From the Editor

Therapeutic to Whom?

By Jonathan Stettin October 30, 2026 16 min read Save Article

Mike Repole asked whether racing is protecting horses or protecting regulations. There is a third answer he left out, and everybody on the backstretch knows what it is.

Mike Repole posted on Breeders’ Cup week, and he came the way he always comes: loud, capitalized, and with a following. He said he has talked to trainers and owners getting ready for Keeneland and the overwhelming theme is frustration. Vet scrutiny. PET scans. Scratches. What should be the best week of the year has become, in his words, downright unenjoyable.

Then he asked the question. Are we protecting horses or protecting regulations?

Plenty of the industry nodded along. Nick Hines, “Sarge,” replied that horses come first, but “when the intention of the attending veterinarian is to find a problem, inevitably they will.” The reposts piled up.

I read Mike’s post three times. Then I read the replies. Almost every word is about people. Frustrated trainers. Stressed owners. Unenjoyable weeks. Owners spending millions. The horse shows up mostly as the reason the business is being inconvenienced.

There is a third answer to Mike’s question, and it is the honest one. A lot of what racing calls protecting the horse is protecting the business. Not the regulations. The business.

I like Mike. We have said so plainly, and I still think his willingness to say out loud what others whisper is better for this game than another generation of the same people at the same tables. Some of what he wrote this week is dead right, and we will get to it. But on the medication question, whether he is right depends on where you are standing when you ask. Inside the barn, he is speaking for almost everyone. Step outside it, and the answer changes.

IF IT’S HARMFUL, BAN IT EVERYWHERE

Mike says Lasix makes zero sense. It’s allowed in claiming and allowance races but banned for 2-year-olds and stakes. If it’s harmful, ban it everywhere. If it’s beneficial, allow it consistently. On logic alone, he is right.

But that split was not forced on horsemen. It is what they fought to keep. Under the federal Act, a full race-day ban was the default unless the HISA Board unanimously found, among other things, that furosemide doesn’t enhance performance. In May the Board kept the status quo. Todd Pletcher, who trains for Mike, called it “one of the few topics that everyone seems to be in agreement on.” The inconsistency Mike is railing against is the compromise his own side lobbied to preserve.

And consistency points one way. As we laid out in April in The Lasix Question: What the Science Actually Says, Britain, Australia, Japan and Germany race without race-day Lasix, and their horses are every bit as healthy as ours. The rest of the world took Mike at his word. It banned it everywhere. As for HISA’s no-performance finding, it was the price the statute set for keeping the drug, and it sits next to a 22,589-horse study showing horses run 0.56 to 1.09 seconds faster on it. I know which side I’d bet.

THE DVM TEST

Here is a simple experiment. Take what racing calls therapeutic and routine and describe it to a veterinarian who has never worked a backstretch. A sport-horse vet. A small-animal practitioner. A human sports-medicine doctor.

A joint injection so a horse can get through his next work.
Anti-inflammatories to manage soreness so he can keep training.
A powerful diuretic four hours before post because his lungs bleed when he runs.

Most of them would be shocked. Not because the drugs are exotic, but because of what they are being used for. Outside racing, the usual answer to a sore, inflamed, or bleeding athlete is rest.

And the human comparison does not hold, because the human gets a say. A human athlete can tell the doctor exactly where it hurts. He can refuse the needle. He can retire. The horse can’t tell you, can’t consent, and can’t walk away. Every one of those decisions is made for him, by people whose money depends on him running.

That is the problem with the word therapeutic in our sport. There is treatment that heals the horse, and there is treatment that keeps the horse in the entries. Racing has used one word for both for a long time.

You don’t have to take my word for it. Take the industry’s own buyers. A review of phenylbutazone use by Soma, Uboh and Maylin in the Journal of Veterinary Pharmacology and Therapeutics noted that many clinical veterinarians won’t perform a prepurchase lameness exam unless the horse is free of anti-inflammatories, and regulatory vets want the same before a pre-race exam, so the drug doesn’t mask what is wrong.

