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December 18, 2009

Make Your Own Informed Opinion Of The FEI’s Progressive List

with JOHN MADDEN. Photo by Molly Sorge.

Our columnist asks Dr. Tim Ober to provide more background about what this contentious change could mean for our horses.

It seems to me that our primary concern as horsemen must be the horse.

Dismay is the only word that comes to mind when I witness many of the goings on in our sport. The politicizing by many factions in the process of the Fédération Equestre Internationale’s recent adoption of the Progressive List of therapeutic drugs, to say the least, makes me incredibly sad. Honest, informed disagreement is fine and even important.

In an effort to take this issue out of the political arena and into the light of day, I have asked Dr. Tim Ober to lay out the adopted proposal and comment on the main points of it. Dr. Ober is an educated horseman and a top-class practicing veterinarian. He is the team veterinarian for U.S. Show Jumping.

While not working in his official capacity, but on his own and as a volunteer, he, along with a host of other horsemen, have formulated and gotten passed an FEI General Assembly sweeping change, for the good of the horse, sport, owners and competitors.

Here are some of Dr. Ober’s thoughts.

I wanted to mention a few points regarding the development and current status of the FEI’s Progressive List.

First, in the fallout from the multiple drug infractions of the Hong Kong Olympic Games, the FEI was asked to align its anti-doping program with that of the World Anti-Doping Association. The Ljunqvist Commission for Clean Sport made a series of recommendations, including an outline to create a Prohibited List in line with the WADA approach.

It was apparent from the beginning that the administration of the Prohibited List within the industry, and especially relating to treatment around the time of competition, would be an important element of the application of the list and any new rules. In human sport, the testing program is the primary method of enforcement. In horse sport, the testing program would be the backbone but would be accompanied by a strict set of administration criteria, including the supervision of administration of any medication (by stewarding and reporting). This would be one way to recognize that the horse, as a “passive recipient” of any medication, would be protected within the system.

Second, the question of whether non-steroidal anti-inflammatory substances are performance enhancing in the horse comes up quickly, because WADA does not recognize NSAIDs as performance enhancing in human athletes. In fact NSAIDs are allowed without restriction in human sport. Certainly, that approach for horse sport was never considered.

Recognizing the importance of this question for the sport, as well as a lack of available science clearly answering the question, the List Group decided to put the question forth to the General Assembly for a vote, by offering two lists.

The General Assembly voted to adopt the Progressive List. Several large and vocal national federations have disparate policies of their own and are now strongly in protest.

Third, in acknowledgement of the concerns of some of these federations, and in the interest of ensuring that this decision is the right one for the horse, there are several efforts being organized:

• Scientific studies have been proposed and are being organized in order to determine if there are any performance-enhancing effects or lameness-masking effects of these three NSAIDs at these permitted levels. This research will provide clarity from a scientific perspective on the issues surrounding NSAID use.

• Research data already available on the topic of NSAID effect on lameness and pain control is being collected and collated.

• The FEI legal department is actively reviewing applicable national laws to determine an approach to applying the new FEI regulations in countries where national law might be in conflict.

• The FEI has delayed implementation of the new veterinary regulations and the Prohibited List until April 5, 2010.

• A group is working to activate the International Treating Veterinarian’s Association. The goal of this group is to create a method of educating treating veterinarians about how to comply with the FEI rules, whatever they may be ultimately, and to form a cooperative atmosphere among treating veterinarians, as well as a cooperative relationship between treating veterinarians and the FEI. I hope this effort will contribute to a smooth transition to new rules. One goal is to establish an outline of “best practices” for treating veterinarians.

What will change as we go forward with the new rules and the Progressive List? Below is a summary of important changes, which may not include all changes.

List of Prohibited Substances. All Prohibited Substances will now be listed by chemical name. It is important to note that the FEI has adopted WADA language to include substances with a “similar chemical structure or biological effect” as also prohibited. This addresses the concern of development of “designer drugs” which may involve changing only a molecule or two of an existing prohibited substance.

Detection Times. The list of medication substances with a published Detection Time will continue to grow. The FEI has committed to increasing funding for the scientific studies required to develop this information. This information is critically important to treating veterinarians and competitors because it allows careful and correct decision making when providing veterinary care to a competition horse. The term “Medicine Box” is replaced by the term “List of Detection Times.”

