Research: Anti-inflammatory treatment did not decrease movement asymmetry identified in riding horses in training

Sometimes, it seems like research raises more questions than it answers, and a new study from Sweden this summer asked some very interesting questions. Research into asymmetry in horses, as identified by sensor-based gait analysis, brings into the discussion the rider's perception that a horse is sound...even if its movement suggests otherwise. 

FEI NSAID Background: Alex Atock Explains When and Why Bute Was Banned

Many people I meet in the horse world are shocked and even a bit put off sometimes when they first learn that the FEI does not allow horses to compete on even the smallest amount of non-steroidal anti-inflammatory drugs (NSAIDs, pronounced "en-saids"). If it's ok for horses in the United States to race and show on Bute and other NSAIDS, why are the other countries so backward?

Or is it the other way around?

Whether it is horse racing or horse sports like eventing, driving, showjumping and dressage, the world's perception of horses competing on even the lowest dose of therapeutic medication are polarized.

Last week's congress on NSAIDs, organized by the Federation Equestre Internationale (FEI) in Lausanne, Switzerland, was designed to fully educate all interested parties before the FEI's General Assembly vote in November which will ask the world's equestrian bodies if it would like to liberalize the FEI's NSAID policy by going with a "progressive list" of allowed medications for competition horses.

Much of the NSAID Congress was scientific presentations by leading experts like the USA's Dr. Wayne McIlwraith but there were some ethical considerations as well. So far, the FEI has posted 12 videos of lectures from the Congress on YouTube for us to watch. That's a lot of pharmacology research.

But perhaps most important of all the lectures was a bit of a history lesson from horse welfare specialist veterinarian Alex Atock of Ireland, who was in the middle of the FEI's upheaval over NSAID reform in the late 1980s and early 1990s, when he served as head of the FEI's veterinary department. Bute was banned under Alex Atock's watch; who better to take us back in time to find out when and why the ban was initiated?

Listening to this video, I felt like I was thumbing through old issues of Hoofcare & Lameness. As the FEI strugged with the issue of banning Bute, I was writing about it, and about all the horror stories that were happening in the horse industry at the same time. Were they related to Bute? No, but they were related to horse welfare and the perception that people in horse sports had little regard for the well-being and even the lives of their horses. Somehow, this all spilled over to the drug debate, though.

As Atock says, we had German pole rapping scandals, American insurance-collecting horse killers, and the 1990 Breeders Cup had been called the blackest day in horse racing history, as three horses were euthanized as a result of breakdowns in one day's races, including the magnificent three-year-old filly Go For Wand. It's amazing horse sports of any kind survived that era.

The FEI's decision to completely ban Bute from competition horses was painful. It has been painful all along the way since then, but never more painful than the past year, when the old dichotomy opened up again.

Which way will the FEI vote in November--with the liberalized science-is-God view or with the welfare-ethics old guard of Europe who staunchly maintain that Bute and NSAIDs were banned for a reason and horse sport needs to distance itself from the perception that equine athletes are drugged in order to perform?

Does a horse on Bute deserve a Gold Medal if the Silver goes to a horse that is "clean"? On the other hand, should a horse be forced to withdraw from a world-championship competition because of a minor episode of colic a week beforehand that has nothing to do with a performance-enhancing effect of a drug that could be given to treat the colic? Should a vet have to hesitate to medicate a horse because of the performance-drug testing repercussions of a therapeutic substance?

These questions go around and around and around.

By way of education, here's a clip from a lecture by USEF veterinarian Kent Allen, explaining to event riders how to fill out forms to report the NSAID(s) their horses are on, since the USEF rules were changed this year. This clip is one of a 24-part YouTube series with Dr. Allen presented by US Eventing and sponsored by SmartPak to help riders through the process of understanding what is permissable for their horses and how to manage their horses within USEF rules while competing at USEF (as opposed to FEI) events. That's right: 24 videos to explain how to manage your horse's medications within the rules, and to help riders understand the issues and regulations surrounding the approved and unapproved medications themselves.

