On May 17, 2009, Jesse Easterling stumbled into a medical tent at Everest Base Camp. The amateur mountaineer was due to make a bid for Mount Everest's summit in just a few days, but based on his condition at the tent, Easterling clearly wouldn't be going back to the mountain that season. He had developed a large lump on the back of his neck, and was so out of it that he couldn't even remember his name.
Eventually, the Everest doctors were able to ascertain the cause of Easterling's disorientation: after a month on dexamethasone, a powerful anti-inflammatory steroid, he had stopped taking the drug cold turkey. This can shock to the body, enough to completely shut down the adrenal system and lead to multiple organ failure. That Easterling was still standing was a near miracle; if something wasn't done immediately, he would soon be dead.
Ultimately, Easterling was evacuated by helicopter and spent 12 days recovering in an intensive care unit in Kathmandu. He later sued his physician in the United States—who had prescribed Easterling the dexamethasone, recommending that he take it regularly on his trip to Everest—and won an undisclosed settlement.
Easterling's story is at the heart of a sensational 2013 Outside magazine article exploring the rise of dex abuse on Everest. The article cites two high-profile cases of Himalayan mountaineers using dexamethasone in non-emergency situations (Easterling's and a professional Spanish expedition to Lhotse in 2011) and their nearly lethal consequences. It includes expert testimony from people like Eric Johnson, the former president of the Wilderness Medical Society and one of the doctors who treated Easterling, who said he "would be shocked if 50 percent of Everest climbers aren't using dex at Camp III and above."
The article paints a picture of a mountain overrun by amateur and professional mountaineers using dex as a performance enhancer, doping their way to successful summits. But is this really the case?
"There seems to have been a lot of discussion lately around this issue of 'doping' on Everest," said Andrew Luks, an assistant professor of pulmonary medicine at the University of Washington. "The issue got some attention in the lay press when the Outside article came out about Jesse Easterling's case. Was Jesse Easterling an outlier, or are there a lot of people doing the same thing? There is no evidence to allow you to suggest it is one or the other."
Despite the overall lack of evidence, the climbing community's opinion on the issue has become polarized by rumor and hearsay. On one hand, there are people like Jelle Veyt, a 30-year old Belgian climber who summited Everest for the first time this year.
"I've heard a lot about climbers using dexamethasone here," Veyt told VICE Sports. "I've even heard about blood transfusions at base camp. I think it's true. There is doping everywhere and it's here as well."
By contrast, the commercial expedition leaders VICE Sports spoke with were less certain that dex use on the mountain is much of a problem. "I keep hearing about this doping problem on Everest, but I really do not see it so much," said Russell Brice, a renowned professional climber and the owner of Himalayan Experience, one of the largest commercial expedition companies on Everest. "In my own team, as far as I know it does not happen. We actually wean members off even Diamox [a common drug used to stave off altitude sickness] before they attempt the summit."
These conflicting narratives about the extent of dex abuse on Everest piqued the interest of Luks and fellow high-altitude physicians Colin Grissom, Peter Hackett, and Luanne Freer, the founder of Everest ER. In an effort to shed some light on the issue, they designed the first-ever study attempting to quantify the problem of dex use on Everest.
Over the course of 2014 and 2015, they invited climbers to participate in an anonymous survey that asked questions about their drug use on Everest. A total of 187 climbers responded about drug use on 262 expeditions covering a "long time period." Although Luks couldn't share exact numbers—the study is still undergoing peer review for publication in an academic journal—Hackett was able to offer a general observation.
"A quick take [on the study] would be: there is no 'dex culture' on Everest," said Hackett, a well-regarded high-altitude physician and the director at the Institute for Altitude Medicine. "Hardly anybody uses it."
He alluded to the steroid's superfluity on Everest as a likely explanation for the low number of reported dex use cases in the study.
"I do not recommend dex for Everest," he said. "It's unnecessary. It's much better suited to other peaks where ascent is abrupt, there is no time for acclimatization, [the] risk for altitude illness is high, and climbers don't use oxygen—think Kilimanjaro."
Of course, it's important to note that the study was voluntary, and asked climbers to admit to a specific kind of drug use that many mountaineers told VICE Sports they consider to be cheating. Who wants to admit to cheating their way to a great personal achievement, even anonymously? So even if Luks' dex survey is an accurate portrayal of drug abuse (or lack thereof) on Everest, it points to a thornier, more fundamental question within the mountaineering community: In a sport where the climber's only competitor is Mother Nature, does taking performance-enhancing substances even matter?
For one, mountaineering is a unique sport: the athletes aren't competing against one another, at least not exactly, and there are no official rules. In other sports, doping is both frowned upon and explicitly prohibited because it is seen as giving PED users an unfair advantage. A batter's enhanced ability to hit a baseball farther detracts from a non-enhanced pitcher's ability to prevent home runs. But if a sport has neither rules nor head-to-head confrontations, accusing its players of "cheating" by doping hardly seems relevant.
