Some Thoughts on Baffert and Betamethasone

By now, you’ve obviously heard the news – Medina Spirit, trained by Bob Baffert, tested positive for Betamethasone following his victory in the 2021 Kentucky Derby.  This is clearly an evolving story and we are not here to litigate in public, but the topic is worth addressing, in a factual manner.

Let me start by saying that I’m a pharmacist by training but also add that I have no formal experience as it relates to pharmacy applied to horses.  I’m approaching the news from this past weekend like many of you, from the perspective of a horseplayer.  There are few opportunities where my vocation and “hobby” overlap and it goes without saying that I wish this wasn’t the situation that makes it possible.

Horse Racing Twitter is a melting pot of hot takes, red boarding, inside information, and tons of opinions – some of which are based on incorrect information.  All of that was on full display early Sunday morning after a brief press conference on the Churchill Downs backside.

While we await the results of the “split sample” and other elements of due process to play out, I wanted to attempt to provide some clarity on the topic of Betamethasone.

 

Simply put, Betamethasone is a steroid.  Specifically, it’s a corticosteroid and is most commonly used for its anti-inflammatory properties.  Put differently, it should not invoke images of body-builders.

That’s not to dismiss the utility of Betamethasone in thoroughbreds, indeed it can potentially mask injuries and allow training and racing in horses that might not be able to without its use.  As such, it’s tightly regulated.

It’s reported (via Baffert press conference) that Medina Spirit had 21pg/mL (Picograms per Milliliter) in his post-race sample from May 1st.  In Kentucky, no amount is allowable, though in previous years a threshold of 10pg/mL was in place.  There is a role for Betamethasone, as a therapeutic agent, and current Kentucky regulations require it not to be administered within 14 days of a race.  Generally, when this guidance is appropriately followed, the drug is fully cleared from the blood (note, I didn’t say body).  In fact, the drug is generally cleared within seven days so this is very a conservative guideline.

Many of Baffert’s defenders, along with the trainer himself, have pointed to the minuscule amount of the substance that was found in the sample.  On Sunday morning he refers to the amount as “a trillionth of a gram” – and while not wholly incorrect, it’s my opinion that it is irrelevant.

The sample taken, and the amount reported, comes from blood.  The drug is typically injected in a joint (intra-articular) as that’s the place in the body you want it to exert its effects.  Most steroids, in horses, take about five times as long to clear from the joint as compared to blood.  Another way to think about this – If it’s detectable in the blood, it’s most certainly still present at the injection site.

I’ve tried to come up with an analogy that will help the layperson understand this concept and it’s a challenge.  But suppose you put some fertilizer on your lawn.  And for whatever reason, the easiest way for you to measure how much you used was to take a soil sample from your neighbor’s yard.  So you collect a sample from their yard and you detect a small amount of fertilizer – is that fully representative of what you put on your yard?  No. Again, imperfect, but close.

More on the amount reportedly present in Medina Spirit on race day…Betamethasone is given (usually) as a 9mg intra-articular injection.  Stay with me here.  This means that 0.009 Grams are injected into the joint of the treated horse.  That amount of drug is then diluted within the joint space and some of it makes its way to the blood – further dilution occurs.  So the amount reported (21pg) is not a total amount, it’s a concentration, meaning the amount detected in each millimeter of blood sample.  That’s important because typically, the highest levels detected after the customary injection is around 4ng/mL (nanograms per milliliter).  Which is equivalent to 4,000pg/mL – so again, the hyperbole of “trillionth of a gram” is completely irrelevant. And without getting too technical, the half-life of the drug, in horse plasma is around eight hours.  So every eight hours the amount of drug that is present would decrease by one-half.

 

This situation was further complicated on Sunday morning as Baffert vehemently stated that Medina Spirit had never been treated with Betamethasone.  Assuming the split sample comes back positive, there are only a few possibilities that exist.

 

  1. Baffert is lying
  2. There was contamination
  3. Baffert isn’t lying – He just wasn’t aware of the treatment
  4. Something else caused the positive Betamethasone test

 

It seems unlikely that option 2 occurred as it’s been reported that no other samples (from other horses) were positive.

The implications of option 1 and even 3 seem obvious to me.  There has to be accountability, full stop.  As horseplayers, we all have opinions, and they’re different, so the punishments suggested will cover a range of possibilities.

Personally, option 4 is the scariest.  Let me be very clear – I’m not suggesting the following is likely or for that matter, even possible.  With the 2020 indictments of Jason Servis and Jorge Navarro, we learned that SGF-1000, while undetectable by current testing standards, can produce a “false positive” for dexamethasone – a corticosteroid, like Betamethasone.  From a chemical structure standpoint, dexamethasone and Betamethasone differ by a single methyl group.  They’re different to be sure but it’s like Coke vs. Pepsi.  Could a false positive be in play here?  I’m not sure, I don’t know enough about SGF-1000 to comment but if that statement from the FBI documents is accurate, it’s within reason.

Where we go from here is not the subject of this article.  Personally, I was “brought” into this game by Bob Baffert as Real Quiet won the 1998 Kentucky Derby. It would be a shame and more than a little ironic if he were to help usher me out the door over 20 years later.  Like you, I’m fed up, but for now, I’ll wait for the due process and go from there.

