presented at the American Veterinary Medical Association meeting, Boston 2015

Gustafson S, DVM, 918 South Church Avenue, Bozeman, MT 59715

Appreciation of the evolved nature and behavior of horses provides the foundation for the ethical veterinary care of equine athletes. The establishment of a veterinary patient client relationship (VCPR) is instrumental in providing ethical care for the competition horse. Ethical veterinary practice supports the horse’s long-term health and welfare interests while avoiding pharmaceutical intervention in the days before competition.

Horses evolved as social grazers of the plains, moving and grazing in a mutually connected and constantly communicative fashion on a near-constant basis. Contemproary equine health and prosperity remains dependent on providing an acceptable degree of this near-constant movement, foraging, and socialization. When horses are confined to fulfill convenience and performance interests, the horse’s natural preferences need be re-created to a suitable degree to avoid exceeding the adaptability of the horse. As the adaptability of the horse is exceeded, welfare is dimished and the need for medical intervention to remedy behavioral, health, and soundness deficiencies is intensified. Contemporary practices regularly exceed the competition horse’s adaptability, resulting in the need for extensive veterinary intervention to sustain health and competitiveness.[1]

The more medical care and pharmaceutical intervention required to sustain any population of animals the lower the population’s welfare.[2] Ethical veterinary care supports the horse’s best welfare interests, as well as the safety of the horse’s riders and drivers. Medical intervention of the equine athlete should be avoided in the days and hours before competition, as pre-competition medication is associated with increased vulnerability and diminished welfare.[3] To properly support the health and welfare of equine athletes, the practitioner must be familiar with their patients both inherently and individually. Socialization, constant foraging, and abundant daily locomotion are the long-evolved requirements to promote and sustain optimal soundness, behavioural health, performance, and healing in competition horses.

Healthy horses function and perform more consistently and predicatbly in an unmedicated state. Contemporary pre-competition medication practices remove the horse’s ability to protect their health and sustain soundness by masking pain and suppressing symptomology and are therefor heavily regulated. Horses who require medication to alleviate medical conditions in order to compete are rendered vulnerable to injury and physical and behavioural dysfunction imperiling the safety of both horse and horseperson. Horses requiring medication to compete are often not fit to compete safely. Horses and horsefolk are best served to compete free of short-term pre-competition pharmaceutical influence. Infirmities require appropriate medical care and rehabilition before competition is considered and resumed, rather than pre-competition medication to allay active medical problems. The equine practitioner should focus on post-performance evaluations and necessary therapies to sustain horse health on a enduring basis. An emphasis on fulfilling the medical, physical, and behavioural needs of the horse to prepare for the future competitions is the essence of ethical veterinary care of the competition horse. Pre-competition medication practices that replace or supplant appropriate health care are not in accord AVMA Principles of Veterinary Ethics.[4]

For human entertainment, convenience, and revenue, horses are bred, isolated, stabled, conditioned and medicated to perform competitively. Comtemporary pre-competition medication practices are often at the expense of the horse’s health, safety, and welfare. Many current medication practices violate the AVMA Principles of Veterinary Ethics, specifically the clause that states a veterinarian shall provide veterinary medical care under the terms of a veterinarian-client-patient relationship (VCPR).

The AVMA Principles of Veterinary Ethics state that it is unethical for veterinarians to medicate horses without a VCPR. Pre-competition pharmaceutical interventions to remedy insufficient attention and preparation for the horse’s long-evolved health requirements are seldom in the best interest of the horse. The medical and pharmaceutical practices which support equine competitive pursuits should be designed to enhance the health and soundness of the horse on a long term basis and should not be intended to enhance performance.

Pre-competition pharmaceutical intervention has been demonstrated to have an overall negative affect on the health and welfare of competitive horse populations. Where horses are allowed to be permissevely medicated with an VCPR, injuries and catastrophic injuries are more prevalent. Horses are best served to be properly prepared to compete in a natural non-medicated state. Pharmaceutical intervention of the equine athlete should be avoided in the days before competition, as pharmaceutical intervention increases fragility. Intense and widespread pre-competition medication practices correlate with catstrophic injury vulnerability and diminished welfare.[5]

Equine athletic pursuits have historicaly been designed to measure the natural abililty of horses and the trainer’s ability to bring out the horses’ natural ability. Equine competition was originally designed to measure the natural ability of horses rather than their medicated ability.[6] It is important that the welfare and veterinary care of the horse take precedence over economic and human interests. Horses are born to socialize, communicate, locomote, and chew on a near-constant basis. For behavioral and physical integrity, these preferences need to be re-created to an acceptable degree in the competition stable. The ethical practice of veterinary medicine includes providing clients with the guidance to provide appropriate husbandry, nutrition, conditioning, medical management, and behavioural fulfillment of their equine athletes.