Dr. Allen is chairman of the USEF Drug and Medication Committee and vice-chair of the FEI Medication Advisory Group.  He is also official Veterinary Coordinator of the 2010 Alltech FEI World Equestrian Games. It is of critical importance to him that riders and trainers understand the medication process and that the American horse public understands the reasoning behind the USEF policies, which are different from the major European nations, but in line with some other countries around the world.

The one-med-or-two forms explanation is vaguely reminiscent of some of my phone calls with Blue Cross Blue Shield about my HMO care.

I highly recommend that ANYONE who even thinks of commenting one way or the other on the medication debate in the FEI watch all the FEI NSAID Congress videos AND Dr. Allen's USEF rules videos.

Educate yourself before you speak. The FEI and US Eventing have laid out a great menu of education for you, for free. You don't have to buy airplane tickets, stay in hotels, or sit all day in uncomfortable chairs. Just watch and listen and learn about medication rules, here, there and everywhere.

What do you want the future of the horse world to be like? How do you think international horse sports will be perceived if medications are allowed?

Most importantly, now that Alex Atock has reminded us where we have been, and opened up the closet where the skeletons have been hiding, where on earth is all this going?

© Fran Jurga and Hoofcare Publishing Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

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FEI NSAID Congress Presents Medication Facts and Philosophies for Equestrian Sport Decision Makers

Background: In November, the Federation Equestre Internationale, the world governing body of horse sports, will convene its General Assemby in Taipei. On the agenda is the groundbreaking and emotional vote whether or not international horse sports should allow horses to compete on low levels of mild anti-inflammatory medication, similar to what is now allowed in the United States. Currently the FEI operates under a zero tolerance policy, which is in keeping with many nations' national policies and even legal statutes. 

An attempt to pass this important rule change at last year's General Assembly was clouded in confusion and resulted in international furor that led to a decision to reconsider and re-vote in 2010. To make sure that the latest information was available to all voting nations, a congress convened in Switzerland last week with leading veterinary experts.

For this reason, the Alltech FEI World Equestrian Games in Kentucky next month will be competed under current FEI rules. Had last year's attempt passed permanently, horses from all over the world would have come to the USA and perhaps competed on medication for the first time in their careers, much like the international racehorses who come for our Breeders Cup. Some countries had grumbled about boycotting the 2010 WEG if the drugs were allowed. 

An emotional issue? It's hard to think of a more hot-button issue in international sport or racing. It is what sets the USA apart from the rest of the world. We think they should be like us. They think we should be like them. And so the world goes round.

Last week's FEI Congress on Non-Steroidal Anti-Inflammatory Drugs (NSAID) Usage and Medication in the Equine Athlete has been called an invaluable contribution to the debate on the in-competition use of NSAIDs. In a ground-breaking approach by the FEI, the Congress brought together both the most up-to-date scientific data and non-scientific aspects of NSAID usage for over 200 delegates from 29 countries at the two-day Congress, which was held at the Olympic Museum in Lausanne, Switzerland.

The second day of the Congress clearly demonstrated that this is a debate that cannot be viewed purely from a scientific perspective and that ethical values and legal issues also have to be taken into account.

Following Monday’s mainly science-based presentations, FEI General Counsel Lisa Lazarus opened Tuesday’s session by outlining details from nine European countries that prohibit or may prohibit the use of NSAIDs under national law.

In light of these legal issues, Ms Lazarus stated that the FEI has two options: either abandon any proposed change in the treatment of NSAIDs, maintaining the status quo that NSAIDs cannot be administered to sport horses during FEI competition anywhere in the world; or permit the use of NSAIDs at appropriate levels as far as the FEI and its members are concerned, but make it clear to all athletes and participants that the FEI’s rules do not supersede national law, and that anyone participating in the sport in any of the nine countries must note that national laws prohibit, or may prohibit, the use of NSAIDs.