University of Kentucky pharmacologist Thomas Tobin made the same point years ago in a review of pre-purchase drug testing. Anti-inflammatories, corticosteroids and local anesthetics can be used to mask defects of wind and limb in horses offered for sale. That is why smart buyers test.

When we are buying the horse, we insist on seeing him without the drugs. When we are running him, we call the drugs therapeutic and fight the people who want to see him clean.

Or take Dr. Larry Bramlage, as respected an orthopedic surgeon as this sport has. He has said corticosteroid joint injections should never be part of a routine training program, whatever the stand-down time, because you need time to reassess the joint “without the corticosteroid masking anything.” That is not an animal-rights activist talking. That is the man the industry calls when a champion’s leg is in trouble.

Or take the profession’s own trade association. The American Association of Equine Practitioners’ position on therapeutic medication endorses rest as an important part of racehorse healthcare and recommends building rest into medication programs. Its clinical guidelines for racetrack vets say a horse’s entry date should not be the primary factor in deciding its medical care. Read that one twice. The vets’ own association had to put in writing that treatment shouldn’t be scheduled around the condition book.

THE COMPENSATION ARGUMENT CUTS THE OTHER WAY

Mike’s sharpest question is this one. Could a horse with a manageable condition end up compensating and injuring something else because appropriate treatment was restricted?

It is a fair question. The science answers it, just not the way he wants.

A horse that is compensating is a horse in pain. The pain is the signal. It is the horse’s only way of telling you something is wrong.

The research on catastrophic breakdowns is about as consistent as anything in equine medicine. California’s racehorse postmortem program, run since 1990 by the CHRB and UC Davis, reports that roughly 90 percent of catastrophic musculoskeletal injuries are linked to pre-existing conditions, most of them preventable with timely diagnosis. Kentucky’s own necropsy program, started after Barbaro and Eight Belles, puts it at more than 85 percent. Dr. Susan Stover’s lab at UC Davis has shown that most long-bone fatalities come from weakening during attempted healing of an existing stress fracture.

Here is the part that matters most. UC Davis found those pre-existing stress fractures rarely cause lameness and can be missed on X-rays. Caught early and given time, the new bone heals as strong as the original, and the horse can return to training and racing with minimal risk of a catastrophic fracture. Time is not the enemy of the racehorse. It is the cure.

Read that again. Most breakdowns are the last chapter of a story the horse has been telling for weeks. Medication that quiets the story doesn’t end it. It just means nobody hears it until the horse goes down.

That is why withdrawal times and stand-downs exist. Not to punish trainers. So the vet examines the horse, not the drug. New York learned that the hard way after the 2011–12 Aqueduct inner-track meet, when the state’s task force put joint-injection practices squarely in the spotlight and corticosteroid rules were tightened.

Australia studied it directly. Whitton and colleagues, in The Veterinary Journal in 2014, found racehorses that got local corticosteroid injections and kept training had more musculoskeletal injuries afterward than horses that didn’t. Any benefit wasn’t enough to offset the added risk for at least 49 days, and horses injected repeatedly fared worst. The authors cautioned that the injection likely flags a horse whose joint is already in trouble rather than causing the damage itself. Fair enough. That is exactly the point. The injection is a marker of a horse that needed time and kept training instead.

California saw it up close. The CHRB’s report on the 23 deaths at Santa Anita in 2018–19 found pre-existing pathology at the fracture site in 21 of 22 catastrophic injuries. The one horse without it had a history of multiple joint injections at the exact site where the bone failed. Investigators flagged what looked like overuse of joint injections, sometimes repeated without diagnostic imaging, all within the rules at the time.

The warning signs show up before the breakdown. A UC Davis case-control study by Hitchens, Hill and Stover in Frontiers in Veterinary Science found Thoroughbreds that suffered fatal injuries had nearly three times the odds of having shown lameness in the three months before. A Kentucky study they cite found anti-inflammatory levels were higher in horses injured in a race than in horses that ran in the same race. The horse was telling somebody. The question is whether anybody listened, or just treated the symptom and entered him.