Equine welfare is best supported when horses are properly prepared, physically and mentally sound, and fit to perform in an unmedicated state. Physically or behaviourally impaired horses who require medication to compete should not compete until they are able to compete without pre-competition pharmaceutical intervention. All sensation, behaviour, and proprioception should remain physiologically normal. Sensation and cognitive awareness should not be suppressed with pre-competiton medication. This inludes the use of sedatives, stimulants, and pain relievers of all sorts. Treatments should not interefere with functional physiology.

Sound horses properly prepared for competition have little need for pre-competition medication. Unsound or behaviorally dysfunctional horses should be medically and behaviorally rehabilitated in a fashion that restores soundness before training and competition are resumed. Medication is for infirm horses, and infirm horses should not compete. Horses who require medication to compete become increasingly unfit to compete safely. Rather than therapeutic intent, many pre-competition medication practices have become performance enhancing at the expense health and welfare of horse and rider.

It has been demonstrated through time that horses and their riders are best served to compete medication free. As a result, anti-doping laws have been established by all agencies that regualte equine competition. Veterinarians are required by both ethics and law to follow these regulations. Horseracing statisitcs support that the less medication horses receive the more favorably and safely horses compete.[7]

The safety of the competition horse is dependent on unimpaired neurological functioning. Unimpaired sensation and cognitive ability are necessary for a horse to compete safely and fairly. Any medications or procedures which negate or diminish sensation and awareness in the horse impair the ability of the horse to compete safely.[8]

The safety, longevity, and durability of the equine patient should considered before short term pre-competition medical solutions are implemented. Familiarity of the patient includes familiarity with stabling, genetics, behavior, and husbandry of the patient. Many if not most medical conditions are a result of human mismanagement of equine stabling and conditioning. When the adaptability is exceeded, horses become unsound. Assessment of stabling conditions and athletic preparation practices are essential components of ethical equine care. Healing must be allowed to progress before competition and training are resumed. Client education is essential to create a husbandry situation conducive to equine healing. Restoration strategies that recreate the horse's social grazing and locomotion preferences facilitate and potentiate horse healing. Appropriate healing of many equine maladies is encouraged when the veterinarian provides appropriate medical care and carefully facilitates a scenario to provide the horse with appropriate physical rehabilitation and behavioural fulfillment. 

An interdependence exists between horse health and locomotion. Horses evolved to be near-constant walkers and grazers. Horses did not evolve to be confined in stalls and stables, but rather evolved to live and move on a near-constant basis. Despite domestication and selective breeding for docility and captivity, horse health remains dependent on locomotion. Locomotion is inherent to digestion, to respiration, to metabolism, to hoof health and function, to joint health, and to behavioral fulfillment. When horses are deprived of adequate and abundant locomotion, they develop strategies to keep themselves and their jaws moving, as is their essential and inherent nature. Horses deprived of friends, forage, and locomotion are at risk to develop stereotypies to provide themselves with the movement they need to survive. The more stereotypies present in a population of equine athletes, the lower the welfare.

No longer is intense medical intervention prior to competetion a viable, ethical approach. It has been demonstrated that the more intensely horses are medicated to compete, the lower their welfare. The more medications required to sustain any population of animals, the further the deviation from their physical and behavioural needs. Rather than pre-race treatments, the ethical approach includes  performance of exensive post-competition examinations to address any weaknesses or unsoundness as a result of the performance.

Alternatives to precompetition medication with non steroidal anti-inflammatory medication and steroids include fulfillment of the horse’s long-evolved nature. Musculoskeletal soundness is attained by proper breeding, development, husbandry, and conditioning practices. Management of exercise induced pulmonary hemorrhage is achieved by specific daily development of the horse’s pulmonary and cardiac function. Unwelcome competition behaviors are best managed by fulfillment of the horse’s inherent behavioral needs, which include abundant daily socialization, locomotion, and nutrition.[9]

Recommended reading

Chyoke A, Olsen S & Grant S 2006 Horses and Humans, The Evolution of Human-Equine Relationships,  BAR International Series 1560, Archeopress, England, ISBN 1 84171 990 0

Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books

McGreevy P 2004 Equine Behavior: A Guide for Veterinarians and Equine Scientists Philadelphia: Elsevier Limited. ISBN 0 7020 2634 4

Waran N, McGreevy P & Casey RA 2002 Training Methods and Horse Welfare in Waran N, ed The Welfare of Horses, Dordrecht, The Netherlands: Kluwer Academic Publishers, p151-180

Paul McGreevy BVSc, PhD, MRCVS. Equine Behavior, 2004, A Guide for Veterinarians and Equine Scientists. Second Edition, Elsevier; 2012, Chapter 13 Equitation Science

Budiansky, S. (1997). The nature of horses: Exploring equine evolution, intelligence, and behavior. New York: The Free Press.