Lynn Hillyer (GBR) of the British Horse Racing Authority, explained that the Racing Authorities of Europe, Hong Kong, North and South Africa, Australasia, Asia and the Middle East (except Saudi Arabia) rule that horses must not race under the effects of any drugs, but acknowledge that medication is necessary – off the racetrack – to ensure a horse’s physical well-being. “In other words, medication should be an aid to recovery, not a tool to enable a horse that should be resting and recuperating to race or train.”

Stephen Schumacher, Chief Administrator of the Equine Drugs and Medications Program of the United States Equestrian Federation (USEF), stated that the USEF Equine Drugs and Medications Rules allow NSAIDs usage with quantitative restrictions. “We believe that the welfare of our horses is not put into jeopardy with the judicious use of NSAIDs and their use may in fact be beneficial,” he said.

Dominik Burger, President of the Veterinary Commissions of the Breeding Associations for Swiss sport horses, spoke on the breeding perspective. He concluded that the issue would benefit from a pluralistic ethical analysis based not just on the welfare of horse and rider but also on regional and global public values like integrity, equity, justice, duties and responsibility.

Steve Maynard, Laboratory Director at Horseracing Forensic Laboratory Sport Science, outlined that quantitative analysis, applied to determine the exact level of a substance being present in the body, is significantly more costly than qualitative analysis carried out to detect the presence of a substance.

The public perception of equestrian sports, sponsors and the media perspective were all aired in Tuesday’s panel discussion, when British journalist Brough Scott asked some hard-hitting questions about the possible repercussions of reintroducing NSAIDs in competition.

Sven Holmberg, FEI First Vice President chaired the final debate on the pros and cons of the in-competition use of NSAIDs. Tim Ober (USA) and Mike Gallagher (CAN) spoke for the use of NSAIDs and Peter Kallings (SWE) and Christian Paillot (FRA) spoke against their use.

FEI Veterinary Director Graeme Cooke, who had earlier updated participants on the work of the FEI List Group, summarized both sides of the debate, drawing on key points from all the speakers over the two days. The FEI has achieved a number of key objectives through the Congress, he said, gathering up the science that had become available since 1993, bringing together the scientific and non-scientific, providing an opportunity to hear related views, and ensuring there will be a record of this unique event in order to inform not just National Federations, but everyone with an interest in the debate and allowing for further review before the FEI General Assembly in November.

In his final summing-up, Holmberg stressed the importance of keeping the debate alive between now and the vote on in-competition use of NSAIDs in November, so that the decision taken at the FEI General Assembly is one that is founded on sound knowledge and in the best interest of the sport and the horses.

“There is no doubt that both sides of the Atlantic and the rest of the world have the same clear goal in mind: that the welfare of the horse is really paramount to whatever we do,” he said.

A report on the Congress will be sent out to all National Federations, and the FEI website will continue to offer a feedback area for comments. To maintain the flow of information for National Federations that were unable to attend the Congress, videos of all speeches and power point presentations, as well as the panel sessions and full debate, will be made available on the FEI YouTube Channel later this week. 

A mini site for the Congress with documents and abstracts has been set up on the FEI web site. Comments on the medication issue are invited; please email your opinions to nsaidcongress2010@fei.org

© Fran Jurga and Hoofcare Publishing Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. Please, no use without permission. You only need to ask. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

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USEF Reduces Medications Levels: Only One NSAID Allowed in Competition Horses After This Year

16 January 2010 | Fran Jurga's Hoof Blog at Hoofcare.com

Horses showing in USEF-sanctioned horse shows will be subject to new drugs and medications policies beginning at the end of 2010 as more than 30 years of permissive use of pain medication is being restricted under a more conservative rule. Even with half the medication formerly allowed, US horse shows still have a very liberal policy compared to most countries.

