What's Going On Here: Unknowns in Medina Spirit Case

Just a reminder: The method of administration of the betamethasone found in the failed post-race drug test of Medina Spirit after he finished first in the 2021 Kentucky Derby Presented by Woodford Reserve (G1) has not been fully established. Owner Zedan Racing Stables and trainer Bob Baffert have been well-represented as this case has slowly moved forward, and those attorneys have done an excellent job on the public relations side to suggest that the betamethasone found in the failed drug test was from an ointment, Otomax, used to treat a rash. Their statements would suggest this is a fully established conclusion. Eventually it may be fully established that the betamethasone that caused the failed post-Derby test was from the ointment, as opposed to an injection. But it's worth noting that while these conclusions have been trumpeted by the attorneys for Baffert and Zedan Racing Stables, the entity that might have a different opinion on the finding, the Kentucky Horse Racing Commission, has not addressed this issue to date. The KHRC has said very little, striving to follow a regulation that precludes the commission from making public statements prior to issuing stewards' rulings. In one of the few times anyone representing the regulator has discussed the case in an open meeting, KHRC general counsel Jennifer Wolsing told Franklin (Ky.) Circuit Judge Thomas Wingate in June 2021 that the way the betamethasone was administered is not important. She said the betamethasone prohibition is "not differentiated" in terms of how the corticosteroid is administered, whether it came from an ointment or injection. So it's possible the stewards and the KHRC may not even consider how the betamethasone was administered in any ruling or appeal. With the KHRC's quiet approach in place, Baffert's attorneys have had no counters to statements like the one they released Feb. 14, after the day's stewards hearing—which was not open to the public (a standard that may soon change). "We are now left to trust that the stewards will apply the uncontroverted facts to the Kentucky racing rules as they are written," Baffert attorney Clark Brewster said Monday. "Medina Spirit was treated by veterinarian prescription with a topical salve for a skin infection. The Kentucky rules expressly permit use of topical salves, and the treatment given to 'Medina' did not violate any rule. The post-race specimen positive reporting 21 picograms of betamethasone was caused by the topical salve. The Kentucky rules (and all other jurisdictions) restrict only betamethasone acetate or sodium phosphate. These formulations are injectable solutions into a horse's intra-articular joint. Medina Spirit was never injected with betamethasone and the evidence presented today proved that conclusively." With the KHRC remaining silent, Brewster is doing his job defending his client. But, to this point, the KHRC has not conceded that the manner of administration of betamethasone matters. And the matter of administration, as point of fact, also has not been conceded by the KHRC. The issue on whether the method of betamethasone administration matters under the Kentucky rule likely will play out as the stewards issue a decision on the horse's victory and any sanctions against Baffert. The stewards will have the first say on this issue, largely through their decision. The issue on the method of administration and whether it matters under Kentucky rule, would then figure to be a point of contention if there's an appeal to the KHRC's full board, which likely would bring in a hearing officer. If the KHRC ultimately finds it necessary to address the method of administration, there also could be some interesting issues. First of all, it's worth noting that the words used in the statement issued by the lab, which was read into the record during a hearing on the New York Racing Association's effort to ban Baffert for some length of time, are not as strong as they have been interpreted by Baffert's defense. While the defense team flatly states the post-race specimen positive reporting 21 picograms of betamethasone was caused by the topical salve, the New York Drug Testing and Research Program report says: "We consider this to be a research project that will be submitted to a peer reviewed journal and as such is confidential until the data has been submitted for review." The letter provides a brief outline of the study. It says the lab applied Otomax to two research horses. In those research horses, the lab says it found levels of betamethasone valerate, not betamethasone acetate. It says it found only betamethasone valerate in the Medina Spirt sample as well, not betamethasone acetate. Baffert's attorneys, and other experts, have explained that acetate is only found when betamethasone is injected—not in ointments. Based on this part of the study's findings, they conclude that the betamethasone is from the ointment. But the conclusions of the betamethasone coming from an ointment are very much from a study that was conducted a bit on the fly. The conclusions, at this point, are not from some established, peer-reviewed study. Perhaps this study eventually will play out as conclusive if it stands up to peer-review, but I suspect those peers will question whether the time that passed between the collection of the Medina Spirit sample and the New York testing could have impacted the finding. Is comparing the Medina Spirit sample to samples from research horses that were administered Otomax in a lab and had their samples quickly collected a fair comparison? Is a study using two horses in a lab enough to make conclusions? I don't know the answers to these questions, but they seem worth asking. I suspect experienced researchers will consider these issues in any peer review. It should be noted that the New York Equine Drug Testing Program, where Dr. George Maylin serves as director and oversaw the Otomax study, is considered to be one of the leading equine drug-testing programs in the world but most would consider his assistant in this study a less-than-neutral party. In testimony in the NYRA-Baffert case in New York, Dr. Clara Fenger (PhD., DVM, DACVIM) said she assisted Maylin in the study. Fenger previously had testified as an expert witness on behalf of Baffert in his appeal of a 15-day suspension in Arkansas after two of his horses, Charlatan and Gamine, tested positive for lidocaine after racing May 2, 2020, at Oaklawn Park. Baffert would see his sanctions in that case, where suspicions of contamination were raised, reduced to two $5,000 fines. In the NYRA-Baffert hearing, Fenger said she has provided testimony in horse racing cases involving drug and medication issues 25-30 times since 2014—always on behalf of trainers or owners. Fenger seems like an interested party, but perhaps this did not impact the research. The thing is, at this point, it's just hard to say as there's been no peer review. In the NYRA-Baffert hearing, Dr. Maylin did not testify. In 2014 an attorney for trainer Todd Pletcher successfully argued in Delaware that a betamethasone rule and withdrawal time on the books there was not subjected to proper peer review and publication requirements. An assistant attorney general dropped that case. Now it seems, at least on the issue of how much credence a non-published study should be given, the shoe is on a horseman's foot. This story was updated to correct sentences on the lab's betamethasone findings on acetate and valerate.