Hausberger M, Roche H, Henry S, and Visser E.K. “A review of the human-horse relationship” Appl Anim Behav Sci 109, 1-24. 2008

Waran, N. McGreevy, P., Casey, R.A (2007). Training Methods and Horse Welfare, In

The Welfare of the Horse (pp.151-180 ) Auckland, New Zealand

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[1] McGreevy, P.D. (2004). Equine Behaviour: A Guide for Veterinarians and Equine Scientists. Edinburgh: Saunders; 2004.

[2] Appleby M, Mench J, Olsson I, Hughes B (2011). Animal Welfare. CABI, Second edition; 2011. 

Fraser D (2008). Understanding Animal Welfare: The Science in its Cultural Context. Wiley-Blackwell; 2008.

[3] Gustafson S, A Contemporary Approach to Equine Behaviour Education, Proceedings, World Veterinary Congress, 13 October 2011, held in conjunction with the International Veterinary Behaviour Meeting (IVBM).

[4] The AVMA Principles of Veterinary Ethics, https://www.avma.org/About/Governance/Documents/2014S_Resolution8_Attch1.pdf

[5] Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011

 http://www.khrc.ky.gov/Documents/RaceDayMedicationTranscript.pdf

[6] Magner D 2004 Magner’s Classic Encyclopedia of the Horse Edison, New Jersey: Castle Books

[7] Kentucky Horseracing Commission Raceday Medication Transcript, NOVEMBER 14, 2011

 http://www.khrc.ky.gov/Documents/RaceDayMedicationTranscript.pdf

[8] Furr M, Reed S editors (2007). Equine Neurology; Wiley-Blackwell

[9] https://www.amazon.com/Horse-Behavior-Sid-Gustafson-DVM-ebook/dp/B00ILG3JX0/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1507510362&sr=1-1

Dr Gustafson graduated from Washington State University as a Doctor of Veterinary Medicine in 1979. He is a practicing veterinarian, equine behavior educator, and novelist. The application of behavioral science to the husbandry of horses enhances optimal health, performance, soundness, contentment, and longevity. Behavioral, social, locomotory, and nutritional strategies enhance the prosperity, vigor, and health of stabled horses. Sid offers veterinary care, training, husbandry, and conditioning from the horse's perspective to achieve willing and winning equine partnerships with humans.

A Solution to Horseracing's Medication Troubles

http://nyti.ms/1kGbh3Y

On-track pharmacies have the potential to restore racing integrity in America. 

The on-track pharmacy would be the only place drugs are allowed on the racetrack. The attending veterinarian examines a horse and prescribes a treatment. If medication is determined to be part of the therapy, the veterinarian submits the horse’s name, the diagnosis and requested medication to the racing regulatory body. The pharmacist and the regulatory veterinarian evaluate the request and dispense the medication. Everything is recorded; drug, dosage, frequency of administration, expiration date, lot number, brand name, etc.

Veterinarians would not be allowed to drive around the backside with truckloads of drugs, as this current practice has led to indiscriminate inappropriate treatments that have led to breakdowns and doping problems. On-track pharmacies would restore the medication protocols to be decided by veterinarians rather than trainers. 

Currently, trainers in large part decide what drugs their horses receive. With an on-track pharmacy policy in place, if a trainer thinks his or her horse needs a certain medication, a veterinarian would be required to assess the horse, arrive at a diagnosis, and then request the medication from the pharmacy, where further vetting would occur. 

Rather than being utilized as medication technicians, as attending veterinarians currently are, they would again become doctors practicing veterinary medicine. Instead of being paid for drugs they administer, horse doctors would again be compensated for their medical evaluation of the patient.

The pharmacy is the only place medication could be stored or dispensed on the racetrack, other than with the emergency trauma and colic responders. Pharmaceutical manipulation to enhance performance would be eliminated. No drugs would be allowed to come into the track through any other venue. Every horse would be medicated via this process, with the exception of emergency treatments. 

