> The second method is more troubling. At altitudes above 3,000 metres, mild symptoms of altitude sickness are common. Blood oxygen saturation can drop, hands and feet tingle, headaches develop. In most cases, rest, hydration or a gradual descent is all that is needed. ...investigators found that Diamox (Acetazolamide) tablets, used to prevent altitude sickness, were administered alongside excessive water intake to induce the very symptoms that would justify a rescue call.
This doesnt sound accurate. I have trekked the Himalayas for over a decade - the risks of AMS are very real. Two people I have trekked with have died due to AMS on separate himalayan treks - both had trekked multiple times before, and were well aware of the risks. Both the fatalities were around 12000-14000 feet - much below the Everest Base Camp trek. When AMS hits, you need to descend - as fast as possible, with whatever means you have at your disposal. Otherwise you have unknowingly entered a Russian Roulette.
And Diamox is used as a preventative course for AMS - alongside excessive water intake - this is standard guidelines in all high altitude himalayan treks.
Were there other issues involved in the fatalities around 12-14k ft? Freezing etc?
In aviation rules you can have passengers at 12k ft without oxygen for an unlimited amount of time. The crew needs to use oxygen if you're between 10k and 13k for more than 30 minutes. Above 13k both crew and passengers must use oxygen immediately (EASA rules, FAA is different).
So they seem to consider 12k to not be dangerous to passengers.
Speaking from experience in the mountains: 12k at rest and 12k under subsequent days of exercise produce very different responses. What might be a mild headache sitting in the back of a plane could be a pretty distinct AMS case lugging a pack up and down mountains.
The main issue is that exercise exacerbates hypoxia. You're climbing a mountain, your muscles need oxygen, but you're not getting enough.
But the temperature does make it worse. Your body is trying to generate heat, which increases oxygen demand. Your blood vessels are constricting, so circulation is less efficient, limiting oxygen distribution. All together, this creates all sorts of health risks.
Sitting in a comfy plane seat browsing the internet is not the same thing. Besides, even healthy adults just sitting can experience mild hypoxia effects above about 10k ft - fatigue, mild cognitive effects, headaches. But if you're just sitting, it's generally tolerable. Of course, you don't want pilots working in those conditions for any length of time.
There are like a half dozen cities with 100.000+ population at over 12k feet altitude. And towns and villages a lot higher. So right, 12k is no's dangerous per se.
An amount of soda sufficient to make you ill would be very VERY detectable in food. Speaking as someone who makes their own honeycomb toffee and soda bread, it's really easy to mess up the ratios and end up with an excess that tastes nasty, and that excess is pretty small.
A small amount won't make a different, it'll just stimulate a bit more H+ production from your stomach's proton pumps.
Edit: The article I read claims the scam involved baking powder, which makes even less sense given that it's even more noticeable, bitter and metallic.
I have to agree. A handful of times during my life that I had some bad heartburn but no antacids I used the tried and true method of a teaspoon of baking soda mixed in a shot of water and slammed it back. It tastes horrible. Even a teaspoon is so strong in taste I guess I would describe as salty. And no I did not feel unwell but my heartburn got better.
And as a kid I once mistook 1/2 teaspoon baking soda and added 1/2 cup to a batch of cookies. The taste was so noticeable and disgusting the only option was to throw out the cookies.
So a teaspoon is a home remedy, a half cup is impossible to ignore, I just don't understand how this report about it in the food could be true.
Ahhhh! Mystery solved. About 40 yrs ago I came to work to taste the most foul cookie (pretty cookie at that!). This is what they must have done. Nobody admitted to making the cookies. I always thought it was a gag. LOL
In Nepal, my parents always warned me before eating at some rest stops because they said the food was doctored with baking soda to make you feel fuller, guess it was true after all and not just an urban legend heh.
Namche (damn autocorrect) Bazaar which everyone in the Everest region passes through is a bit over 11K feet. 12-15K feet just isn’t that high in the scheme of things. Many peaks in the western US are in that range or more. Yes, minor headaches are pretty normal when acclimatizing. But anything more, you need to go down.
> But guides and hotel staff ... tell them they are at risk of dying, that only immediate evacuation will save them.
