NY Commission Expresses Frustration About Endless Lasix Studies

The New York State Gaming Commission (NYSGC) took a unanimous voice vote on Thursday to request an exemption from the Horseracing Integrity and Safety Act Authority (HISA) that will allow the continued use of Lasix in races other than those for 2-year-olds and in stakes.

Asking for the exemption also opts states into a three-year study that will be conducted by HISA that is designed to shape future federal Lasix policies, possibly as early as 2026.

The vote itself was hardly a surprise. Not applying for the exemption would have banned Lasix usage outright in all New York Thoroughbred races starting Jan. 1, 2023, as per the HISA statute.

No state racing commission in the nation has yet to vote against seeking that exemption, and none are expected to, according to discussion among the NYSGC commissioners at the Oct. 27 meeting.

But what was unexpected was the pushback from several commissioners on two fronts: 1) A desire to know when the seemingly endless, decades-long cycle of Lasix studies on racehorses would finally produce conclusive results, and 2) Why shouldn't New York, which has made a concerted effort over the past few years to cut back on Lasix usage with seemingly positive results at New York Racing Association (NYRA) tracks, leap at the chance to go Lasix-free at all levels of Thoroughbred racing statewide?

Commissioner John Crotty, in particular, expressed his frustration. He asked NYSGC equine medical director Dr. Scott Palmer, VMD, who advocated for the board to seek the HISA exemption, how many Lasix studies have been done over last several decades.

Palmer acknowledged that there have been “a number of them,” adding, “I can't give you the exact number off the top of my head. But I can tell you the most convincing one was a study done in South Africa perhaps 10 years ago that found that Lasix did mitigate the impacts of exercise-induced pulmonary hemorrhaging (EIPH) in racehorses.”

When Crotty asked this question, Palmer had just finished summing up his opinion on a study published this week in the Journal of the American Veterinary Medical Association (AVMA) that found that horses racing on Lasix were 62% more likely to die within three days of racing than were horses running without the diuretic.

Palmer had termed that AVMA study “very impressive and comprehensive,” with an “enormous” 4-plus million population of horse starts. But he also noted that “as well as this study was designed and conducted, there are always limitations.”

Among them, Palmer said, were that true causes of sudden deaths can be elusive, even with a complete necropsy examination, and that other drugs besides Lasix were not accounted for in the study.

But Palmer did express optimism that the AVMA study could lead to further insightful research.

Crotty then noted that when the NYSGC held a day-long Lasix summit back in 2015, several work-in-progress studies at that time were anticipated as being the breakthrough research that would give definitive answers. Now it's seven years later, those studies have arrived, new ones have begun, and the NYSGC is being told to expect yet even more studying on the topic.

“What would be, at the end of the day, a conclusive study from your point of view?” a respectfully exasperated Crotty asked Palmer. “Because no study has actually been done to prove anything, that I know of.

“Every time they look at it, they say, 'Well, it's not quite conclusive. You've got to look at this other factor,'” Crotty said. “I assume that the veterinarians and the scientists who are doing this are competent and capable people…. What would be necessary, if HISA's going to do this, to believe that they will do it right, versus all the other broad studies before this?”

Palmer replied that “no study is perfect…and that it's a standard part of the report of the study to list those limitations. So the way you get to the bottom of an issue like this is to do multiple studies with a slightly different approach.

“And I can tell you for sure that one of the most exciting possibilities of this potential research with HISA is that they are now requiring contemporary reporting of all medications given to racehorses. This has never been done before. And for that reason, all of the Lasix studies to date have never been able to list all of the medications given to the racehorse [to] determine whether or not the medications contribute to EIPH or to sudden death.

“So the advantage of a study by HISA would be that they will have a unique database that will include treatment of every single Thoroughbred racehorse in [America], and that data will be in a single database that can be mined for information about what medications racehorses are being actually given,” Palmer said.

And once that three-year study is completed, the prospect looms for–you guessed it–more research.

“With a control group and a study group to get to the bottom of these issues that we're struggling with,” Palmer said.

For the first three years of HISA, a state racing commission may request a no-Lasix exemption so long as it does not apply to 2-year old covered horses or covered horses competing in stakes races.

The NYSGC received commentary from NYRA, the New York Thoroughbred Horsemen's Association, Inc., the Finger Lakes Horsemen Benevolent and Protective Association, Inc., and Finger Lakes track management, all advocating for the exemption.

The stakeholders largely raised concerns that, absent the exemption, New York Thoroughbred racing would be placed at a distinct economic and competitive disadvantage with surrounding states that have sought the exemption.

Commissioner Peter Moschetti, Jr., asked Palmer if, in the nearly two years since NYRA began conducting Lasix-free races for 2-year-olds and stakes horses, there have been any negative consequences. Palmer stated that there was “no evidence” of harms to horses.

“It seems to me that's pretty good evidence, although two years might be a limited period of time,” Moschetti said.

“I would agree that's an accurate statement from what we've seen so far,” Palmer replied.

Then Moschetti asked, “So are we factoring that in in our decision to seek an exemption? We have had this discussion [for] years, going back and forth [in an effort to] remove race-day drugging of horses, right? So what an opportunity New York has now: HISA is going to implement, in January, this rule that would eliminate Lasix use…. Is your recommendation factoring in what has happened in the last two years, where New York kind of led the way [toward] racing horses without Lasix? It's a great opportunity to see what would happen. It appears that nothing bad has happened, right?

Palmer answered that “if we were operating in a vacuum, that would be accurate.” But we're not, he added, noting that if New York doesn't seek the exemption, it will be excluded from what he believes is a greater opportunity: to participate in the HISA study.

“Also there are significant issues with the business model in New York, versus the mid-Atlantic states [that have requested the exemption]. And I think that consistency in a region is really, really important. One of the goals of the entire HISA program is national uniformity,” Palmer said.

“The risk-benefit ratio of allowing Lasix versus the harm that could come from it is, to me, not significant. I think the value is great and the risk is minimal,” Palmer said. “I think the implications of what happens here in New York are profound in terms of horse racing in New York and neighboring states. And I think that all of those factors have to be taken into consideration when you're making this kind of a decision.”

At this point, NYSGC chairman Brian O'Dwyer interjected.

“Dr. Palmer, the commission is well able to determine the competitive nature and to factor that in,” O'Dwyer said. “I'm not asking you that, nor are the commissioners. We are asking you for your medical advice and medical opinion. Not your opinion on the structure of racing, and I would appreciate it if you would confine your opinion to that.”

Palmer then rephrased his argument: “Well, my medical opinion is that there are many advantages to asking for this exemption, to the benefit of the horse, that go far beyond the issue of New York racing.”

After the unanimous voice vote to seek the exemption, both O'Dwyer and Crotty expressed reservations about New York exempting itself from the no-Lasix federal rule.

O'Dwyer said he voted for the exemption with “great reluctance,” but “I've learned in my life that you have to rely on the experts, and that Dr. Palmer is our expert and has asked us to do this.”

Crotty said that from the perspective of seeing totally Lasix-free racing work in other parts of the world and on a limited basis at NYRA tracks, “it's hard to rationalize why [seeking the HISA exemption] is useful. But we're in a big system. It's a conglomeration of states and different interests. So if this is a way to achieve a better outcome, it seems like a reasonable thing to sort of more forward with.

“But,” Crotty added, “to have to exempt out of [Lasix prohibition when you're trying to achieve that goal], it seems like an odd construction.”

As Palmer put it: “The Lasix issue is an issue of competing truths. And competing truths are tough things to deal with. There's no right or wrong about this.”