This is the model in Hong Kong, where the breakdown rate is one of the lowest in the world. This policy effectively prevents doping while providing horses with the necessary therapeutic medications to train and race. Every treatment is transparent. The bettors, trainers, owners, and all others are made aware of every treatment for every horse. The result is racing with increased integrity, increased safety, increased public support and increased handle.

The effectiveness of an on-track pharmacy on a wide-scale basis depends on the construct that all racehorses are stabled at the track, at least for a period of time before they run. Horses that are stabled off the track would be able to avoid the pharmacy protocol, unless some sort of stabling island surrounding the track could be established.

In Hong Kong, horses are required to be stabled at the track to race. Modifications to manage American racing could include that the pharmacy protocol, while best serving horses on a continuous basis, would be enforced after horses are entered into a race. This would also allow a gradual implementation of the on-track pharmacy. Protocols to include ship-ins could include prerace testing for horses stabled off track, but as we have seen, testing as a reliable method to manage doping has vast limitations.

Horsemen and veterinarians will oppose this, of course, as it is inconvenient, restrictive, and allows total transparency. On-track pharmacies have the potential, nonetheless, to manage doping and restrict the pharmaceutical manipulation of performance.

It is pharmaceutical manipulation that has caused much of the trouble the industry is having. Injuries to horses and jockeys are often because of doping and other improper medication practices, which also devalue horses, shortening their careers.

The sport was designed to test the natural ability of the horse, and the trainer’s ability to bring it out. Doping and pharmaceutical manipulation have become an integral part of horse racing in America. The breakdown rate in America is many times higher than in Hong Kong, and the ease of pharmaceutical manipulation is a primary reason.

Development of an on-track pharmacy policy is in the best interest of the racehorses, the riders, the players and the owners. It is this system that has the greatest potential to restore integrity to horse racing in America.

Sid Gustafson, D.V.M., is a novelist and equine veterinarian specializing in thoroughbred sports medicine and equine behavior. He currently practices regulatory veterinary medicine, representing the safety and welfare of thoroughbred racehorses. 

Link to the New York Times article by Dr. Gustafson outlining a potential solution to better manage racehorse doping in America to improve the health and safety of racehorses and riders.

Dr Gustafson is an equine veterinarian, veterinary behaviorist, and novelist. Dr Gustafson provides equine behavior and welfare consultations to help recreate the needs and preferences of horses in training and competition.

Racehorse Advocacy, The End of Raceday Medications

Racehorse Advocacy

The End of Raceday Medications 

Sid Gustafson DVM

Equine veterinary behaviorist representing the health and welfare of horses

Thanks to a wide and diverse variety of racehorse advocacy efforts, a review of racehorse raceday medication practices by a variety of racing jurisdictions and organizations is making advancements to support the drug-free welfare and humane care of racehorses. Raceday medications are in the process of being rescinded, as are the indiscriminate and abusive use of drugs in racehorses in general. It has become clear to many that current racehorse medication practices in the United States and Canada exceed the adaptability of the racehorse, resulting in unnecessary breakdowns and injuries and death to both horses and jockeys. Rather than drugs, it is the humane care of racehorses that supports soundness of wind and limb.

A variety of groups have responded to the call by the HSVMA and HSUS to better care for racehorses. The Kentucky Horse Racing Commission invited the HSUS to testify at its raceday medication hearing, and I provided a version of the racehorse advocacy that follows. The Interstate Horse Racing Improvement Act is making its way through the United States Congress, and is supported by several congressional representatives. Make sure your representative supports this important Act. Governor Cuomo has called for an investigation of the New York Racing Association breakdowns. The New York Times is running a series of articles exposing the medication charade that has endangered horses and riders for decades in America. The Breeder’s Cup committee has banned raceday Lasix for two-year-olds racing in this year’s Breeder’ Cup.

Drug-free racing will improve stabling, conditioning, and husbandry practices for racehorses. Medication has long been a crutch that facilitates the improper care of stabled horses. Rather than alleviate medical conditions, recent data clearly demonstrates that racing medications allow people to exceed racehorse adaptability.  Drug use perpetuates fragility in racehorses.[1] Fragility is dangerous for both horses and riders. To appreciate the principles of equine behavior is to understand what is required to maintain pulmonary health in horses confined to stalls being conditioned to race, and it is not drugs. The solution to managing Exercise-Induced-Pulmonary-Hemorrhage and preventing breakdowns is appropriate breeding, development, horsemanship, training, and husbandry rather than drugs. The care that establishes and enhances pulmonary health and endurance in horses is the same care that enriches stabled horses’ lives. It is the same care that keeps racehorses’ musculoskeletal systems sound. It is humane care that keeps horses on their feet during races.