Big news from Louisville, Kentucky tonight: At the annual convention of the United States Equestrian Federation (USEF), the governing body of most equestrian sports in the United States, a significant rule change is being agreed upon which will reduce the number of medications that a horse can have in its system when competing.

Various committees within USEF have been working toward a compromise on this issue throughout the convention, which began on Wednesday. Current USEF rules allow two non-steroidal anti-inflammatory medications to be used simultaneously; that policy has been in place for more than 30 years.

The change was not without its opponents; the US Hunter Jumper Association's Open Hunter Task Force had filed for a rule change (GR410.1) that would have allowed two medications if written notification was given, but then withdrew its proposal on December 9.

Some breed and sport representatives felt that limiting medication is a penalty to older horses or to lower-level shows that do not have the best footing. Perhaps some horses will now show in fewer shows, or be entered in fewer classes. Some arguments were made that the current low value of horses makes it a hardship to sideline horses that could be competing if medicated. It remains to be seen if the new rule will affect horse show revenue; it is not expected to take effect until December 2010.

In most European countries, no medications are allowed; no medications are allowed in competitions sanctioned by the Federation Equestre International (FEI), the world governing body of horse sports. A recent vote to change the FEI medication policy caused an international uproar.

There is a lot to this story, and more will emerge in the days and weeks to come as the official final wording of the rule and dates are made public. One thing is known, and that is that the push to make the change came from veterinarians, who are often accused of promoting drug use in show horses.

Dr. Kent Allen, longtime chair of the Drugs and Medications Committee for USEF, commented on the obvious rise in joint injection that may be the result of a limit on medication. In a document available on the USEF website he offered this insight: "First, it is important to understand that a joint injection properly performed in experienced veterinary hands is the single most effective anti-inflammatory treatment we have for (an) equine joint.

"Secondly, there are numerous medications to inject into joints. Often it is hyaluronic acid in combination with a variety of cortisones, or bioregenerative therapies such as IRAP. Some of these medications are extremely safe and all of them will significantly reduce joint inflammation.

"On the question of 'are joint injections going to be overused', the answer is that is already happening today! In some cases joint injections are being used as treatments in 4, 6 or 8 joints without a diagnosis of joint inflammation ever being established. This is dangerous not only from the standpoint of increasing the number of joint injections in the horse and potential side effects but you may or may not be treating the real problem. Accurate diagnosis, including lameness examination, nerve blocks, joint blocks and diagnostic imaging is the most effective method of determining what the problem is and if the horse needs joint injections. This also has the benefit of reducing the cost to owners as well as the risk to the horse."

USEF approved the use of Surpass, a topical anti-inflammatory recently; there's no prediction so far if there will be a trend to more specific treatments rather than generalized medication for pain, stiffness or soreness.

While rumors of a compromise were circulating today, equestrian journalist Nancy Jaffer broke the news tonight in her column for the Star-Ledger in New Jersey that the new medication policy would be adopted. More insight into the process of the rule change can be found in Nancy's article.

The new rule will affect most breed shows, including Arabians, Saddlebreds and Morgans, plus USEF-sanctioned hunter-jumper, dressage, driving, endurance and eventing competitions and individual breeds and sports who are under USEF's umbrella. It will not affect Quarter horse, Paint, Tennessee Walking horse or Appaloosa shows, as well as many other breeds, or the sports of reining, cutting and barrel racing, unless they are held at a USEF event or as part of a USEF-member breed show.

The medication policy change is endorsed by the American Association of Equine Practitioners, the American Veterinary Medical Association and by the Humane Society of the United States.

USEF assembled an impressive bank of articles and information on medications in sport and performance horses for the delegates to the convention. Since medication policy is sure to be a topic of conversation throughout the coming months, you might want to save some of those documents for reference.

© Fran Jurga and Hoofcare Publishing. Please, no use without permission. You only need to ask.

Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page).

To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found.

Questions or problems with this blog? Send email to blog@hoofcare.com.