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13 comments
    • A very well written and well thought out article which makes perfect sense. Thank You for all your hard work!!
      Michael Kipness, A.K.A., ‘The Wizard”

  • GREAT PIECE. I am also a veteran Pharmacist of 40+ years. I couldn’t explain it any better than you. I have no forum other than Twitter which doesn’t allow me to get any cognitive thoughts in the allotted space. Again…GREAT WORK !!

  • Didnt Gamine test positive for the same drug last year in the Kentucky Oaks? Dont all of us in horse racing play by them same rules? I didnt see you writing this article for a trainer at any various tracks that have had horses that tested positive for the same drug. Of course not. By the way how many positive test jas this same trainer had in the last 2 years. The was the lidocaine patch the assistant was using. There was the jimsonweed in the hay for Justify. That’s way nobody belise him any longer.

  • Very well done and your explanation for a fan is awesome. I’m a former equestrian competitor and my dad was an equine vet who also performed drug testing for horse shows. I too came back involved in the sport because of Baffert ( 1st Derby Cavonnier, loved Silver Charm and Real Quiet)

    • That was once true but they changed the limit to 0. Was misreported in the original wapo story and they have since issued a correction.

  • Your knowledge and comments are interesting for somebody who is not a vet. Vast knowledge concerning injection procedures and rate of dilution. Ate you sure your not a vet. ?

  • Opinion of mine.

    We live in a real cancel culture and it is time our industry put an end to it. The singular drug violation is small compared to the entire list of drug violations. However it is much more.
    No matter what you think of Baffert you can’t deny his accomplishments. Like other athletes, business, and most of society, the desire to be the best sometimes takes a push of the the limits of rules to the very edge. And sometimes they go past. Bob has alone put himself in this position. The past 18+ months has been excuse after excuse and a public announcement that he was doubling up his effort to clean up his program. And yet we are here again but at a much higher public image.

    Race tracks and Regulators have been reacting defensive to the insane rant of cancel and giving into a narrative that they can not win. Time they stood up. For the protection of the ENTIRE INDUSTRY the Kentucky Racing commission needs to suspend Baffert’s license for a year. The price of being the best is the example you show. The problems he has repeatedly shown might not be Lance Armstrong caliber but are reflecting and effecting everyone. I wish it wasn’t so but doing nothing just plays into the hands that want to end this sport.

  • I think bobby baffert is a penal system…..he is a TV hog like Jerry Jones is in Dallas Texas sonnnnnnnnnnnnnnnnn

  • This was mostly a great article, until you incorrectly insinuated that Lab testing is unable to detect the differences between different corticosteroids, including Betamethasone and Dexamethasone, ignoring published research that it can.

    I would hypothesize that that the reason that Dexamethasone provokes False Positives is because it is a DEXTRO molecule, meaning it has a righthanded shape.

    The pyschopharmacological literature notes that drugs with DEXTRO orientations are more likely to have stronger Central Nervous System effects that mimic Stimulants, like Dextroamphetamine.

    This resulted in different molecules being used for treating ADDH depending upon whether enhanced focus and alertness were desired in the treatment or not.

    We now have Baffert’s admission that Betamethasone was indeed used as a topical cream in the days leading up to the Derby, so I think that should put your hypothesis that the detection of Betamethasone was a False Positive to rest.

    It was on the contrary a TRUE positive…unless you believe that the Vets are Lizard People deliberately administering Betamethasone to mask the presence of the REAL performance enhancing drugs.

    I can’t prove that did not happen…but until you have some proof that it did – outside of pure speculation – Baffert is once more guilty mainly of hiring incompetent veterinarian advice and not monitoring treatments when he SWORE that he WOULD.

    I still think he is guilty, somehow. Medina Spirit did not match the Pace Profile of any previous Derby Winner, and should NOT have been able to last through the stretch.

    In case you think I am making shit up, Baffert himself said that he “showed a gear that we had no idea he had” and that he did not believe the horse had that in him prior to the race. Neither did I.

    Objective STATS also suggest the horse did NOT have that in him, and his win was either a Fluke due to coincidental BAD RACING LUCK for RYW, Essential Quality AND Soup and Sandwich, or performance enhancement.

    But if he is going to be brought down, then a stronger case needs to be made than claiming that Betamethasone can be mistaken for growth factor preparations in laboratory assays.

    In my opinion, the agencies responsible for overseeing Doping Testing need to proactively produce research on the issue of whether Betamethasone can create False Positives in the manner which you suggested. I do not believe that the current Lab Assay literature supports your contention. This paper details all the different methods which have been reliably used to identify molecules accurately, and specifically mentions “the critical pair of Betamethasone and Dexamethasone.”

    However, I do not believe the paper shuts the door entirely on the proposition that the two molecules can be confused with one another.

    https://www.sciencedirect.com/science/article/pii/S2095177913000324

    • Bob – There’s a lot to unpack there.

      I should probably clarify a couple of things.

      First off, false positive, in the context of the FBI indictment, is probably not the best phrase to use. If the lab detects it, I believe it’s there. The question is why – is it a metabolite of another product (prodrug or similar) or contamination from the manufacturing facilities that aren’t FDA approved?

      I’m also not suggesting the lab could mistakenly identify Betamethasone instead of Dexamethasone.

      Given today’s developments and a couple of other personal considerations, I’m not going to comment further.

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