Horses with healthy lungs and sound limbs are content and fulfilled horses whose lives their caretakers adequately and extensively enrich. Lung health is supported by limb health. Appropriate husbandry and training maintains and establishes soundness of both wind and limb. Breathing and running are biologically intertwined on the track, a breath per stride. To stride correctly is to breathe correctly. To breathe correctly is to breathe soundly, and race sound. Limb soundness and pulmonary soundness are physiologically entwined.

Horses who are bred, socialized, and developed properly from birth, and who train while living enriched stable lives are seldom likely to experience performance-impairing EIPH while racing. They are more apt to stay sound of limb. Humane care of the horse prevents bleeding, my friends. Humane care of the horse prevents breakdowns. Pulmonary health is reflective of appropriate husbandry, breeding, training, nutrition, and the abundant provisions of forage, friends, and perhaps most importantly, locomotion. Bleeding in a race is reflective of inadequate care and preparation, of miscalculations and untoward medication practices. Drugs and raceday medications perpetuate substandard horsemanship, artificially suppressing the untoward result (bleeding and breakdowns) of inadequate preparation of the thoroughbred. Drugs are no longer the solution. Humane care of the horse based on evolved behavioral needs is the solution to safe horseracing.

The solution to manage bleeding and prevent breakdowns in racehorses is to breed, develop, teach, train, and care for horses in a horse-sensitive fashion. Horses evolved as social grazers of the plains, group survivalists moving and grazing together much of the time. Horses require near-constant forage, friends, and locomotion to maintain health of wind and limb, even if they are stabled. Racehorses are no exception. The last place a horse evolved to live is in a stall, alone, with a limited view and uncirculated air. Training and husbandry need to be a good deal for horses in order for horses to maintain healthy partnerships with people. Pulmonary health is reflective of overall health and soundness in horses. Pulmonary health is reflective of limb soundness.

In order to maintain pulmonary health, natural conditions need to be re-created in the stable. The solution to managing racehorse health is proper horsemanship and husbandry, which is sadly lacking at today’s racetracks. Horses prefer to graze together and move nearly constantly in natural settings, and to race without drugs, natural has to be re-created in the stable. The equine requirement for near-constant grazing and moving is essential for joint and bone health, hoof health, metabolic health, and pulmonary health. In order for lungs to stay healthy, horses need more movement than they are currently provided. Abundant on track and off-track locomotion is necessary to condition a horse’s lungs. Lungs deteriorate when movement is restricted by excessive confinement in a stall. Horses breath all day long, and trainers need to appreciate abundant movement is required through much of the day to maintain pulmonary strength and health.

To enhance pulmonary health is to enhance the horse’s entire life and outlook. Not only do properly stabled and trained horses’ lungs hold bleeding in abeyance, they hold sway and win. Pulmonary health and bleeding prevention are dependent on smooth running and biomechanically sound locomotion.

Horses evolved in the open spaces of the northern hemisphere and require the cleanest, purest air to thrive and develop healthy lungs and hearts. Stable air needs to be constantly refreshed to maintain pulmonary health. Ventilation is essential, and enclosed structures are often inadequate in providing healthy air horse require. Appropriate barn design and stabling practices maintain pulmonary health. Bedding is critical. Clean straw provides stall movement by simulating grazing. Horses stalled on straw are noted to move about with their heads down nibbling and exploring for hours, recreating nature to some degree, keeping their lungs healthy with movement, their respiratory tracts drained by all the head-down nibbling and grazing. This is not enough. For healthy lungs, horses need to get out of their stalls for hours each afternoon. Horses need near-constant movement to maintain optimum lung health. Long-standing horses’ lungs deteriorate quickly. Not only does near-constant movement maintain and enhance pulmonary health, abundant locomotion maintains metabolic health, joint and bone health, hoof health, and digestive health. To enhance support, and maintain lung and limb health without drugs is to enhance the overall health and soundness of the horse.

Sid Gustafson DVM

http://therail.blogs.nytimes.com/2011/10/28/goodbye-lasix-and-good-riddance/

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[1] http://www.nytimes.com/2012/03/25/us/death-and-disarray-at-americas-racetracks.html?pagewanted=all

Dr Gustafson is an equine veterinarian, veterinary behaviorist, and novelist. Applied veterinary behavior enhances optimum health, performance, soundness, contentment, and longevity in animal athletes. Natural approaches to development, training, nutrition, and conditioning sustain equine health and enhance performance. Behavioral and nutritional enrichment strategies enhance the lives of stabled horses.