Why are there different forms (salts) of betamethasone (in this case acetate and valerate)?

Many drugs do not dissolve well in water, so other molecules are added to them so that they can dissolve in water in order to make useful dosage forms. Sometimes these other molecules are added to the drug to make them last longer in the animal when injected into something like a joint, that is, dissolve very slowly (think of a slow-release drug). Often, the betamethasone used to inject into a joint has two forms, one that is already dissolved to act sooner and one that remains in the joint and delivers [the] drug more slowly. For use on the skin, betamethasone valerate is used and can be absorbed into the animal. Betamethasone from any of these salts is the same in the animal's body; it's a potent drug used to reduce inflammation and pain and its effect is long lasting in any form.

What happens to these other molecules added to betamethasone?

The body removes these extra molecules added leaving the main drug (in this case betamethasone) to do its work. For betamethasone valerate in an ointment, some of it will be absorbed and the amount depends on the integrity of the area it is being applied to. The valerate added to betamethasone would be found in the urine along with some betamethasone valerate. For betamethasone acetate, the acetate is removed and used in the body to make other things so finding it in the urine would be quite unusual.

How does a drug like betamethasone work to reduce inflammation and pain?

Inflammation occurs due to the animal's immune system working and its reaction to an injury. The drug acts to calm down the immune system to produce its effect. Betamethasone in any salt form does not work immediately when injected in a vein, a joint, or applied as an ointment. This effect takes time to occur (at least a few hours after the animal gets the drug). Even when the drug is completely gone from the body, the effect remains for some time (hours or days) because it takes the immune system time to gear back up (and hopefully the injury is healed). So that means even if small amounts or no drug is found in the blood, the effect on inflammation and pain lingers after a dose.

Do we know the relationship of the amount found in the blood and the drugs' effect on reducing inflammation and pain?

Absolutely not, we do not know how much drug in the blood is needed to get the effect to reduce inflammation and pain. Measurement of the drug in blood is not a good indicator of the dose of the drug used or when the drug was given; it simply tells us that the animal has received the drug. This is the reason that there is such a long time between injection of the drug into a joint and when a horse can race “clean” as set up in the rules of a racing commission.

What can measurement of drug in the blood tell us?

Measurement of drug in blood can tell us how much total drug can be found in the blood of the horse but not how much total drug is in the body of the horse. For Medina Spirit, a measurement of 21 pg/mL in the blood was found the day he won the 2021 Kentucky Derby. The average blood volume of a horse is 54.5 liters (54,500 mL or 12.3 gallons). So, if you multiply 21 pg/mL x 54,500mL of blood, you get 1.14 micrograms total in the blood. The usual dose injected into a joint in a horse is 9 mg (9,000 micrograms), and since the betamethasone acetate used is designed to dissolve slowly, we would suspect that there could be more drug remaining in the joint than what is reflected in the blood.

So, what does this all mean? 

Well first, betamethasone is betamethasone, it doesn't matter how it got into an animal (injection, ointment, etc.), it is active in reducing inflammation and pain. Next, finding low amounts of the drug in the blood does not tell us when the drug was last given. It does tell us that an exposure has occurred and may be ongoing. Since the drug effect is long lasting (and lasts even after the drug concentration is low or no longer measurable in the blood), a significant effect on inflammation and pain may still be occurring. Finding betamethasone valerate in the urine is not unexpected when betamethasone valerate is used as an ointment [as] some is absorbed. When using betamethasone acetate injection, finding no acetate in the urine is expected because the body uses the acetate that is shaved off the betamethasone to make other things.

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Beychok, who is the leading figure in a class-action lawsuit filed by gamblers who say they would have made money on the 2021 GI Kentucky Derby had it not been won by Medina Spirit (Protonico), says he has grown so disillusioned by the sport that he will stop betting on a regular basis after attending this year's National Handicapping Championship. His future bets will be limited to the handful of times he attends live racing.

