Oswald Oelz

“I will climb until I am dead,” says Oswald Oelz, sitting opposite me recently at the International Mountain Summit in Bressanone. The 73-year-old native of Austria lives as a retiree in an old farmhouse in the Zurich Oberland region in Switzerland. “I have a farm with sheep, parrots, ducks, geese, chickens. I write, read a lot, climb. And I travel around the world.” Oswald called “Bulle” Oelz scaled Mount Everest in 1978, on the same expedition, during which Reinhold Messner and Peter Habeler climbed the highest mountain on earth for the first time without bottled oxygen. Oelz succeeded first ascents in the Alps, in Alaska, Jordan and Oman. Until 2006 he worked as chief physician at the “Triemli hospital” in Zurich. The professor also researched in the field of high altitude medicine.

Oswald Oelz, you are a mountaineer and a doctor, you have got to know both worlds. Time and again, there are fatalities in the high mountains due to high altitude cerebral or pulmonary edema. Has the climbing community learned nothing over the past decades?

The climbing community has learned nothing insofar as they still climb up to altitudes where a human being doesn’t really belong. Above 5,300 meters, man is not able to survive in the long run. Nevertheless, he goes up there. This is a charm, a thrill. If he is sufficiently acclimatized, he can stay up there for a shorter or longer time. The problem is that, on the one hand, people are willing to ascent who are less fit for high altitude and, on the other hand, they climb too fast too high. The typical example is Kilimanjaro, where you climb up to almost 6,000 meters within five days or even less. There is a very high death rate. Per year about twenty so-called climbers die. That is kept strictly under lock by the government.

Oelz on the summit of Mount Everest

On Everest, reportedly two-thirds of the summit aspirants are prescribed performance enhancing drugs to increase their chances of summit success. Who is responsible for doping on the mountain, the climbers themselves or rather the doctors who hand over these drugs to them?

I have no idea to what extend climbers are doped on Everest. But I have no doubt that there are quite a lot using the “three D”: Diamox, Dexamethasone and Dexedrine. The mountaineers take Diamox for a long time, then Dexamethasone, a cortisone preparation, during the ascent and finally, to mobilize the last resources, Dextroamphetamine – a poison which was given to the Stuka pilots in the Second World War to make them more aggressive. In the history of alpinism, many climbers have died as a consequence of taking these amphetamines on Nanga Parbat and other mountains because they pushed themselves beyond their limits. Obviously this medication is prescribed by doctors. On the other hand, these drugs are also available illegally. Today you can get everything you want provided that you pay for it.

Actually, Diamox and Dexamethasone is emergency medicine.

This is certainly also a cause of the problem. I think Diamox is the most harmless of these. If someone makes this brutal ascent of Kilimanjaro within five days up and down, he is almost certainly a candidate for high altitude sickness. This can be avoided to a great extent by taking Diamox. It has few side effects. The beer tastes horrible, which is the worst side effect. You have to drink a little more water because it has a diuretic effect. But otherwise I personally recommend Diamox, if someone who wants to climb Kilimanjaro and has problems with high altitude asks me.

Climbing in Jordan

You were on top of Mount Everest in 1978, along with Reinhard Karl (Karl was the first German on Everest, he died in an ice avalanche on Cho Oyu in 1982). Four years later you suffered from a high altitude cerebral edema at Cho Oyu almost killing you. How can this be explained? You really had to assume that you can handle high altitude well.

I was not able to bear high altitude as good as, for example, Reinhold Messner but quite properly, when I had acclimatized. But I always had this time pressure. I was working in the hospital. I wanted to get as high as I could as quickly as I could in the few days I had left for mountaineering. In 1982, I had a severe high altitude cerebral edema. In 1985, on Makalu, we moved within nine days from Zurich up to 7,000 meters. There I had a life-threatening high altitude pulmonary edema. I would have died if I had not tried for the first time a therapy which then worked. I took the heart medication Nifedipine, which lowers the increased blood pressure in the pulmonary circulation, which is especially crucial in the case of a high altitude pulmonary edema. That saved my life. Afterwards I have made the appropriate studies, and we were able to prove that this drug can be used as a prophylaxis for people who are predisposed to high altitude pulmonary edema. In my opinion this isn’t doping. Furthermore we could show that in case someone is already suffering from a high altitude pulmonary edama, it can improve the situation significantly. Meanwhile, it has been found that the same effect can be achieved by Viagra. It widens the vessels also in the lungs, not just below. Thus the increased pressure in the pulmonary circulation decreases, and the people are doing better. This is, of course, more fun than taking a heart medication.

You referred to prophylaxis. Is it really practiced?

I know people who do it. In 1989, we published a work in the “New England Journal of Medicine”, the leading journal in the medical scene, in which we showed that people with a predisposition to high altitude pulmonary edema can be protected to a certain extent by prophylaxis with this cardiac medication. People who e.g. suffered from a high altitude pulmonary edema even in the Alps at an altitude of 3,000 to 3,500 meters should be recommended such a prophylaxis. Of course, it would be wiser to tell them: “Stop this stupid mountaineering, instead swim, run or whatever!” But these people are not teachable. They want some medicine.

“An embarrassing spectacle”

You had the privilege of traveling in the Himalayas at a time, when it was still a deserted mountain region without any tourism. How do you think about what is going on there today?

I follow what’s happening today in the Himalayas with fascination. It is unbelievable what the young really good climbers do in the difficult walls of the seven-thousanders. What I am following with great sadness is what takes place on Everest and on the other commercialized eight-thousanders. These endless queues of clients who are pulled up by their Sherpas – I think that’s an embarrassing spectacle.