So here is the honest answer to Mike’s question. If a horse can only race safely with treatment that hides his condition, the answer isn’t to run him on it. It is to treat him, rest him, and bring him back when he is right. The choice is not medicate-to-race or do nothing. There is a third option, and it is called time. Time costs money. That is the whole debate.

The bone science backs it. University of Melbourne researchers modeling how racehorse bone accumulates and repairs damage found that rest is needed to adequately repair it. Their follow-up modeling found that at least two rests a year, or rests of at least six weeks, cut bone damage, and that swapping rest for light training worked less well.

And skipping it doesn’t make the bill go away. It defers it. Time can heal a lot of what drugs only mask. Run a horse through a condition instead, and the damage compounds. The horse who dodges the breakdown often pays later, in a retirement spent in pain, if he is lucky enough to dodge the kill pen at all.

That isn’t rhetoric. The American Association of Equine Practitioners’ own guidelines for transitioning retired racehorses note that lameness from osteoarthritis is common in horses coming off the track, especially in the fetlock.

PET SCANS, SCRATCHES, AND SARGE

Sarge says that when a vet sets out to find a problem, they will. With respect, a competent veterinarian doesn’t manufacture a problem that isn’t there. What a good vet finds is something that is there, or something that is budding. That is the job.

That is exactly what a PET scan is for. It shows bone activity tied to stress and injury, the kind of thing that isn’t obvious on a physical exam. This week the Breeders’ Cup has PET and MRI imaging available through Rood & Riddle and Hagyard, and every runner gets jog-up exams and at least one stall-side exam from the veterinary team.

Are the vets inventing problems? The best numbers we have say no. Chelsea Hackbarth dug into Kentucky’s vet scratches for the Paulick Report this spring. At the April Keeneland meet, just under 5 percent of entries, 58 horses, were scratched for unsoundness. In 2025 Kentucky data, fewer than 5 percent of vet-scratched horses made it back to the races within 30 days, compared with 26 to 52 percent of the winners of those same races. Somewhere between 16 and 30 percent of the scratched horses never raced again.

If the vets were making things up, those horses would have been back in a few weeks. Most weren’t. A lot of them never came back at all. Hackbarth’s own read is that in the vast majority of cases the vets are scratching horses that shouldn’t start. To be fair, she also found no statistically significant link to the fatality rate, and nobody can prove what would have happened if a scratched horse ran. That cuts both ways, and the burden should sit with the horse.

Remember Non Compliant at the 2024 Breeders’ Cup. Bob Baffert’s filly was the third choice for the Juvenile Fillies and came out after a PET scan. Her co-owner didn’t call it a conspiracy. She said something wasn’t right, that the filly’s “safety is the most important thing,” and that she was getting 60 days off before the Oaks trail. That is what a horseman sounds like when a scan catches something budding.

One more thing on aim. Mike and Sarge both point at HISA. HISA doesn’t scratch horses. As Lisa Lazarus said this spring, vet scratches are solely under the authority of the state racing commissions and their regulatory vets. At the Breeders’ Cup, it is the event’s own veterinary panel. If you are angry about a scratch, at least send the letter to the right address.

And the trend line is not ambiguous. HISA tracks ran 1.04 racing fatalities per 1,000 starts in 2025, against 1.21 at U.S. tracks outside HISA, with the national rate the lowest since the Equine Injury Database began in 2009. You can hate the bill and still read the scoreboard.

SHOW US THE NUMBERS

Two days before the first race, the Breeders’ Cup put out the safety and integrity measures in place at Keeneland. It is a serious list. Medical records for every domestic contender pulled from HISA and reviewed by the Veterinary Review Panel twice, the second time after pre-entries closed October 19. Thirty days of records for international horses. Out-of-competition testing through race day. Mandatory 24-hour surveillance. Jog-up exams before any horse steps on a Keeneland surface. The AI-powered Sleip gait app. PET and MRI on call. This is the fourth Breeders’ Cup under full HISA jurisdiction.