“I'm just fed up with the drug cheating,” he said. “I'm fed up with the takeout. I'm fed up that we apparently can't get into a position to implement new and better drug testing. I have more outlets now to gamble. I live in Louisiana, which was a state, up until last year, where the only thing available was horse racing. Now, there is daily fantasy sports, which I enjoy, and the takeout is much, much better. Soon we will have on-line sports betting. I am a consumer. I have just found better products.”

Beychok made headlines last year when filing a suit against Baffert, contending that he would have made more than $50,000 on the Derby had the race been won by Mandaloun (Into Mischief). Mandaloun finished second behind the Baffert-trained Medina Spirit, who tested positive for the banned race-day medication betamethasone. He wants the court to rule that Baffert must compensate gamblers involved in the suit who would have cashed if Medina Spirit did not win.

“My first motivation was as a gambler,” he said. “I was kind of pissed off when it was announced he was positive for a banned race-day drug. Looking back on what had happened in the past with some of Baffert's positives in major races, I just knew that nothing was going to happen. I felt I had to do something because I didn't think anyone else would. I decided I wasn't going to take it anymore. I was going to do something not only for myself but for the more than 250 other bettors who have joined our class action. We're tired of being defrauded by Bob Baffert. In big races, his horses keep turning up positive.”

Beychok insists this isn't about the money.

“Any money that I get from this lawsuit, I'm donating to Thoroughbred aftercare,” he said. “I'm not putting a penny of this money into my pocket. Hopefully, I do get paid. But what I'm trying to do is to raise the point that we cannot, in a game of chance, on a game of gambling, let anybody, be it Bob Baffert, Jason Servis, Jorge Navarro, defraud us as bettors.”

Baffert's legal team has fought back and is seeking to have Beychok's suit thrown out. In a court filing last week, Baffert said Beychok's allegations were libelous and called his actions a matter of a “tinfoil conspiratorial premise.”

“That was for public consumption,” Beychok said. “That's all. I just laughed at it. The judge will look at the law and decide if applies in this case or if it doesn't.”

Beychok said he's not surprised that Baffert is putting up a good fight.

“Bob Baffert is very good at this and he has a very good PR machine,” he said. “He's good at it because he had to do it so many times over the last 15 years when his horses have tested positive. He's got to come up with an excuse, a PR campaign. He's good at this stuff and so are his lawyers.”

Beychok said he would like to see Baffert issue a mea culpa.

“My hope for this game that I do love is that he does what Lance Armstrong did,” Beychok said. “At some point, he needs to come clean and tell the truth. That might preserve some of his legacy.”

While about to step back, Beychok said he's willing to give horse racing another chance, that is if there are meaningful changes.

“I hope it changes because I love the game and the people in it,” he said. “I hope everything changes and I can say I am back. If I ever feel like this is a fair game I will come back.”

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“Santa Anita Park is committed to integrity, accountability and fairness in our sport. As it stands, the Kentucky Horse Racing Commission (KHRC)–which is the governing body for horse racing in Kentucky–has not released all of the information nor has it offered a ruling on this matter. We will continue to await action by the KHRC and will make a decision once their regulatory process is complete.”

Santa Anita is Baffert's home track and where the majority of his stable is based. He will be unable to enter horses in races or occupy stalls at any Churchill-owned tracks, which include Fair Grounds and Arlington Park, due to the split sample from Medina Spirit (Protonico)'s first-place finish in the May 1 GI Kentucky Derby returning positive for betamethasone, a prohibited substance in Kentucky.

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“In response to the inquiries, this will acknowledge that the Medina Spirit split sample confirmed the finding of betamethasone at 25 picograms,” Robertson said in a statement. “There is other testing that is being conducted, including DNA testing. We expect this additional testing to confirm that the presence of the betamethasone was from the topical ointment, Otomax, and not an injection. At the end of the day, we anticipate this case to be about the treatment of Medina Spirit's skin rash with Otomax. We will have nothing further to say until the additional testing is complete.”

