Updated: Aug 1, 2021
A client asked me this question several weeks ago, and I’ve been obsessed ever since. I've attempted to summarize here my perspective shift after endless reading, interviewing insurance agents and veterinarians, poling the horse community, and allowing my curiosity to run amuck.
Part I: Why does colic happen? What is the statistical probability of needing colic surgery? Can 2 ounces a day of powder prevent colic? What does prevent colic?
Part II: Compare nutritional value, annual cost, and requirements across four different plans.
Part III: Summarizing the PRO's and CON's of colic surgery insurance/reimbursement plans. If we consider these options rationally (without emotion), is it worth buying a supplement that offers colic surgery insurance coverage?
*Fair warning: I tried my best to simplify the nutrition, cost, requirements and overall value of these programs, but there are many, many, many factors to consider! Whether or not you choose to purchase insurance coverage for your horse is a very personal decision to be discussed with your partners and equine professional team.
Why Does Colic Happen?
Colic happens in horses for many reasons; gas, spasms, impaction, torsion, intussusception (my favorite to say), displacement, strangulation and more (The Horse, 2021). It can be initiated by parasites, sand, stress, dehydration, inflammation and dietary changes making it one of the leading causes of death in horses. The most serious types of colic, the ones leading to colic surgery, include impactions (i.e. parasites, sand, ileal impaction, or impactions at the pelvic flexture or right dorsal colon) and strangulations from lipomas, large colon volvulus, or displacement (Blikslager, 2019). However, most colic episodes are mild and resolve with minimum input. As many as 9 out of 10 colic cases may only need a trailer ride, fluids, a dose of Banamine, a night of monitoring, and the scary episode is over. It's emotional, yes, but not life threatening.
Every veterinarian that I talked to for this article confirmed that colic is incredibly mutlifactoral and that good horse management is key to prevention. Parasite control, well balanced nutrition, water quality and availability, and movement constitute the best anti-colic plan. The horses' digestive system is over 85 feet long, difficult to study, and more complex than we can imagine. So, how do we even begin to discuss the value of colic insurance? I will start with some statistics and wrap up the conversation with nutrition, cost, requirements and overall value. Buckle up...it's not gonna be smooth sailing.
What is the likelihood of YOUR horse colicing?
I really wanted to dig into this question, because it's obvious that these insurance programs are making supplement companies a lot of money. Let's be real...there's no philanthropy going on here. They wouldn't do it if it wasn't profitable. That means they are playing the odds and winning. This is a simple case of "the casino always wins". What do they know that we don't? If I were considering spending thousands of dollars each year on a supplement that offered colic surgery coverage, I'd first want to understand probability and opportunity costs. What are the chances that my horse will actually need colic surgery? If probability is low, what else could that money be used for? What are the opportunity costs? I started my research by digging into the scientific literature and drawing out some numbers.
The only consistent and reliable statistic for colic frequency that I could find, suggests that the incidence of colic in the United States is about 4% (Blikslager, 2019). Out of the 9.2 million horses estimated in the U.S. that's 368,000 horses that will colic each year (American Horse Council, 2017). SmartPak says it's twice that on their website, but they do not reference a source study, so we can't use it. More importantly, reimbursement from supplement companies ONLY covers colic surgery costs and not the costs incurred from simple, non-surgical procedures. So, next step, what's the probability of my horse needing colic surgery?
A statement on Foranequine.com (July 5, 2017) suggests that 95% of colics are of unknown origin and resolve with only mild to moderate intervention. These numbers are further supported by a study published in 1997 by Tinker et. al. covering 31 US farms and 1,427 horses. Only 4 horses out of 104 colic cases within one year needed colic surgery. That 3.8% in the 1997 study is not too far off from 5% estimated by Foran Equine. Let's be generous and assume that 5% of the 368,000 horses colicing each year do go to surgery. That's 18,400 colic surgeries in the US each year meaning your individual horse has a 0.2% chance of having colic surgery out of 9.2 million horses. Now, obviously that's an oversimplified statistic, because colic is mutlifactoral and probability can change with lifestyle. For example, horses out on pasture have a smaller chance of colicing than stabled horse. Some reports predict a higher percentage of horses colicing each year- maybe up to 10% of some populations. If we look at the 2.7 million horses showing and experiencing higher than normal stress, then 10% of that population is 270,000 and 5% of that is 13,500. If my calculations are correct, then my show horse has a 1 in 200 chance (0.5%) of needing colic surgery in her career. There is a 1 in 500 chance if we look at all horses across the country.
