Ginkgo biloba and acetazolamide for acute mountain sickness

Editor—Gertsch et al report the results of a randomised controlled trial of ginkgo biloba and acetazolamide for acute mountain sickness in trekkers in the Everest region of Nepal.¹ However, it is not clear why entry to the study was restricted to non-Nepali trekkers. Many Nepalis working in the trekking industry in the Everest region are not stereotypical. Sherpas who have lived their whole life at altitude and are at similar, if not greater, risk of acute mountain sickness as Western trekkers (see www.portersprogress.org). Although including Nepalis at risk of acute mountain sickness in the study would have entailed some additional logistical arrangements, these should not be beyond the abilities of a large, international research team.

Studies such as this, which exclude high risk, low status groups for no obvious reason, perpetuate discrimination and inequalities. Evidence is required on how to prevent acute mountain sickness in all groups, and not just rich Western tourists.