Laboratory Harmonization. FEI laboratories are currently harmonized with regard to the list of substances with a published Detection Time. The laboratories are actively engaged in achieving harmonization in testing for substances on the Prohibited List. This will go a long way toward ensuring that the “speed limit” (e.g. what constitutes a positive test) is consistent across all FEI jurisdictions throughout the world.

Treatment control. Any treatment around competition will be subject to stewarding. All treatment must be re-ported in advance and must be approved.

Emergency Treatment: Any treatment around competition using a Prohibited Substance will require completion of either FEI Medication Form 1, now identified as an Equine Therapeutic Use Exemption, or ETUE. This form must be signed by the FEI Delegate Veterinarian and the President of the Ground Jury in order for a horse to compete after such treatment.

Supportive Treatment: Any treatment around competition using a substance not listed as prohibited must be reported in advance of any treatment to the FEI Delegate Veterinarian using FEI Medication Form 3. This form must be signed by the FEI Delegate Veterinarian in order for such treatment to be approved.

• Phenylbutazone, Flunixin Meglumine and Sodium Salicylate. The “Progressive Prohibited List” will allow the presence of ONE NSAID (from a choice of three) in the system of the competition horse at a low level and when administered within narrow and carefully defined administration criteria. These criteria allow the administration of one of the three eligible NSAIDs more than 12 hours prior to competition.

Specifically, a horse may receive:1 gram of Phenylbutazone (generally a half dose) once within a 24-hour period and not within the 12 hours preceding competition.

OR

250 mg of Flunixin Meglumine (generally a half dose) once within a 24-hour period and not within the 12 hours preceding competition.

OR

A low dose of Sodium Salicylate sufficient to maintain a urine concentration below 750 ug/ml administered once within a 24-hour period and not within the 12 hours preceding competition.

A horse may not receive any medication for more than five consecutive days. There will be more guidance on this detail of the administration procedure after the completion of research that is currently underway.

A horse may receive only ONE of the three NSAIDs during the course of an event.

All treatment must be reported to the FEI Delegate Veterinarian in a strictly prescribed manner using FEI Medication Form 3 and in advance of treatment.

These methods of administration will be strictly enforced during competition. That enforcement, along with the strict laboratory testing already in place, will ensure clean sport.

More detailed guidance in relation to the method of administration (IV or oral) will become available after research that is currently underway has been completed.

Why Is The Progressive List A Good Idea?

• The horse will have some help with the aches and pains of competition without medication that will influence performance. This recognizes the physical demand we ask of these athletes, who are on an intense schedule of high-level competition.

• The health of the competition horse will benefit with an improved level of care.

• The new rules offer competitors a way to provide supportive treatment, within the rules, using limited administration of legitimate medication and brings all medication under veterinary supervision. In fact, administration of medication always involves two veterinarians, the treating veterinarian and the FEI Delegate Veterinarian.

How Do We Know This Is Safe?

• The U.S. Equestrian Federation has had a medication rule in place for many years that is more permissive than the new FEI rules. Despite this consideration, the rule has generally worked well, and horses on balance benefit from the rule. The new FEI rule allows for administration of only half the dose which would be permitted under the USEF rule.

After considering Dr. Ober’s thoughts, I implore every reader to make his own opinion on the Progressive List, not based on gossip around the water cooler, but on fact.

I have been lucky enough to travel the globe with horses and have just returned from Europe where the adoption of the list is a hot topic. Every rider, owner and trainer I spoke to is firmly in favor of it. This further reinforces my concern about the political nature and misunderstandings that people have in opposition of it. Please make your own decision.

I know well that I’ve written this with a strong pro-change bias. I can’t help that, it is what I believe in for the horse. Having said that, I hope I can remain open minded to thoughtful, educated changes to the Progressive List and its implementation. I hope horsemen will take the time to educate themselves to this issue from all sides because as always education, in importance, is second only to the love of the horse. You can’t love them if you don’t know how to.

If you enjoyed this article and would like to read more like it, consider subscribing. "Make Your Own Informed Opinion Of The FEI’s Progressive List" ran in the March 26 issue. Check out the table of contents to see what great stories are in the magazine this week.

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