Gentiana , Snake Bladders & Sulphur : Bad Altitude Info Award 2013

Best contender so far  this year : the Tibet and Lhasa Health & Safety section on Lonely Planet , about the (perceived ) dangers of Diamox treatment : 

“the use (of) Diamox is controversial. It can reduce symtoms , but may also mask warning signs. Severe and fatal cases of AMS has occured in people taking this drug.”
The advice seems well researched at a first glance , correct doses are given and there are a number of sources at the end of the document.

It has a number of serious problems though , starting with
fake sources
LP lists a number of sources / suggested reading … which all are very solid , and all say the opposite of what LP claims .

*Pollards classic High  Altitude Medicine Handbook , a given in my backpack since many years : 

” there is no evidence ” that Diamox has a masking effect. Feeling better with Diamox comes from the increased ventilation made possible by Diamox.  

*Richard Dawoods Travellers Health. Dawood worked three seasons with The Himalyan Rescue Association clinic in Periche  and one one can safely assume he agrees with their position on Diamox/acetazolamide : “the most tried and tested drug both for altitude sickness treatment and prevention… unlike dexamethason this drug does not mask the symtoms but actually treats the problem” 

The main reason Dawood would agree on this is that he is the author  , the AMS section in his book and on the HRA site are identical…

*Pocket First Aid & Wilderness Medicine , by Duff and Gormly : ” Azetazolamide increases the breathing rate at altitude and speeds up the acclimatization process… Acetazolamide does not mask the onset of AMS , HAPE and HACE”


* Last but in no way least : CDC , which are responsible for the national health guidelines in the US. CDC has consistently pushed for better/wider acceptance of preventive medication with Diamox in their altitude advisory ( shortlink : ) . This year they published a separate Cusco advisory . Cusco is lower than Lhasa , and wording is more direct now : everyone travelling to Cusco should be prepared to prevent or treat altitude sickness with Diamox. 



Finding today anything written that can’t point to  a single online resource gives a weird 90’s feeling. And the resources have been out there for a looong time : the High Altitude Medicine Guide and the Himalyan Rescue Association sites were both up in ’95 , soon followed by the International Society for Mountain Medicine and CDC . Any  of these sites will for example point out that the most efficient medication is oxygen , which never comes up at LP. This could be an atavism going back to first printed Tibet LP guides , saying that the effect from oxygen is “mainly  psychological” (!)



LP brings up a number of alternative medications. First up is Rhodiola , which is called a Tibetan herbal medicine. Reading this as a uniqe local tradition is definitely off the mark : Rhodiola grows over wide areas over the world  , including Russia , Sweden and China . The search for a  medical use of Rhodiola started in the classical  Greek period, re-surfaced with Carl von Linné and … Josef Stalin, the later being the main reason westerners today are aware of Rhodiola.  The fuzzy wording “recommended by locals” leaves no clue if this is to be seen as a part of the Tibetan medical tradition , or if this is a word on the street thing , like the infamous soroche.  pills in South America. 

The entusiasm for non-proven medication is not limited to Rhodiola : the proposed medication list also includes Gentiana against AMS , which will  baffle …, basically everyone , including doctors and herbalists. To top it off the litteral Snake oil cures comes up : the classic Chinese cure of dried snake gall bladders against pneumonia (!) is mentioned.


Extra points for bringing up “Sulphur allergy ” ( Sulphur is an essential trace element , used in the body, and routinely added to i.v. solutions ) The mixup here is with sulfonamides , where allergic reactions are  in no way is certain between the antibiotic sulfonamides ( “sulfa” ) and the non-antibiotic group , like one of the worlds most common prescription medications , the diuretic furosemide. 




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