As of the deadline for this story, the Kentucky Racing Commission had yet to make any statements regarding Medina Spirit and the Betamethasone positive and neither had it confirmed that Medina Spirit has failed any drug tests. However, Churchill Downs took action of its own Wednesday, suspending the trainer until the conclusion of the spring meet in 2023. If Baffert cannot compete in the 2022 and 2023 Kentucky Derby many prominent owners may choose to give their horses to other trainers.

Churchill issued a statement Wednesday, which read, in part: “The suspension prohibits Baffert, or any trainer directly or indirectly employed by Bob Baffert Racing Stables, from entering horses in races or applying for stall occupancy at all CDI-owned racetracks. This decision follows the confirmation by attorneys representing Bob Baffert of the presence of betamethasone, a prohibited race-day substance, in Medina Spirit's bloodstream on the day of the 147th running of the Kentucky Derby in violation of the Commonwealth of Kentucky's equine medication protocols and CDI's terms and conditions for racing.”

Churchill Downs CEO Bill Carstanjen made it clear that the company has no tolerance for anybody whose action might compromise the integrity of the sport.

“CDI has consistently advocated for strict medication regulations so that we can confidently ensure that horses are fit to race and the races are conducted fairly,” Carstanjen said. “Reckless practices and substance violations that jeopardize the safety of our equine and human athletes or compromise the integrity of our sport are not acceptable and as a company we must take measures to demonstrate that they will not be tolerated. Mr. Baffert's record of testing failures threatens public confidence in thoroughbred racing and the reputation of the Kentucky Derby. Given these repeated failures over the last year, including the increasingly extraordinary explanations, we firmly believe that asserting our rights to impose these measures is our duty and responsibility.”

CDI said that it was reserving the right to extend Baffert's suspension if there are additional violations in any racing jurisdiction.

NYRA suspended Baffert for an undetermined period starting May 17 and they announced that the ban would stay in place until further notice.

“On May 17, the New York Racing Association, Inc. announced the temporary suspension of Bob Baffert from entering horses in races and occupying stall space at Belmont Park, Saratoga Race Course and Aqueduct Racetrack,” NYRA spokesman Pat McKenna said. “That suspension remains in effect and NYRA will make a determination regarding the length and terms of Mr. Baffert's suspension at the appropriate time and based on information generated by the ongoing investigation in Kentucky.”

After the news broke that the horse had tested positive following the Derby, trainer Bob Baffert and owner Amr Zedan requested that a second sample be sent to a laboratory, hoping that it would not show any traces of the prohibited medication.

If Medina Spirit is disqualified, the official winner of the Derby will be Mandaloun (Into Mischief). In 1968, Dancer's Image was disqualified from the Kentucky Derby after tests revealed the presence of phenylbutazone in his system and Forward Pass was declared the winner.

Once the racing commission makes it official that Medina Spirit has failed both tests, a hearing will be held before Churchill Downs stewards. If they decide that Medina Spirit must be disqualified then the Baffert team will have the option of appealing the case to the Kentucky Racing Commission. Should it decide to uphold the disqualification and penalties given to Baffert by the stewards, the next move from the Baffert team would likely be to appeal to the courts and to seek a stay pending the outcome of the case.

It took four years for the Dancer's Image case to work its way through the court system. He was not officially disqualified until 1972.

Baffert did not respond to a text from the TDN. When reached by phone, Zedan said he had no comment and referred questions to his attorney, Clark Brewster.

Brewster said he was confident that the original results of the Kentucky Derby would hold up and that Baffert would be exonerated. Baffert has said that Medina Spirit was treated with Otomax, an ointment that contains betamethasone and is used to treat dermatitis. For that reason, Brewster will make the case that the drug positive was nothing more than a case of inadvertent contamination. He said that the Medina Spirit team will request additional tests in an effort to prove that Medina Spirit was in fact treated with Otomax, which would indicate, he said, that the horse was not injected with the medication and that there were no attempts to use the medication as a performance-enhancer.

