To the Editor:
We read with interest the editorial: “Medical and sporting ethics of high altitude mountaineering” 1 and the thoughtful comments of the invited discussants. 2 We would like to clear up what we believe are a few misconceptions.
It is debatable whether the use of performance-enhancing drugs in high-altitude mountaineering is increasing as a percentage of people taking part in the sport. We remember the popularity of “triple-D's:” Diamox (acetazolamide), dexamethasone and Dexedrine (dextroamphetamine) in certain circles several decades ago, but that was hardly the beginning. Caffeine tablets were carried by British expeditions on Mt. Everest in the 1920s. There certainly seem to be many physicians nowadays who are clueless about high altitude mountaineering yet who are willing to prescribe drugs for prevention of high altitude illness 3 and perhaps also to enhance performance at altitude. Many drugs are also purchased over the counter in pharmacies in unregulated countries based on misinformation available on the Internet.
We do not believe that the World Anti-Doping Agency (WADA) and its 2012 Prohibited List 4 is relevant to this discussion. “Doping” applies only to the use of drugs or other means to confer an advantage in competition. High altitude mountaineering may be competitive, but it is not a formal regulated competition. No official body, including the International Mountaineering and Climbing Federation (UIAA), decides whether ascents “count.” Any WADA type regulation would be unenforceable. Acetazolamide is included on the WADA list of prohibited substances in the category of “Diuretics and other masking agents,” because diuretics enhance the excretion of banned substances, making them harder to detect. The document does not specifically mention dexamethasone, but says, “All glucocorticosteroids are prohibited …”
Although many substances banned by WADA, such as anabolic steroids, are inherently harmful, acetazolamide and dexamethasone have legitimate uses in the prevention and treatment of high altitude illness. 5 Most experts agree that drugs should not be used as a substitute for gradual acclimatization except under extreme circumstances such as a rescue attempt. The use of acetazolamide to aid acclimatization is widely accepted. 5 There is no ethical dilemma for prescribing physicians, as long as they are aware of the risks and potential benefits of these drugs.
There have never been special mountaineering ethics, although there have been heated arguments about style. In the 19th Century, long before Reinhold Messner declared that he would climb Mt Everest “by fair means or not at all,” the famous British mountaineer, Albert Mummery joked that an alpine peak, the Dent du Géant, was: “Absolutely inaccessible by fair means.” There has never been an accepted definition of “fair means.” This will always be in the eye of the beholder. We would encourage one ethical principle: to tell the truth by disclosing the use of supplemental oxygen and other drugs in reporting ascents, just as one would admit to using bolts or fixed ropes.
Climbers should make their own informed decisions, with the help of knowledgeable medical advisors, about the use of oxygen and other legal drugs such as acetazolamide and dexamethasone. Nobody can forbid the use of these drugs and other “artificial aids” outside of officially regulated competition. We agree with Dr. Basnyat that “adults will ultimately make their own choices.” 2