“Have you ever injected a joint with corticosteroids just because it was the horse’s birthday?” Professor Roger Smith

Although apparently absurd, Professor Roger Smith’s opening question at the BEVA congress debate introduced one of the recurring themes of the session — how vets should behave when asked by owners to provide treatments without first undertaking a thorough diagnostic work-up, or in the absence of evidence that treatments are effective.

The discussion centred not on the administration of banned drugs (clearly both illegal and unethical), but on the issue of how far it is reasonable to go, within the rules, to “keep horses on the road”.

The use of multiple, repeated “maintenance” joint injections between competitions was cited as an example of potentially unethical practice, given the lack of evidence that the horse will benefit from such treatment and the acknowledged potential risks of joint sepsis or laminitis after injections — particularly when steroids are used.

Some speakers and delegates essentially felt that what isn’t against the rules is acceptable. Others felt that the fact that treatment is not contravening regulations does not necessarily make it ethical.

This argument applies equally to elite and grassroots competitors.

Is it ethical, for example, to perform a neurectomy (cutting a nerve so that a horse no longer feels pain) to create soundness? Or to give a little phenylbutazone (bute) to a horse that has gone mildly lame the day before an unaffiliated championship, if there is no clearly recognised rule against doing so?

The answer from an ethicist’s point of view, Dr Madeleine Campbell argued, must be that the horse’s welfare should be prioritised.

“Equine sports medicine ought to be aimed at safeguarding the welfare of equine athletes in both the short and long term,” she said. “In fact, the priority is all too often one of keeping athletes competing in the short term, whatever the long-term welfare costs.”

Under pressure

Stock shoot with Emma and Mark Butler

Concerns were expressed about horses with complex multifactorial problems, such as a sore back and low-grade hindlimb lameness with multiple sites of pain. Such cases might benefit from time off as well as treatment, but the pressure to keep them competing means that instead they may receive a multitude of treatments without rest.

The motivation for using multiple, sometimes unproven therapies, both medicinal and non-medicinal — such as some surgeries, shockwave therapy, acupuncture, homeopathy and different types of manipulation — and whether it is ethical to do so, was discussed. Those arguing that equine sports medicine is ethical pointed out that firm evidence of efficacy or pathology is often absent in human as well as in animal sports medicine, and the use of unproven treatments is common to both.

Some expressed views that the pressure to get horses to a major event can be such that some enter the competition “patched up” but underprepared, putting them at increased risk of further injury.

The subject of sporting ethics was also explored. Leaving aside welfare issues, it is arguable that a sound showjumper who loses to a horse medicated prior to the competition — even if the rules allow such medication — has not been beaten fair and square.

Similarly, is it unfair if a young horse that has been given ACP to “take the edge off it” beats a non-sedated competitor at a local show, even if there is no specific rule banning the use of ACP at that event?

Guardians of welfare

Maintenance of anaesthesia Equine anaesthesia for major surgery requires careful monitoring and support of vital function

None of the participants argued that the use of horses in sport ought to be banned; all accepted that this is ethically justifiable and that equine athletes, like human athletes, are prone to injury and should be provided with expert medical attention.

Suggestions were made for how equine sports medicine could be made more ethical. These included the introduction of between-competition drugs testing (as currently happens for racing thoroughbreds in the UK) and storage of samples, and improved communication between the many different people who may treat the same horse at various times between and during competitions.

A “before and after” audience vote showed that the majority opinion swung from believing that equine sports medicine is ethical, to thinking that it is not as it is currently practised.

The BEVA debate highlighted the fact that equine sports vets are the guardians of the horse’s welfare in a sport where good performance is essential for successful continuation of the industry.

The American College of Veterinary Sports Medicine and Rehabilitation in the States, recently established for vets specialising in sports medicine, already has some UK members.

It is hoped that a combination of official recognition of properly trained specialists, analysis of what constitutes ethical equine sports medicine, and research to provide the evidence base for treatments, should help to protect and promote the welfare of horses competing at all levels and across disciplines.

Ref: Horse & Hound; 19 November 2015