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.”