“Bob Baffert wins the Derby and within days is pilloried. People are on social media saying he is a cheat,” Brewster said. “The upshot of this is that they all believe this was an injectable into the joint and he's trying to get a horse in that might have some joint issues or pain. That's nonsense.  If it can be proven that it simply was salve for eczema and used on a portion of his hip, which I think we can document…And it's not just Bob saying that, it would be proven scientifically. Reasonable people with some of facts will reach the same conclusion. The Horse Racing Integrity act? I love it. Let's make the rules uniform for everybody. But if you reject the science and use Draconian decision making, then it's bad for everybody. It's like rejecting climate change. When you are at a picogram level you have to use common sense and when you show the method of how it got into the horses's system, that is relevant and important for any decision making. I am very confident that reasonable people with the same facts will reach a reasonable conclusion, which means victory for Bob.”

PETA issued a statement Tuesday in which it called for Baffert to be permanently banned from the sport.

“Bettors who've been cheated by putting money down on the rigged Kentucky Derby may contact PETA or attorneys who are filing class-action lawsuits, but the other victim here is Medina Spirit,” said PETA Senior Vice President Kathy Guillermo. “He should be thoroughly examined by independent veterinarians to find out why he was administered a powerful medication and whether it was through injections to his joints rather than with a topical cream. The racing industry must at last stop buying Baffert's nonsensical excuses and kick him out for good.”

The Animal Wellness Action called for Churchill Downs to permanently ban Baffert from participating in the Derby.

Though the Kentucky Racing Commission has yet to take any official action against Baffert, he has been banned indefinitely by Churchill Downs and the New York Racing Association. The Stronach Group, which operates Santa Anita, Baffert's home track, has not taken any action against him, but may have been waiting for the split sample to come back. Should he be suspended by the Kentucky Racing Commission, all other state racing commissions will have to honor that suspension.

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The statement appears below in its entirety:

“As Medina Spirit prepares to run in the Preakness Stakes today, I want to keep the focus on this amazing equine athlete and not me, which is the primary reason I will not personally be in attendance. I do not want to serve as a distraction to what has always been of paramount importance–the joy of this great sport and the horses that make it possible.

“As I have stated from the beginning, there was never any attempt to game or cheat the system and Medina Spirit earned his Kentucky Derby win. While the presence of 21 picograms of an allowable therapeutic medication has yet to be confirmed by the split sample analysis, it would have nothing to do with Medina Spirit's hard-earned and deserved win. That win was the result of the horse's tremendous heart and nothing else.

“Notwithstanding the foregoing, I acknowledge that I am not perfect and I could have better handled the initial announcement of this news. Medina Spirit's Kentucky Derby win was so personally meaningful to me, and I had such a wonderful experience on May 1 at Churchill Downs, that when I got the news of the test results, it truly was the biggest gut punch I had ever received and I was devastated. That, coupled with the fact that I always try to be accommodating and transparent with the media, led to an emotional press conference on May 9 in which I said some things that have been perceived as hurtful to some in the industry. For that I am truly sorry. I have devoted my life's work to this great sport and I owe it, and those who make it possible, nothing but an eternal debt of gratitude.

“For those who want an explanation for what transpired with Medina Spirit, I have tried to be open and transparent from the beginning. Our investigation is continuing and I don't have definitive answers at this point. What I do know is that neither my barn, nor my veterinarians, directly treated Medina Spirit with the anti-inflammatory medication betamethasone. Even though it is allowable, it is just not something we have ever used with this horse. The only possible explanation that we have uncovered to date–and I emphasize the word possible–is that betamethasone is an ingredient in a topical ointment that was being applied to Medina Spirit to treat a dermatitis skin condition he developed after the Santa Anita Derby.

“I have been deeply saddened to see this case portrayed as a “doping” scandal or betamethasone labeled as a “banned” substance. Neither is remotely true. Betamethasone is an allowable and commonly used medication in horse racing. Further, 21 picograms would have zero pharmacology in a horse. All I ask is that everyone not rush to judgment and allow all of the facts, evidence and science to come to light.