Luanne Freer (© Marmot.com)

“Never open your mouth, unless you’re in the dentist’s chair.” These were the words Salvatore Gravano called “Sammy the Bull”, a mafioso from New York, used to describe the “Omerta”: the unwritten law of the underworld to be silent no matter what happens. Even athletes using doping substances usually say nothing unless they are found to be guilty. In this respect, mountaineering is not an “island of bliss”. Anyone who has ever been on expedition has probably met some climbers who carelessly use medicine that actually should be used in case of emergency – or even performance enhancers. Just nobody of these climbers admits to do so. Luanne Freer is the “Everest doctor”. For twelve years, she has treated climbers in “Everest ER”, the emergency room at the Base Camp on the Nepalese side of the highest mountain on earth. I asked the 57-year-old about her experiences on the topic of doping on Mount Everest.

Luanne, in 2003 you founded “Everest ER”, the highest infirmary in the world. Since then, you have spent many climbing seasons in Base Camp. How widespread is doping among Everest aspirants?

We aren’t really sure, because it tends to not be talked about openly. Our doctors tend to discover it only after there has been a complication or if the patient comes in with a possibly related issue. That’s why Dr Luks, Hackett, Grissom [Andrew M. Luks, Peter Hackett and Colin K. Grissom are internationally renowned high-altitude physiologists from the United States] and myself did a confidential and anonymous survey of Everest climbers. We collected a lot of data and are still sifting through all of it.

Luanne working at Base Camp

Have you noticed that climbers are thoughtlessly using emergency medication?

I will say that I’ve seen some climbers using very powerful drugs without much thought or insight into the potential harm they might do themselves.

What do you estimate, how many accidents on Everest are due to drug abuse?

I know of just one or two in which I’m pretty sure that a non medically approved use or dosage probably contributed to a death or accident.

Who is more to blame: the climbers who use drugs on Everest or the doctors who recommend them to do so?

I can’t blame climbers. But I do implore healthcare providers who prescribe these medications to educate themselves first about the science behind their safe use, and then educate their patients if they prescribe to them. It’s imperative that anyone with a bottle of pills knows exactly how and why to use them safely. It’s our duty as healthcare providers to insure that.

Do you see any trend that high altitude climbers want to find back to a drug-free sport?

I have heard opinions from every corner – those who advocate using every possible enhancement for speed and safety, and those who feel that even the use of oxygen is ethically repugnant.

Everest ER after the 25 April avalanche

The last two climbing seasons on Everest ended prematurely, in 2014 due to the ice avalanche in the Khumbu Icefall, in 2015 due to the avalanche that was triggered by the earthquake and hit the Base Camp. Do you as an Everest doctor wish for a quite normal Everest season next spring?

All of us hope for a safe and uneventful season. Unfortunately that is rarely the case, so we instead hope that weather is good, the earth is stable, and climbers come with great experience and in the best shape of their lives.

UIAA avoided the term “doping”

The drug Diamox contains an active ingredient which is able to reduce the intracranial pressure. Many trekkers and climbers take the pills prophylactically against acute mountain sickness. Actually, Dexamethasone is an emergency medication for high altitude cerebral edema, but is also often used preventively. Are the climbers and their doctors just dewy-eyed or do they act negligently? “At least, they break the rules of fair sport,” Kuepper answers. “Since it is strictly doping, even if the UIAA – despite my intensive efforts – was not willing to call a spade a spade.” Above all, the trekking and expedition operators are acting incredible negligently, by urging their clients to take drugs “without any individual benefit-risk analysis”, says Kuepper. “During Everest treks you can regularly hear: Okay, we have some five minutes left, time enough for another coffee and our Diamox pills.”

“Pockets full of drugs”

Everest ER

US doctor Luanne Freer is quoted in the UIAA report. In 2003, she founded the “Everest ER”, the highest infirmary in the world, located in Everest base camp. “We estimate that during our informal survey on Everest spring 2012, at least two thirds of climbers we contacted were prescribed several performance enhancing drugs (PEDs) and had intent to use them not for rescue, but to increase their chances of summit success“, said the 56-year-old physician. One day a commercial guide had asked the ER team to counsel his clients on use of PEDs for summit day. “We were alarmed to find a tent full of anxious climbers with pockets full of prescription drugs (prescribed by their personal physicians and filled at home pharmacies) and with no understanding or instructions on when and how to use them”, said Luanne.

Bottled oxygen on the list

Prof. Thomas Kuepper

The UIAA Medical Commission has listed drugs that are used by mountaineers and climbers. Among others the list includes oxygen. That caused more debates within the members of the commission than any other section, says the report. That was due to the fact that bottled oxygen is established in high altitude mountaineering and is not regarded as a drug in many countries, explains Professor Kuepper. In addition, there are data showing that the death rates of mountains above 8500 meters were significantly lower for climbers who use supplemental oxygen. “My opinion is: Those who need it, do not belong up there”, says Kuepper. “By definition ‘method that artificially enhances the performance’, it’s doping, because it changes an 8000er to a high 6000er.”

New category?

The UIAA wants to sensitize mountaineers and climbers to the problem of drug misuse. Dangerous interactions that might occur are listed for each active ingredient. However, the report is also an appeal for fair sport, says Thomas Kuepper: “The UIAA is no drug squad. Who really wants to use it, can do it. But then he must also be fair enough to point out after a successful ascent that he has used drugs. There would not only be the difference with/without supplemental oxygen, but as another category with/without drugs.”