On the other hand, climbing world records do exist, so it's possible to argue that doping on Everest does matter. Some professional climbers are, in fact, indirectly battling each other become record holders. On the other hand, when mountaineer sets a climbing record, there's no official waiting at base camp with a cup for the mountaineer to pee in. The archivists at the Himalayan Database, the closest thing Everest has to scorekeepers, say they don't take steroid use into account when judging whether a summit was successful or not. This is partly because don't have any way to test for drug use, and partly because even if they did, they have no official authority over mountaineering in the region.
The World Anti-Doping Agency has set forth explicit rules on what does and doesn't count as doping in mountaineering. Yet as Himalayan Database archivist Richard Salisbury told VICE Sports, there's no one around to enforce those rules. Moreover, determining whether dex was used for legitimate reasons during a climb can be tricky. Again, climbing is different. "[Doping] is fairly easy for the climbing world to do it because they carry dexamethasone as a first aid medicine," said Mike Trueman, a professional mountaineer with over four decades of climbing experience. "Unlike most sports, we actually carry the performance-enhancing drug with us to begin with."
Many of the climbers who spoke to VICE Sports attributed the perceived doping issue on Everest to the dramatic rise in the number of commercial expeditions on the mountain in the past two decades. The inexperienced climbers that tend to make up these commercial expeditions are more likely to be possessed by a kind of "summit fever." For many, prohibitive costs (upwards of $60,000) and time commitment (climbers spend nearly two months at Everest Base Camp during the season) mean they will only get one shot at summiting Everest in their life. As such, they'll do anything to make sure that their time and money aren't wasted—and because they lack the mountaineering experience to know better, they turn to dex as a kind of chemical guarantee.
Dex isn't the end of the story when it comes to performance enhancement in mountaineering. WADA is increasingly concerned about climbers using EPO, a drug common in cycling thanks to its capacity to boost blood oxygen levels. And for climbing purists like Jost Kobusch, a 23-year-old German who told VICE Sports he also had heard of a glut of amateur climbers using dex on summit day, even using oxygen on Everest is a form of cheating. "Oxygen is doping," he said. "It's basically making the environment suitable for you. The sportive thought is you can do it or you can't."
When Edmund Hillary and Tenzing Norgay became the first people to summit Everest in 1953, they used oxygen. So have the vast majority of the more than 4,000 climbers to follow in their footsteps up the world's tallest mountain. The International Climbing and Mountaineering Federation, the sport's international governing body, doesn't condemn oxygen use, but in a recent report on doping in mountaineering it noted that "there is no doubt oxygen is a drug." Its guidelines for oxygen use spurred more debate than any other substance mentioned in the report.
Whether or not you consider oxygen as a form of doping, it's undeniable that mountaineering has a history of drug use. It began with amphetamines such as pervitin, Benzedrine, and Dexedrine in the 1950s and 1960s, which were used by climbers during summit attempts on some of the most dangerous mountains in the world. Corticosteroids such as dexamethasone didn't appear on the scene until the 1970s, when doctors like Hackett started injecting them into climbers suffering from High Altitude Cerebral Edema (HACE), a potentially fatal swelling in the brain due to altitude.
As Hackett and his fellow high-altitude specialists quickly discovered, dex works wonders in combatting these symptoms and restoring a climber's sensibilities enough to get them off the mountain. Yet it wasn't long before climbers realized that taking dex also could boost energy and give a climber a feeling of euphoria as they pushed toward the summit. As Hackett told Outside, "I only used them for people who were unconscious or severely ill. I wish I'd had the idea to use them for people who weren't so bad off, because I would've seen miraculous results."
But according to Natasha Burley, an anesthesiologist from Scotland and one of the three physicians tasked with running Everest ER at base camp this year, the prophylactic use of dex can present serious problems.Physicians without experience in high-altitude medicine will prescribe it for climbers heading to Everest without realizing the danger, she said, citing Easterling as a prominent example of this malpractice.
"For us, dexamethasone is one of the most dangerous drugs to be used [on Everest]," she said. "One of our big concerns is climbers using dexamethasone to climb the mountain because it has extremely serious repercussions."
Extensive use of dex—meaning for more than seven consecutive days—can mess with the body's adrenaline systems to the point where organs can stop functioning. Moreover, if climbers are using the drug preventatively as they push toward the summit, it renders it ineffective as an emergency treatment. If shit hits the fan and a climber using dex comes down with HACE, there's little that can be done to help them. "If you're taking dex you should be going down, not coming up," Burley said. "Otherwise, you're a risk for everyone on the mountain."
In the end, the Everest doping debate covers a vast spectrum of issues: at one pole, the ethical and medical condemnation of non-emergency dex use; at the other, nearly universal acceptance of oxygen use. In between, opinions are as varied as they are numerous—and according to many climbers VICE Sports spoke with, that's exactly what mountaineering is all about.
"The reason I love mountaineering is that it doesn't matter what you take," Jelle Veyt said as he relaxed in his tent at base camp. "Some people even consider oxygen doping, but to me it doesn't matter what you do to summit as long as you're honest about it. There are no rules, so you have to make your own rules for the mountain. It's only cheating if you're dishonest about it."
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