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Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT)

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38043.501690.7C (Published 01 April 2004) Cite this as: BMJ 2004;328:797

Exclusion of high risk, low status groups perpetuates discrimination and inequalities

EDITOR - Gertsch et al (2004) report the results of a large, double
blind, randomised controlled trial of ginkgo biloba and acetazolamide for
acute mountain sickness (AMS) in non-Nepali trekkers in the Everest region
of Nepal.(1) However, it is not clear why entry to the study was
restricted to non-Nepali trekkers. Many Nepalis working in the trekking
industry in the Everest region are not the stereotypical Sherpa who has
lived their whole life at altitude. The farmers from the low lands who
undertake a lot of the seasonal portering work in the Everest region are
at similar, if not greater, risk of AMS as western trekkers.(2)

Although including Nepalis at risk of AMS in the study would have
involved some additional logistic arrangements – such as providing study
information in appropriate languages and gaining access to the portering
community – these should not be beyond the abilities of such a large,
international research team. Nor should identifying and excluding those
Nepalis who may not be at risk of AMS due to prolonged acclimatisation.

The exclusion of Nepalis at risk of AMS from the study is
particularly surprising given that one of the authors of the study is
clearly identified as being associated with the Himalayan Rescue
Association – an organisation which disseminates large amounts of
information in the Everest region on the risks of AMS to Nepali porters
working in the trekking industry.(3)

Studies such as this, which exclude high risk, low status groups for
no obvious reason, perpetuate discrimination and inequalities. Evidence
is required on how to prevent AMS in all groups, and not just rich western
tourists.

1. Gertsch JH, Banyat B, Johnson EW Onopa J, Holck PS. Randomised,
double blind, placebo controlled comparison of ginkgo biloba and
acetazolamide for prevention of acute mountain sickness among Himalayan
trekkers: the prevention of high altitude illness trial (PHAIT) BMJ,
doi:10.1136/bmj.38043.501690.7C (published 11 March 2004)

2. http://www.portersprogress.org/

3. http://www.himalayanrescue.com/

Competing interests:
None declared

Competing interests: No competing interests

22 April 2004
Jean Adams
Research fellow
School of Population and Health Sciences, The Medical School, University of Newcastle, UK, NE2 4HH