I got Acute Mountain Sickness at just 11k feet. Headache, nausea, dizziness, fatigue. I passed out until hitting the ground woke me up. I was very disoriented and vulnerable. If someone had told me that I had to get to a hospital or I'd die they could have led me like a tame goat. And they could be right. If you have high-altitude cerebral or pulmonary edema it is life threatening.
A guide getting a kickback can make it a lot more likely just by cutting short the boring acclimatization time.
I did the Everest base camp trek in late 2015, at that time it was quite common (saw it myself and heard about it) that people would do the trek up but to get down they would fake a leg/back injury or blame altitude sickness and the chopper from Kathmandu would come pick you up, as long as you had the right insurance.
Why would it be fixed? Insurance companies aren’t willing to invest in oversight, and everyone else profit, there is no incentive for changing the system.
I did the EBC trek last year and at ~4400 meters, we heard about a local Nepalese woman dying from complications of AMS in the local clinic. There might be fishy things going on with the rescues, but the health risks are real.
A story older than Nepal (misleading tourists). And an article from 6 months ago shows how the govt treats its own people with more examples in HN discussion. https://news.ycombinator.com/item?id=45166972
What is less discussed is what happened to people who were able to identify the scam and refused to let it happen.
As someone who has done quite a few 14ers in Colorado, many of which I wasn't in the greatest shape for, most people do not get AMS especially below 12k, and therefore the numbers in this article definitely do look like somebody somewhere is faking it or being defrauded. Much of the time you just need to hydrate better if you're going up in elevation above 10k and you'll be fine.
> But none of that worked “The scam continued due to lax punitive action,”
It percolated up. It’s usually what happens with corruption. If lower levels are found out to have a lucrative scheme, the higher ups (auditors, police, legislators) make a big fuss about stumping it publicly, but behind the scenes go and ask for a cut.
It is a surprise to me that anyone summiting has access to insurance at all. I suppose that if the fraud rate is as low as 3.5% and insurance is contracted specifically for the trip, then a rational payor will raise rates and carry on.
On the whole, there is finite capacity of certain assets, like helicopters. If the emergency carrying capacity is X and true emergencies are .6 X then there is spoiled capacity of .4 X, in which fraudulent emergencies are placed, keeping everyone in the system whole so that when true emergencies approach .9 X there is no need for fraud. This follows the "optimal amount of fraud is non-zero" and eliminating this fraud might remove the margin needed for the system to exist at all.
An anecdote tells of the British government's bounty on dead Indian cobras
giving locals the perverse incentive to start breeding the snakes, to be able
to kill more of them and collect more bounty
While it is true that guides and business owners are always looking for opportunities to earn extra cash, the reporting is a tiny bit off here.
Start of AMS like symptoms can easily be mistaken for walking fatigue and dehydration. It is easier to identify if you are at rest, but during the trek that is seldom the case. So when you actually start realizing something is wrong, you already are at an elevated risk. The only thing that works in these cases is to descend and as fast as possible at that.
Considering the fact that AMS will absolutely and a 100% kill you if you play around with it, guides presenting trekkers with an option of helicopter rescue is not that bad, at least if you look at the worst that can happen.
"In at least one case cited in the investigation, baking powder was mixed into food to make tourists physically unwell."
The only ill effect I can find from overconsumption is a "tingly sensation on the tongue". Of course, that doesn't mean the 'poisoner' wasn't ignorant of this, and genuinely did it trying to make them sick. Or maybe they simply said, "If you feel your tongue tingling, YOU ARE DYING!!!".
if you leave out the poisoning part who is really losing money off this? insurance companies getting scammed is a good thing unless they go and pass on all of the extra cost to customers. its basically DIY wealth redistribution when you consider that nepal is a developing country and most of the local business that make money like this probably have lower profit margins than some american insurance.
To be honest I'm surprised insurance is offered at all. I did the EBC trek a couple years ago. The temptation to take a helicopter down was real & I didn't have insurance.
131 comments
> The second method is more troubling. At altitudes above 3,000 metres, mild symptoms of altitude sickness are common. Blood oxygen saturation can drop, hands and feet tingle, headaches develop. In most cases, rest, hydration or a gradual descent is all that is needed. ...investigators found that Diamox (Acetazolamide) tablets, used to prevent altitude sickness, were administered alongside excessive water intake to induce the very symptoms that would justify a rescue call.
