How Doping Made Its Way Up Everest

Thursday, May 23rd, 2013

When I first read about mountaineers summiting Everest without supplemental oxygen, I assumed they were doping and wondered how this was seen within the climbing community:

High-altitude climbers have long used substances banned by the World Anti-Doping Code — everything from amphetamines to steroids to acclimatization aid acetazolamide, or Diamox, which prevents acute mountain sickness. The erectile-dysfunction drugs Viagra and Cialis are also common, since they decrease pulmonary-artery pressure, and if you talk to enough people you’ll hear rumors about climbers using EPO, the red-blood-cell booster popular with pro cyclists. Yet, due to the unique health challenges at altitude, the line between staying safe and getting a leg up has always been blurry.

Not counting Diamox, which carries minimal risk, dex is by far the most popular mountaineering drug. Banned by the World Anti-Doping Agency (WADA) but endorsed as a high-altitude rescue tool by the Wilderness Medical Society, dex works like most cortico-steroids, supplying synthetic cortisol to the body and suppressing inflammation. In the brain it stabilizes cell membranes, preventing fluid from leaking out of blood vessels into the surrounding tissue.

Because it inhibits cerebral swelling, dex is a terrific life rope for climbers who start to show signs of edema. It’s most often taken in pill form, but it can also be injected during emergencies. High-altitude doctors refer to it as a magic bullet, and some Spanish-speaking mountaineers have taken to calling it levanta muertos, because, as Argentine guide Damian Benegas says, “it brings life to a dead person.” The most famous case of this occurred during the 1996 Everest disaster, when Beck Weathers rose from a comatose state after Alpine Ascents guide Pete Athans gave him dex.

Over the past two decades, climbers have discovered that dex also works magic on the way up, increasing lucidity and triggering feelings of euphoria. This is where the trouble starts, because people who take cortico-steroids for more than a week impair their immune systems: adrenal glands that naturally produce cortisol are essentially shut off by the drug and stop responding to stress. As a result, wounds don’t heal quickly, and users are susceptible to infection. Emotional swings are also common after prolonged use, though doctors still don’t understand the precise mechanism for that.

Many in the medical community argue that dex should be employed only in life-threatening scenarios, since prophylactic use masks HACE symptoms and reduces the drug’s efficacy in the event of emergency. “You basically take away your safety rope by using it on the way up,” says Dr. Luanne Freer, the 55-year-old founder of the Everest ER clinic. “If you get stuck in a storm, then we have nothing to give you as a rescue drug.” Adds leading dex expert Dr. Robert “Brownie” Schoene, of Berkeley, California, “It is probably the one drug that has been abused in terms of enhancing mountaineering performance.”

This is due in part to how easy it is to obtain. You can fill a prescription at any pharmacy (Easterling’s source: Target) or buy it on the street in Nepal for five cents a dose. And demand is on the rise as Everest clients dishing out $70,000 per climb look to increase their odds of summiting. According to Bill Allen, co-owner of the Colorado outfitter Mountain Trip, half of his clients ask about dex before setting out for Everest. Johnson, the Everest ER doctor who treated Easterling, says, “I would be shocked if 50 percent of Everest climbers aren’t using dex at Camp III and above.” And not just clients: “I’ve had highly paid, sponsored climbers and guides — people whose names you’d know right away — ask me about dex. They don’t want their clients or anyone else to know they’re using it.”


  1. Todd says:

    Some clarifications of the article:

    Mountaineers who summit 8,000 meter peaks (death zones) without supplemental oxygen are:
    1. freaks of nature with ridiculous V02 max (see Viestur’s “No shortcuts to the top”)
    2. Lucky; note the case of Iñaki Ochoa de Olza. His records included climbing 12 of the world’s 14 tallest mountains without the aid of oxygen or oxygen tanks — and yet he died of HAPE (High Altitude Pulmonary Edema) on Annapurna.

    Thus, since no one is invicible from HAPE, and one’s tolerance can’t be predicted, people pack Diamox and other things to buy some time if things go wrong. Meds only help buy some time for descent. Remember, with altitude sickness, descent is the only possibility of recovery.

    The meds people take before summiting are often sleeping pills, because it’s progressively difficult to sleep at altitude, and oxygen, because no drug will warm you like oxygen. Less than full flow from an oxygen tank + waiting in line on Everest’s Hillary Step + 30mph wind = frostbite even for the best mountaineer. Ueli Steck turned back from Everest’s summit in 2012, saying that without O2 his feet were getting cold and he didn’t want to lose toes.

    I think the article’s example is an edge case, a serious one, but more caused by deluded newbies, than a chronic cancer among the traditional sportsmen. I doubt and have not heard of people taking serious meds for performance nor before they get sick; it’s just silly to pull your one reserve chute before you need it.

  2. Isegoria says:

    My thought is that EPO creates such “freaks of nature with ridiculous VO2 max” — and before cyclists found EPO, they were blood doping to achieve the same result. Red blood cell count and VO2 max may not be all there is to handling altitude though.

    Also, I remember reading that Peruvians have been using coca leaves to treat altitude sickness for centuries, and it works better than anything modern medicine has come up with. Has that “treatment” found its way to the Himalayas? You’d think so.

    I agree that taking (megadoses of) corticosteroids before you show any symptoms sounds like pulling your reserve chute before you need it.

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