“Lastly, while this has been extremely hard and emotionally draining on me and my family, today is not about Bob Baffert. Instead it is about Medina Spirit and all of the other equine athletes in our tremendous sport. I hope that everyone will direct their attention to them and give them the love and respect they so richly deserve.”

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You'll forgive me a little hesitation before addressing the 146th running of a race that can seldom have been staged in so febrile a context. Two weeks ago, I was incautious enough in this column to hope for just a nice, boring Derby, after the rancour of 2019 and the dismal postponement of 2020. Then, last week, I asked why even his own industry had been so ungenerous to a trainer who had now won four of his seven Derbys with horses that had at various times changed hands for an aggregate $54,500.

Me and my big mouth, huh? But then I'm no different from anyone else. Every single member of our community will feel like he or she has something at stake in the latest contamination of its standing in the wider world: from our judgement, to our very livelihoods. By the same token, we all have a share in how we go about repairing matters.

Because this is not just a question of whether or not Bob Baffert can cogently secure exculpation. The merits of his case will be tested by due process. For the rest of us, the imperative will remain the same regardless of the outcome. We cannot keep missing our cue.  If all we do is mutter resentfully, every time society turns up the spotlight, then we can't be surprised if the theatre gradually empties until they take off the show altogether.

True, some of Baffert's own peers have responded with candid vexation to the latest and most conspicuous fissure he has opened in perceptions of our sport. They have been irritated by his emotive attempts to depict himself as a victim of “cancel culture”, and to transpose fault from his own regime–which seems, on a charitable reading, at least to be curiously accident-prone–to a lack of regulatory discrimination.

Albeit Baffert has raised the bar, his profession includes many paragons of achievement who have never had so much as peppermint on a horse's breath. These tend to respect boundaries rather than push them. Yet even some who position themselves on the “pragmatic” end of the therapeutics spectrum are exasperated. They view Baffert's history of infringements not as inherently sinister but as tiresome and avoidable.

Some feel that even proceeding to Pimlico with Medina Spirit (Protonico) guarantees a lose-lose scenario both for his connections and for the sport as a whole. To be clear, The Stronach Group have handled an invidious position competently. They couldn't and shouldn't stop the horse running. Nor could they have made their position more accessible and coherent than by a) rightly stating that “we cannot make things up as we go along” while also b) stipulating with Baffert exhaustive pre-competition testing. But it's a horrible situation, all round, with the hapless horse transformed overnight from a symbol of hope to one of despair. If he is beaten, connections will have gained nothing from standing up for his right to run. And if he does win, well, it'll be interesting to hear what kind of reception he gets on returning to unsaddle–and, indeed, when entering the Belmont paddock with his trainer's third Triple Crown on the line.

As we've already suggested, however, the story has already left Baffert and Medina Spirit far behind. (Which is exactly what makes so many people mad at Baffert, even if they consider his horse a perfectly deserving Derby winner.) Predictably enough, the mainstream news agenda has hastened to combine this trauma with various others recently endured by our sport, too wearily familiar to require reprising here. Just as predictably, and just as promptly, apologists have complained of a parallel conflation, so that trainers concerned only for the welfare of their horses are tarred with the same brush as those who cheat brazenly with blood doping or steroids.

But you know what, that's exactly why people out there in Main Street can't tell the difference between, say, Christophe Clement and Rick Dutrow. What else can we expect, if people inside the business keep telling the lay audience that they just don't understand, and please to go away? The choice is clear: insist on our gray areas, or sacrifice them to a corporate clarity of purpose. As it is, what is the world beyond our parish supposed to make of professional associations litigating for what will inevitably be perceived (however unfairly, and however complex the reality) as their constitutional right to dope racehorses?

Medina Spirit this week at Pimlico | MJC photo

We cannot keep putting each new alarm back on “snooze”. It's only human for Baffert, in a corner like this, to be turning round the guns so that it's all someone else's fault: hyperregulation, clumsy veterinarians, whomever. But the rest of us have to do better than that. Whatever the merits of his own case, we're all in that same corner now. And we have to earn, really earn, a way out.

