The future with or without furosemide
In the 1970s when racing started using furosemide, you had be qualified to give it. The horse was either scoped with a state
veterinarian present, or the state veterinarian had to scope the horse and prove that there was bleeding coming from the lungs
before furosemide could be administered. Use of furosemide, therefore, had to be justified. Horses that were not bleeding
couldn't get it.
After 2001, the RMTC stated that because of the issue of performance enhancement (whether furosemide had performance-enhancing
qualities or not), things changed and all horses were allowed access to the furosemide in order to level the playing field
and because it was thought that preventing any episode of bleeding and the possible medical consequences was in the best interest
of the horse.
"If we do away with furosemide, are we putting horses at risk?" asks Palmer. Most countries around the world do not regulate
furosemide based on endoscopic evaluation, but on epistaxis, which is defined as bleeding from the nostrils. In most jurisdictions
around the world, if epistaxis takes place, that horse is subjected to forced rest or retirement from racing.
"If you can use furosemide to prevent bleeding from happening during training, as you go along you can minimize the harmful
cumulative effects on the lung over time," Palmer says. In the absence of any treatment, older horses bleed more than younger
horses, as do those that have more consecutive years in racing compared with those that are early in the process. "One of
the real values of furosemide is that we can use it to diminish or modulate the progressive pathologic change in the lung
that leads to repetitive bleeding cycles."
The incidence of epistaxis in racehorses after a race before furosemide was used in North America was about two per 1,000
starters. It was subsequently shown that the incidence of epistaxis after the introduction of furosemide was about 0.7 horses
per 1,000. Therefore, from an epidemiologic standpoint, horses racing in North America would be about three times more likely
to bleed without furosemide treatment than with it. Although the numbers of horses that do bleed from the nose are low (0.15
to 1 percent), as many as 600 animals in about 60,000 horses may be at risk of epistaxis without furosemide treatment.
"Although that's a relatively low number, it certainly hits home if it's your horse and/or it's a million-dollar horse," says
Palmer. "Particularly if you have to retire it from racing if you cannot use furosemide. Veterinarians understand and appreciate
the public relations concerns, politics and global business implications of the medication issues in racing, but our own bottom
line is that we do believe we must do what is in the best interest of the racing horse."
The current AAEP policy states that the only appropriate medication to give on race day is furosemide. It's the only therapeutic
medication scientifically proven to work.
"When you ask the AAEP to support the elimination of furosemide for treating horses that experience EIPH, you're asking us
to turn our back on the science and extensive medical experience of veterinarians and put this horse at risk, and we're not
going to do that unless we have an alternative," Palmer says. "If we can develop an alternative treatment and management program
for EIPH that we can use prior to race day, then we can support no medication on race day, and I do think that there's value
in that. The strategic goal that we should be aiming for is to send healthy horses to the gate free of the pharmacologic influence
of any medication."
"The good news is that we do have some new therapeutic options in the pipeline, things that we can do that have nothing to
do with the diuretic—furosemide," Palmer says. "But those treatments are much more expensive and largely unproven at this
time. The current economic pressures also are relevant. We have a difficult time finding treatments that are as effective
and as cheap as furosemide."
The AAEP and NTRA can make recommendations, along with the RMTC, which can propose model rules. But none of these organizations
have the ability to effect change—to make a rule that will influence this process. That responsibility rests largely with
the ARCI and individual state racing commissions.
"The role of the equine practitioner in this process is to provide solid information and make recommendations that will hopefully
enable the regulators to make an informed decision that is good for the horse and good for the business of racing," says Palmer.
One of the concerns with a proposed furosemide ban in North America is how many horses will be unable to race here without
furosemide? We don't know the answer to that. The business model of North American racing is unique in the world. If this
medication is eliminated here, the challenge will be how to make what amounts to a profound cultural change in North American
racing with the least impact on the horses' health, as well as that of an industry stressed by a down economy and intense
competition for the gaming dollar.