Clinical research on Mount Everest

Monty Mythen has been working in anaesthetics and critical care for over 20 years. He is Smiths medical professor at University College London and heads the academic department at the Institute of Child Health. He recently spent three months in Nepal helping with the largest ever medical research project at altitude, the Caudwell Xtreme Everest study. He attracted considerable media attention when his children, aged between 6 and 13, took part in a similar study, the Smiths Medical Young Everest study. Golnar Aref-Adib and Tracie Plant spoke to him on the foothills of Everest, Namche Bazaar

First of a generation or family of doctors?

My mother was a district nurse, and I spent many hours travelling with her to see patients. Otherwise it was just an opportunity that presented itself at school. One day our A level biology teacher asked who would like to go Guy's Hospital to learn more about medical school. I put my hand up and said, "Does that mean a day off school sir?" He said yes, so I said, "Well alright then, I'll go." I was intrigued by the visit and pursued the idea of going to medical school.

Why did you specialise in anaesthesia?

One of my favourite attachments as a medical student was anaesthesia. I liked the people, the work, and the results, which seemed to be avoiding the pain and suffering of surgery. En route to anaesthesia I was seduced by intensive care.

What is the most challenging part of your job?

The most challenging part of my job is intensive care. As you get more senior you spend most of your time explaining to families why their loved ones are dying. The most frustrating part is being a university administrator. A university is always broke, which means you are always trying to save money and someone is always trying to make you do better.

How did you become involved with Caudwell Xtreme Everest?

Mike Grocott, the expedition leader, was one of my research fellow trainees in anaesthesia. He had a passion for altitude medicine and climbing and convinced me that pertinent research could be done by taking healthy volunteers to high altitude. However, I was convinced only once we agreed to study a much broader section of the community. A summit team that is a highly selected group of physiological freaks will not add to the understanding of how the critically ill patient may behave in a hypoxic environment. If you take a group of trekkers aged 18 to 72 (as we have) it is uncertain that they will make it to altitude. I think we will make an important contribution to the understanding of human physiology at attitude.

How were the subjects tested?

Primary measurements were taken at four different altitudes on the trekker's ascent to base camp, at 5330 m. These were cardiopulmonary exercise testing, neuropsychological assessment, near infrared spectroscopy of brain and exercising muscle, and blood markers. The trekkers kept daily records of their basic cardiovascular observations.

How will the research help in a clinical environment?

Most of our team work in intensive care. A common denominator there is hypoxia in some form. It is now generally agreed that hypobaric hypoxia is a viable model for the response experienced by a critically ill patient. We hope that by studying healthy volunteers in a hypoxic environment we will understand what the triggers are that differentiate the rapid adaptors to hypoxia from the slow adaptors. Then we can devise treatments and new interventions that can save lives when people are thrust into a hypoxic environment.

How did your children become involved?

My family wanted to visit me while I was in Nepal with Caudwell Xtreme Everest. My wife's stepsister is married to a Sherpa, and so this was an ideal opportunity for them all to come here. That presented an opportunity to my colleagues at the Institute of Child Health to study the children as they trekked to altitude. This was the start of the Smiths Medical Young Everest study.

How do you feel about the press demonising you for "sending" your children to Everest?

They were not sent; they went on a trekking holiday. They volunteered to do research for my colleagues. They were able to consent for the research, which was safe, non-invasive, and helpful.

How can a 6 year old consent?

In the same way he or she can ask for a Nintendo Wii.

How was the children's experience?

The children had a fantastic time. While we must always be concerned about exposing our children to risk, the risks associated with coming to this altitude (4000 m) are low.

What advice would you give to future doctors?

Buy good shoes.

What's your life's passion?

My children.

Caudwell Xtreme Everest was a research project done by the Centre for Altitude Space and Extreme Environment Medicine, University College London. For more information go to www.xtreme-everest.co.uk/.

Competing interests: None declared.

Provenance and peer review: Non-commissioned, not externally peer reviewed.

   

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