The Thoroughbred Safety CommitteeDr. Rick Arthur - Equine Medical Director, California Horse Racing Board
Stuart S. Janney III: Turning now to the subject of medication, Dr. Rick Arthur has many years of experience as a private veterinarian and more recently as the equine medical director for the California Horse Racing Board. Today he's going to focus on steroids, TCO2 testing and research.
Rick, thank you for being with us today…
Dr. Rick Arthur: Thank you, Stuart. Good morning.
I'm going to be discussing two issues: anabolic steroids and bicarbonate loading. Bicarbonate loading is just a nice way to say "milkshaking." And if anyone doesn't know, anabolic steroids are, at the simplest level, drugs that mimic the male hormone testosterone. What I want you to be thinking about as I go through this presentation is why these issues weren't resolved years ago.
What is bicarbonate loading and why should we care? The body tightly regulates pH, or the body's acid-base balance, primarily through bicarbonate metabolism. Intense anaerobic exercises our athletes do produce acid, a lot of acid. The burning sensation one feels with heavy exercise is acid build up in our muscles. Acid build up within the muscle cell is a major component of muscle fatigue. The body has only so much natural buffering capacity. Additional bicarbonate or any other alkalizing or buffering agent provides a sink for that acid. This can be monitored by measuring total carbon dioxide, or TCO2, in blood.
This is a summary from a meta-analysis of human research. The conclusion: neutralize acid and enhance performance. How much does it help? There is considerable variation depending on the type of exercise but for running, the improvement averages about 1-2% in races lasting a few minutes.
What is an improvement of 1 to 2%? For racing, it is mind-boggling. Keep in mind that a 1-length improvement in the performance in the right horse would have altered the order of finish in 6 out of 10 races here at Saratoga yesterday; and in 8 out of 9 at Del Mar.
For horse racing the issue is even more complicated. While the overall improvement in performance may average 1-2%, there is enormous individual variation. In one study, an NCAA Division-1 track athlete improved his 800 meter time by 2 seconds. At that level, 2 seconds is the difference between first and last, or in this case, last and first. Anecdotally, the same is true in race horses. If you know which horse responds to milkshaking, there is the opportunity to race the horse hot or cold, and that is a nightmare for our sport. The unscrupulous know this; in a federal wire fraud case involving a milkshaked horse, the U.S. attorney used words like "race fixing," "doping" and "performance enhancing."
Does bicarbonate loading work in race horses? Oak Tree funded a retrospective analysis of data in Southern California looking at the relationship between TCO2 and performance. If one plots TCO2 against the top 3 finishers, the relationship is clear. TCO2 is related to performance and the relationship is statistically significant. The higher the TCO2, the better the chance of hitting the board. The same can be shown for winning...
TCO2 is a normal physiological measurement and, as such, is subject to natural variation. Distribution of TCO2 should be a bell-shaped curve and it is if the horses are left alone. Statistically we can determine what is normal and what is abnormal. That is the basis of TCO2 regulation. Australia uses the international threshold of 36mml/l; they do not have the complicating issue of Lasix. They have calculated the chance of a normal horse exceeding the threshold of 36mml/l at 1 out of 600,000. In Australia a TCO2 violation is a 6-month suspension for the trainer. In the US, most jurisdictions use 37mml/l to accommodate the Lasix issue; some even use 39 mml/l. The RMTC best practices recommendation is 37mml/l.
How big of a problem is bicarbonate loading?
At Del Mar in 2004, unannounced TCO2 testing was done on a little over 80 horses from 8 races. Twenty percent were over 37mml/l and 10% were over 39mml/l. TCO2 regulation works; at Del Mar in 2006 and 2007, no horse tested over 37mml/l. Interestingly, certain trainers have lost there ability to move up claimed horses since TCO2 regulations were put in place.
Trainers claim they have no idea why their horses have high TCO2s. At the Hollywood Park 2006 spring meet, 40 TCO2 samples from 37 horses tested over 36mml/l with only one violation over 37mml/l. Twenty-one of the 40 samples came from just one trainer and 28 of the 40 samples came from two trainers.
In the summer of '06, the California Horse Racing Board began issuing official warnings to trainers with samples over 36mml/l to the effect the warning would be used as an aggravating factor in any subsequent hearing for a TCO2 violation. With this simple step no TCO2 sample tested over 36mml/l at Hollywood Park spring meets in 2007 or 2008; and that is out of nearly 9,000 samples tested.