So for now forget all those picograms and thresholds, and whether Baffert is as innocent as he claims, or whether he's a little too reckless, or worse. The fact is that our whole culture, to this point, has enabled far more obviously egregious cases at every point of the compass: guys who are thriving because a) the worst that can happen is that your assistant gets a few days with his name on the racecard and b) too many investors would prefer a piece of a barn's inexplicable strike-rate than to admit that it's actually all too explicable.

Some stables won't even enter at particular tracks, or against particular trainers, because they know they won't be in a clean fight. Many of us, especially when patrons of Messrs. Servis and Navarro professed such amazed indignation, have remembered Captain Renault being “shocked, shocked” that gambling is taking place in Rick's Café. (He is, of course, promptly handed his winnings by a croupier.)

Let's not kid ourselves either that this is only happening at bush tracks, or that we can solve everything by turning Baffert into a pantomime villain. Just as he can't blame everyone else, nor can everyone else blame only Baffert. Do that, and we'll very soon discover how short a slip divides frying pan and fire.

In the end, Captain Renault comes good. But he needs the inspiration of high-principled Victor Laszlo, the one man in Casablanca whose conscience permits him to sleep well. So who, in our business, will step up for that role?

Well, again without presuming any judgement on Baffert himself, it was fascinating to see B. Wayne Hughes of Spendthrift yet again taking a lead. Hughes prides himself on not giving a damn what other people think, so long as he is satisfied that he is doing right. That attitude has not always endeared his rivals, even if they have largely ended up imitating his every move. And you can bet that nothing has panicked Baffert this week more than Spendthrift “hitting the pause button”.

Having always proudly plowed a different furrow from what the English know as “the Establishment”, Hughes has also been in the vanguard in facilitating microshare entry into elite racing. Quite clearly, he understands how the very survival of our sport no longer depends on the jousting of wealthy egos, but on popular engagement. And that requires us to go out there with absolutely nothing to hide.

If we can do that, then we might be granted the respect and time to solve our other problems: breakdowns, say, or what to do about the whip. (Besides, one of the key premises of hay, oats and water is obviously to prevent breakdowns.) But first we have to go into Main Street ready to show everyone, with undiluted honesty and pride, every single thing we do with these beautiful animals.

Oh, one more footnote. The biggest hole in this horse race may not be where everybody is looking. Because whatever Baffert may or may not have to explain, his peers have fallen badly short in presenting just three of the Derby field for the second Classic. If their regimes are really so wholesome, then they shouldn't be scared of what history tells us: that many a Preakness winner has left behind Derby defeat precisely because of a robustness that wasn't artificial.

It's all very well telling Baffert that he must turn out every pocket when he comes to a big race. But he might be entitled to wonder whether one or two of his rivals meanwhile have nothing to hide except their racehorses.

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His status became unclear Sunday when Baffert informed the media that he had been told by the Kentucky Racing Commission that Medina Spirit had tested positive for the corticosteroid betamethasone in tests conducted following the race. A few hours later, 1/ST, the owners of Pimlico, put out a press release stating they were still reviewing the situation. They bought themselves a bit of time when deciding to move the draw for the Preakness from Monday to Tuesday.

“Pimlico has not taken such action yet, Robertson said in a text message. “However, if they do, I will file such a TRO. There is something called due process of law and any rush to judgment or punishment at this point would be premature and unlawful. If anyone takes such action before the split comes back, we will act.”

Baffert told the TDN that he will not, no matter his personal status, be attending the Preakness.

The Kentucky Racing Commission has had little to say about the matter, which probably won't change until after a second lab has tested a split sample. Robertson has already set the ball in motion regarding the testing of the split sample.

“We will be given a list of labs by the Kentucky Horse Racing Commission from which we can chose to send the split,” he said via text. “That list has not been provided yet. No definitive time frame, but past experience tells me that from this moment until split results come back will be at least a couple of weeks.”

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