I support all of it. But a release that lists what was done is not the same as one that says what was found. Here is what it doesn’t tell us:

How many potential starters were flagged in the preliminary reviews, and how many were then cleared or withdrawn.
How many horses had PET scans or MRIs, what prompted them, and what they found.
What the treatment-record reviews actually turned up, beyond confirming they happened.
What measurable improvement in injury prevention or detection these specific protocols have produced.

Not every horse’s findings belong in public. There are legitimate confidentiality concerns, and the Breeders’ Cup has cited the vet-client relationship before when declining to explain scratches. But aggregate outcomes, consistent definitions and transparent reporting would protect privacy and still back up the claims.

This is where both sides should want the same thing. If the protocols are catching real problems, the numbers are the best answer to every trainer who thinks the vets are fishing. If they aren’t, we need to know that too. Right now, everybody in this fight is asking us to take their word for it.

WHERE MIKE IS RIGHT

Fairness is the point of this piece, so here is the other column.

The inner circle is real. Mike names Everett Dobson, who chairs The Jockey Club, is a Keeneland trustee and is a Breeders’ Cup member. All three are a matter of public record. Same faces, different organizations, and the organizations wrote and funded the system now regulating everyone else. We have made that case ourselves, in The 18 Month Mandate, in Hold Us To It, and in The Litigation Era.

The process around scratches needs work. Horsemen deserve to know why a horse was scratched and what it takes to get him back, applied the same way to everyone. Hackbarth suggested something as simple as a reason-for-scratch document. National HBPA CEO Eric Hamelback says the issue is not oversight but the lack of a balanced, accountable process. Churchill Downs’ equine medical director, Dr. Will Farmer, acknowledges a trust gap between trainers and regulatory vets. That is a legitimate complaint, and it should be fixed.

Withdrawal times should be built on science. Asking whether each one is longer than it needs to be is a fair research question. What is not up for debate is why they exist: a clean exam.

HISA’s cost deserves scrutiny. Mike says roughly $80 million a year. HISA’s FTC-approved 2026 gross budget is $77.2 million, about $60.6 million net if every credit is used, and Churchill Downs’ letter to the FTC put the total to date at more than $250 million. Accountability for that money is not optional. We said investigate HISA, fine, just don’t stop there.

But here is the line that matters. The governance argument and the medication argument are two different arguments. Mike’s credibility on the first is real. This week he spent it on the second, and the second doesn’t hold up outside the barn.

THE PAST THE WIRE TAKE

Mike closes by saying protecting our horses and growing the sport should never be in conflict. I agree with every word of that.

They only come into conflict when the business model depends on running horses a veterinarian outside racing would rest. That is the conflict. Not HISA versus horsemen. Not regulations versus horses. The horse’s need for time versus the business’s need for starters.

The shrinking foal crop is real. Short fields are real. Owners asking why they spend millions are real. But medicating a shrinking population of horses to keep them in the entries is the same patch Lasix was for bleeders. It covers the problem and makes it profitable to stop looking at it.

The outside world is already looking. Tripadvisor put a warning label on our racetracks. Those people are not grading us on how frustrated the trainers were during Breeders’ Cup week. They are grading us on the horse. A scratch costs an owner an entry, a week, maybe a dream. A breakdown on national television costs everybody.

The horse doesn’t get a vote. Somebody has to cast it for him. More and more, that somebody is a veterinarian standing next to a PET scanner. The frustration Mike is hearing is the sound of that vote being counted.

In February 1939, as I have heard it, Seabiscuit ruptured a suspensory ligament. There was no PET scan, no injection that would have made him look sound enough to run. So they did the oldest therapy in the game. They gave him time. A year later he came back and won the Santa Anita Handicap. Nobody called that unenjoyable.