One more point to consider is the high mortality rate of horses that do go under the knife. Now this can vary wildly depending on your proximity to a surgery location and your relationship with a vet, but that statistic is quite scary- mortality maybe as high as 1 in every 2 colic surgeries (White and Lessard, 1986). Now that number is old (1986) and I'm sure that colic surgery outcomes have improved over the last 35 years, but that study was robust considering they looked at the success rate of 2,055 surgeries at 16 universities. What this tells me is that even if a supplement company can reimburse my surgery costs, there's a decent chance that I'm left without a horse and a way to replace it. Is the cost of colic surgery insurance worth it considering the low probability of severe impaction or torsion colic and the high probability of mortality during that surgery? Perhaps one of the opportunity costs is good o'l standard equine mortality insurance that includes some colic surgery coverage.
"It is important to realize however, that the vast majority of colics never have their exact causation determined. Happily, this “unidentified type” of colic, also has a recovery rate of over 95%. This can be interpreted as; most horses get a mild form of colic, which is successfully treated by their veterinarian, making further investigation unnecessary. Foran Equine "
I think we may have found out why supplement companies are offering thousands of dollars of reimbursement. If, at best, only 1 out of every 500 customers ever needs reimbursement of any kind, then they can add a small margin to every product they sell and be just fine! Now that assumes that each and every customer using their qualified products actually keeps up with all the requirements described by the Terms and Conditions. These terms and conditions often require higher priced products, wellness plans overseen by a veterinarian, and auto-ship options that can not lapse for more than 7-14 days. So, there is a chance that your reimbursement can be denied, but to be honest, everything I've heard from veterinarians and horse owners suggests fair play from these supplement companies.
Can 2 ounces per day of powder prevent colic surgery?
I'm going to just go ahead and sum up an opinion I've developed after working professionally in the feed & supplement industry for 15 years. No. A few grams of powder in your horse's gut is unlikely to prevent colics that require surgical intervention. Let's think about just what we've learned so far...1) the horse's digestive system is very complex, 2) there are no fewer than 14 ways a horse can colic, and 3) most colics are resolved with minimum input. Therefore, as good as the supplement company marketing sounds, the likelihood of 2 scoops of powder manipulating that complex digestive system to prevent all those colic surgeries is low.
And I am being purposely vague here when I say "2 scoops of powder"! There are hundreds of ingredients being marketed today as "digestive aids" and most of them claim to enhance, stabilize, and/or support your horse's digestive system. I'm not going to single any one ingredient out for this article. To date...no supplement ingredient....not one....ever...has been proven to prevent colic. Let me repeat. No supplement can guarantee a colic-free horse. It sounds ludicrous to have to say, but it goes to show the powerful messaging that we get from supplement companies. A recent survey by Gluck and Pratt-Phillips (2021) reported that 82.7% of the 501 survey responses from horse owners believed that pre and probiotics made their horse's digestive systems better. Our vague notion of "gut health" really works to their advantage and is making their colic surgery reimbursement programs successful.
The problem with listing the meaningful ways of preventing colic is that they too are vague and often hard to implement. Whether you board your horse or keep them at home, there will always be limitations to the amount of turnout/exercise, ideal forage options, minimizing stress and/or all three limitations combined. This is what I call "the reality of modern day horse management". Many will read over a list of best practices to prevent colic and think "yea, yea, yea...I've heard that before, I already do that, or I can't control that, so "Where's the 2 scoop option?"
Generally Agreed Best Practices for Preventing Colic
Continuous grazing of good quality forage: Feeding little and often
Deworming: Having a good parasite prevention program.
