To the Editor:
We thank Drs Hedelin and Péclard for their thoughtful letter regarding our article, “Fighting in Thin Air.” 1 Our piece was written for the Operational and Tactical Medicine Section of Wilderness & Environmental Medicine, and, thus, the numerous tragic civilian humanitarian issues associated with the current Afghan conflict were beyond the purview of the article's purpose. It was written from the perspective of examining the various physiological issues involved in native lowlanders undertaking military operations in High Asia and the consequent altitude-related medical problems they face. Thus, consideration of the medical problems of Afghan fighters native to higher altitudes was not the focus of this paper, either.
No doubt, one could endlessly argue the politics of recent Western military involvement in Afghanistan and Iraq, and the subsequent costs. The story we were trying to tell was that, throughout history, many governments have repeatedly sent lowland soldiers to high altitude battle zones, often times without adequately thinking through the physiological issues involved. As such, we see Dr Houston's quote, “… failure to learn such basic lessons [about mountain warfare] from the past has continued to cause avoidable casualties and has too often led to defeat,” 2 as merely a statement of historic fact from a tactical and operational standpoint.
Regardless of complicated moral, ethical, and political issues surrounding the ongoing Western involvement in Afghanistan, we stand by our sincere 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 … .” We had no intention of making a political statement with our article. Regardless of one's opinion on such a conflict, an undeniable fact is that foreign military forces have been endeavoring to affect change in that beleaguered Central Asian country for more than 10 years. All political agendas aside, and within the context of the purpose of our piece, we believe that the efficient use of wilderness medicine principles can help to make the best of the supremely challenging situation that we recognize as the latest of a long line of foreign interventions that Afghanistan has seen throughout recorded human history.