Furosemide, or Lasix, is an interesting issue we will need to examine some day. Lasix is a performance enhancer and the scientific literature is quite clear on this. The question is why? Is it the decrease in EIPH [bleeding] as many race track practitioners like me believe? Is it the loss of roughly 20 pounds of weight from urine diuresis as some physiologists have hypothesized? Or is it the increase in TCO2? What we do know from our analysis, whatever the mechanism, the effect is added to the TCO2 effect.
Anabolic steroids are a different story. Internationally, anabolic steroids have been regulated for many years; from the international perspective, anabolic steroids are simply performance enhancing drugs and are banned. But anabolic steroids are pervasive in American racing. In spite of all our problems, horse racing has a good story to tell in drug testing. We've tested our athletes longer and for more drugs than any other sport; we still test for more drugs than any other sport. But there's one glaring exception and that exception is anabolic steroids.
Did anyone in this room last year really believe horse racing's showcase event, the Breeders' Cup, would be anabolic steroid free this year at Oak Tree? I think we've come a long way.
The RMTC began looking at the anabolic steroid issue 3 years ago and we looked to international rules as our model. Internationally, anabolic steroids have been regulated in urine for decades and considerable research is already available.
Three anabolic steroids present difficulties because they are endogenous; that is, they are naturally occurring in the horse. All three are also available as pharmaceuticals. Testosterone is present in all horses including geldings, fillies and mares. Our testosterone rule is identical to international rules. Boldenone is present in non-gelded males. Our boldenone rule is identical to international rules. Nandrolone is present in non-gelded males. The international nandrolone rule has technical issues. Our nandrolone recommendation already incorporates the changes expected to be adopted internationally to resolve these issues later this year.
The major exception to international anabolic steroid rules is a threshold for stanozolol. Stanozolol is Winstrol, an exogenous manufactured anabolic steroid. There has been considerable misunderstanding on this threshold. The threshold for stanozolol was not set to be permissive. The threshold was set in an effort to get some degree of uniformity between laboratories. It does no good to have uniform rules if you don't have uniform laboratory capabilities. This is a major issue for U.S. racing, not just for anabolic steroids but for all drugs. The irony in the criticism of the stanozolol threshold is our 1 nanogram per milliliter threshold level is below the screening method limit of detection of most racing labs around the world; not just the U.S. but around the world. By the way, 1 nanogram is 1 part per billion.
Earlier this week, the RMTC scientific advisory committee received an update on our ongoing anabolic steroid research projects. The preliminary results are exciting. Anabolic steroids will be much more effectively and efficiently regulated in blood than in urine - that is if the labs have the right equipment. Blood testing requires laboratory sensitivity in the picogram level; that's parts per trillion. Regardless, the results of these research projects will give us an opportunity to refine our anabolic steroid regulations going forward in blood and will be very important in developing rules for horse sales.
I know anabolic steroid regulation has been controversial. I've had more than my share of nasty calls from colleagues and trainers. But this step is long overdue. I want to leave you with a few thoughts:
I became cynical of the use of anabolic steroids long ago when I saw how their use altered the training of horses. John Kimmel said it best at the Racing Forum at the AAEP a few years ago. As most of you know, John was a practicing veterinarian for several years before he became a trainer. John stood up in front of 100 racetrack veterinarians and asked, "When are we going to ban anabolic steroids?" He went on to say, anabolic steroids allow a trainer to train a horse harder than would otherwise be possible. Keep in mind intensity of exercise has been related to catastrophic musculo-skeletal injuries and I will tell you there is unpublished data in California relating anabolic steroids to training intensity and fatal injuries.
One last comment on a happier note: Treve Williams is an Australian veterinarian. He is of similar stature in Australia as Gary Lavin or Bobby Copelan are in the U.S. Until about 15 years ago, Australia allowed anabolic steroids and then moved, as we are doing today, to ban them. Right after John Kimmel made his comments Treve stood up and described to the same audience how he had fought the Australian anabolic steroid ban tooth and nail. He was sure racing couldn't survive without anabolic steroids, but when anabolic steroids were banned in Australia, Australian racing and the horses never missed a beat.
Thank you for your attention.
Stuart S. Janney III: Thank you very much, Rick. We appreciate your participation at our Summits, with the RMTC, with the safety committee and, today, at the Round Table Conference.