This doesnt sound accurate. I have trekked the Himalayas for over a decade - the risks of AMS are very real. Two people I have trekked with have died due to AMS on separate himalayan treks - both had trekked multiple times before, and were well aware of the risks. Both the fatalities were around 12000-14000 feet - much below the Everest Base Camp trek. When AMS hits, you need to descend - as fast as possible, with whatever means you have at your disposal. Otherwise you have unknowingly entered a Russian Roulette.
And Diamox is used as a preventative course for AMS - alongside excessive water intake - this is standard guidelines in all high altitude himalayan treks.
In aviation rules you can have passengers at 12k ft without oxygen for an unlimited amount of time. The crew needs to use oxygen if you're between 10k and 13k for more than 30 minutes. Above 13k both crew and passengers must use oxygen immediately (EASA rules, FAA is different).
So they seem to consider 12k to not be dangerous to passengers.
But the temperature does make it worse. Your body is trying to generate heat, which increases oxygen demand. Your blood vessels are constricting, so circulation is less efficient, limiting oxygen distribution. All together, this creates all sorts of health risks.
Sitting in a comfy plane seat browsing the internet is not the same thing. Besides, even healthy adults just sitting can experience mild hypoxia effects above about 10k ft - fatigue, mild cognitive effects, headaches. But if you're just sitting, it's generally tolerable. Of course, you don't want pilots working in those conditions for any length of time.
The problems come if you haven't acclimatized.
> In at least one case cited in the investigation, baking powder was mixed into food to make tourists physically unwell.
A small amount won't make a different, it'll just stimulate a bit more H+ production from your stomach's proton pumps.
Edit: The article I read claims the scam involved baking powder, which makes even less sense given that it's even more noticeable, bitter and metallic.
> But guides and hotel staff ... tell them they are at risk of dying, that only immediate evacuation will save them.
I got Acute Mountain Sickness at just 11k feet. Headache, nausea, dizziness, fatigue. I passed out until hitting the ground woke me up. I was very disoriented and vulnerable. If someone had told me that I had to get to a hospital or I'd die they could have led me like a tame goat. And they could be right. If you have high-altitude cerebral or pulmonary edema it is life threatening.
A guide getting a kickback can make it a lot more likely just by cutting short the boring acclimatization time.
Why would it be fixed? Insurance companies aren’t willing to invest in oversight, and everyone else profit, there is no incentive for changing the system.
What is less discussed is what happened to people who were able to identify the scam and refused to let it happen.
> But none of that worked “The scam continued due to lax punitive action,”
It percolated up. It’s usually what happens with corruption. If lower levels are found out to have a lucrative scheme, the higher ups (auditors, police, legislators) make a big fuss about stumping it publicly, but behind the scenes go and ask for a cut.
On the whole, there is finite capacity of certain assets, like helicopters. If the emergency carrying capacity is X and true emergencies are .6 X then there is spoiled capacity of .4 X, in which fraudulent emergencies are placed, keeping everyone in the system whole so that when true emergencies approach .9 X there is no need for fraud. This follows the "optimal amount of fraud is non-zero" and eliminating this fraud might remove the margin needed for the system to exist at all.
https://en.wikipedia.org/wiki/Perverse_incentiveStart of AMS like symptoms can easily be mistaken for walking fatigue and dehydration. It is easier to identify if you are at rest, but during the trek that is seldom the case. So when you actually start realizing something is wrong, you already are at an elevated risk. The only thing that works in these cases is to descend and as fast as possible at that.
Considering the fact that AMS will absolutely and a 100% kill you if you play around with it, guides presenting trekkers with an option of helicopter rescue is not that bad, at least if you look at the worst that can happen.
The only ill effect I can find from overconsumption is a "tingly sensation on the tongue". Of course, that doesn't mean the 'poisoner' wasn't ignorant of this, and genuinely did it trying to make them sick. Or maybe they simply said, "If you feel your tongue tingling, YOU ARE DYING!!!".
Make coverage void in the Himalayas... problem solved