Abstract
In spite of the limited area of coverage of our journal, the readership covers a surprisingly wide range. On the one hand, there are climbers whose main interest is topics such as fitness at altitude, and how to avoid and treat diseases such as acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema. On the other hand, there are academic biologists whose primary interest is in the biology of hypoxia in all its aspects. It is something of a challenge to achieve a balance between these different interests, all of which are spawned by the oxygen deprivation of high altitude.
The present issue of the Journal and that of June of this year exemplify this challenge. The Special Topic of the June issue was one of the most important advances in high altitude biology of the last few years, namely the genetic changes that have recently been described in the high altitude native Tibetan population. The issue had five contributions on this topic. First there was a guest editorial from Cynthia Beall who is on our editorial board and one of the investigators at the forefront of these studies. This was followed by a general review by McInnis and Rupert bringing the whole subject up to date. Then there was an article by Aldenderfer about the duration of time that Tibetans have spent at high altitude. This is a fascinating but controversial area because it has been suggested that the genetic changes have occurred within the last 3000 years, and if this were true it would represent one of the fastest genetic changes ever described in the human population. Another article by Wills was devoted to the factors involved in rapid recent human evolution. And finally Tissot and Gassmann provided an updated review on the physiology of HIF-2α which is encoded by the EPAS-1 gene. This is one of the most striking genetic changes in the Tibetan population. This series of five contributions represents one of the most stimulating in-depth analyses of the new findings and exemplifies the stature of the Journal in the area of hypoxic biology. Parenthetically, while high altitude medicine is sometimes seen as something of a backwater, these new findings have some evolutionary biologists jumping up and down.
However it should be added that the June issue had plenty to interest the climber for whom genetic changes may seem somewhat arcane. For example, there was an article on pulse oximetry at high altitude by Luks and Swenson, which is a topic of great interest to many climbers and expedition leaders because these devices have become so popular and are frequently misused. There was a Pro/Con feature on whether all climbers develop subclinical interstitial pulmonary edema and, in addition, an article on the physiological effects of dexamethasone at high altitude. This medication is now used by many mountaineers at high altitude. So while the June issue was at the cutting edge of one of the most important recent advances in high altitude biology, it also had features that would interest the less academic climber.
The present issue is targeted much more at climbers and people who are concerned with high altitude diseases. One article is on equipment for medical backpacks in mountain rescue, and there is another on medical standards for mountain rescue operations using helicopters. Acute mountain sickness is one of the commonest medical problems at high altitude, and there is a paper on the use of visual analogue scores to improve the assessment of this condition. There is also a brief report on prior altitude experience of climbers attempting to summit on Aconcagua. This is important partly because so many people attempt to climb this mountain and get into difficulties, and also because of the general problem of the increasingly large number of climbers with little experience who attempt to reach the summit of very high mountains.
A feature of the present issue is a number of letters to the editor. Readers who are less concerned with the details of the biology of hypoxia often find these particularly interesting. For example, there is a letter warning of the dangers of using dexamethasone at high altitude in response to the article in the June 2011 issue. Another letter refers to an earlier article to a link between suicide and high altitude and suggests that depression may be a causal factor. A further letter raises the interesting issue of at what altitude does the hypoxia become medically significant. This was in response to another article in the June 2011 issue claiming that people living at altitudes as low as 600 m are more susceptible to some conditions such as diabetes and hypertension but have a lower cardiovascular mortality.
So the message is that although High Altitude Medicine & Biology covers a very limited area of medical science, its readership comes from a large spectrum. It will always be a challenge to satisfy everybody. The climber may grimace when he sees an article on the biology of HIF-2α, and the biologist may roll his eyes when he sees a paper on mountain rescue using helicopters. However these are all grist to the mill in our fascinating area of medical science.