To the Editor:
In a previous issue of Wilderness & Environmental Medicine, Rodway and Muza 1 provide a captivating exposé of the impact of high altitude on military operations in “Into Thin Air” and give an interesting historical perspective. We do, however, have concerns regarding certain points made in the conclusion of the article. Rodway and Muza quote Dr Houston: “[F]ailure to learn such basic lessons [about mountain warfare] from the past has continued to cause avoidable casualties and has too often led to defeat.” 1 It is obvious that “defeat” here refers to the failure of Western armies fighting local armed forces in the Middle East. The quote above implies a position that is controversial, especially from a global perspective. Both historically and in the contemporary world, the vast majority of casualties are local soldiers and civilians, yet we see no mention of medical concern for non-Western soldiers.
Rodway and Muza continue: “[W]e can only hope that the science and practice of wilderness medicine … will aid the efforts of Western governments and their armed forces as they struggle to bring some sense of stability to a country that has known little regularity other than that of a steady and dreadful series of violent conflicts … .” 1
We do not, in this forum, wish to start a debate on the feasibility of this project nor on the moral right of Western governments to impose their will with military means on impoverished countries. We do, however, wish to ask the authors how they came to this conclusion based on the facts presented in the article. The universal need for a better understanding of altitude illness is not controversial, but that is not the point that is being made above.
The authors disclose that they are affiliated with the US army. But that disclosure does not justify a radically biased conclusion in a scientific journal. We wish to end by disclosing that we believe that scientific progress and medical attention should be available according to need and not to allegiance.