Movement: Daily exercise and turnout >12 hours per day
Make any feed changes slowly.
Ok, so even if we COULD prevent colic with a digestive aid, what is the nutritional value of these supplements beyond the colic insurance? I have spent weeks comparing four different supplement programs for you; 3 supplement company programs + 1 standard equine mortality insurance program. I went through the process of applying for colic surgery reimbursement/insurance through all four companies; Platinum Performance Colic Coverage®, SmartPak ColiCare™, Arenus Animal Health Colic Assurance Program™, and Carlton & Associates Equine Mortality/Major Medical Insurance ($30k mortality which includes $5,000 colic surgery coverage + $10,000 major medical). I used my own competition horse as an example seeing as I find her situation and mine to be roughly indicative of show horses across the USA. Here are her stats- 1,350 lb Swedish Warmblood mare competing at Preliminary eventing and worth $30,000 in mortality insurance. She has no history of colic and no gastric ulcers. I also used a diet program from each plan that included a minimum of 1) trace minerals zinc and copper, 2) 1 or more joint support ingredients, and 3) 1 or more digestive aids.
Plan #1: Platinum Performance Colic Coverage®
When I applied for the Platinum Performance Colic Coverage®, I chose the Platinum Performance CJ (joint+trace mineral) + Platinum Balance (digestive aid). This product combo qualifies me for the $10,000 reimbursement level and satisfies my requirement for 1) joint, 2) trace minerals, and 3) digestive aids.
It was very confusing how much of the product I needed to feed each day in order to qualify and stay eligible. A representative assured me that I only needed to feed 1.5 scoops per day for a 1,3500 lb horse that had no previous colic issues rather than the 2.5 scoops per day advertised on one webpage. However, when I went to place the product in my cart, it turns out I can only get them in PAKS totally 2 scoops per day. Confusing, I know! Anywhoo...the the ingredients levels are easier to calculate at 2 scoops per day, so there you go.
I've never been a fan of Platinum Performance products for one simple reason; they commit my cardinal supplement sin! They try to be everything in one- or should I say 2 scoops. By trying to be a vitamin/mineral, joint, fatty acid, amino acid and energy source in just 156 grams, they end up being pretty pathetic in most things. Ok, I'll give them kudos as a joint supplement. The levels of glucosamine, MSM, ASU and HA are legit, but come on... 1.5 grams of lysine! 122 mg of Zinc? 13 milligrams of Copper! Since the typical grass mix only supplies 40-60% of a horse's requirement in zinc and copper, then this supplement will not even meet the bare minimum requirements of the average sized show horse! I can not and will not feed this to my horse due to these extremely low levels. It's a bit shocking when you compare the levels of basic dietary but critical nutrients in this product to what a ration balancer will provide. Just look at rows 1 and 4 in the comparison chart above. The Platinum Performance CJ + Platinum Balance sacrifices good, basic nutrition for fancy label claims.
Platinum Performance Colic Coverage® Terms and Conditions
Plan #2: SmartPak ColiCare™
Now let's look at SmartPak's offer through ColiCare™. I chose their SmartCombo Ultimate Pellet for it's digestive aid package and $10,000 colic surgery reimbursement level. Can I just start off by saying that their nomenclature is god awful! I had to check back multiple times to make sure that I was comparing the right product, because there are so many combinations of ultimate, ultra, super, super duper, and complete combo ultimate ultras. I did choose the higher priced ULTIMATE Pellet over the ULTRA pellet due to the probiotics, prebiotics and enzymes offered in the ULTIMATE pellet. Again, I'm trying to be as consistent as possible across each plan.
Compared to the Platinum Performance CJ + Platinum Balance, the SmartPak SmartCombo Ultimate Pellet seems a bit more robust nutritionally speaking. Like Platinum's product, the joint support ingredients are guaranteed at high levels. At least their trace mineral offering is sufficient for the average horse in moderate work. Whoops...nope...their's no selenium in it! Geessshhh. Won't feed this either due to poor nutritional value!
The "active ingredients" list of the SmartComb