March 16, 2007 -- To hear British scientist Dr. Monty Mythen explain his upcoming experiment, it sounds more like a vacation than research.
Mythen is professor of anesthesia and critical care at the University College of London. In many ways, his upcoming expedition to Mount Everest defies the beakers-and-benches imagery of the typical lab setting.
But the route to the Everest Base Camp, more than 17,000 feet above sea level, will become Mythen's natural laboratory later this month.
And among his experimental subjects are nine children, aged 6 to 13, who will follow dozens of adult trekkers into the high-altitude, low-oxygen environment.
Four of the children are Mythen' own. And a respiratory pediatrician will be on hand in order to deal with any breathing difficulties the children may experience.
"They're very, very excited, thrilled at the opportunity to travel into this new culture," Mythen says. "But they are also interested in the science of it."
However, the experiment is coming under fire from some medical ethicists who say that it puts its young participants -- all of whom are too young to consent on their own -- at unnecessary risk.
Is It Right to Experiment on Kids?
Mythen says his study intends to explore the effect of altitude and lack of oxygen on children. The findings, he says, will be of use to anesthesiologists and critical care physicians, and it may one day be used to help children whose breathing disorders put them at risk of brain damage and critical illness.
But despite the aims of the research, some bioethicists say the potential gains in knowledge are far outweighed by the possible risks of the journey.
"The fact that the experiment will lead to life-saving treatments does not militate against using children in an experiment," says Joan McGregor, director of the bioethics, policy, and law program at Arizona State University's Center for Biology and Society.
"This is showboating, not science," says Dr. Steven Miles of the Center for Bioethics at the University of Minnesota department of medicine. "Such research could be done in a lab which can precisely mimic the conditions of Mount Everest without risking being unable to access health care."
Rosamond Rhodes, professor of medical education at Mount Sinai School of Medicine, agrees.
"Although it may be important to study how children respond to high altitudes and low oxygen levels, taking children into this tremendously hazardous environment hardly seems justified," she says.
The experiment is also a contentious one because it involves healthy children who do not stand to benefit from the research in the way that young cancer patients might if they were given an experimental drug.
The Sticky Issue of Consent
The fact that Mythen's own children represent part of the study group also presents an ethical conundrum.
"The consent issue is also tricky, since parents usually consent for children, who are, if old enough, asked to assent to the research," says Dr. Susan Goold, director of the bioethics program at the University of Michigan Medical School.
"In this case, the children's parent is the investigator -- a clear conflict of commitment on his part, and also undoubtedly influencing the children's ability to dissent."
Mythen says, however, that there is a distinction between his investigation and others that involve children. The study, he says, is an opportunistic one -- that is, he will simply be studying the health of children who are being brought on a holiday.
"They are not there as a result of the experiment, per se," he says. "There is no added danger to them as a result of the study we are doing.
"That's important from the ethical perspective. Otherwise I don't think that it would be morally or ethically correct."
Risks of Everest
Even though the risks posed to the young subjects of this experiment are at the heart of the debate, the degree of danger these children would actually be exposed to through the trek is still a matter of contention.
"There are inherent dangers," Mythen admits. But he adds, "We're being ultra cautious with the children."
Dr. David Shlim of the International Society of Travel Medicine is a founder of the Himalayan Rescue Association. He has spent 15 years in Nepal, in the shadow of Everest.
In that time, he says, he trekked with his own two young children back and forth to an aid station at 14,000 feet -- about two days' hike below the Everest Base Camp.
"I would like to point that there has never been a death of a child while trekking in Nepal," he says, adding that from his studies in the 1980s, the overall death rate among trekkers in Nepal was 1 in 6,500.
"The route to Mount Everest Base Camp is up a valley, with very few hiking risks, other than being careful not to fall off the trail in a few spots, or get gored by yak."
Some emergency medicine experts note, however, that there is no way the trip could be considered child-safe.
Dr. John Tinker, professor of anesthesiology at the University of Nebraska Medical Center in Omaha, says the changes that occur in the circulatory system as a person ascends a mountain can have severe -- and even deadly -- effects.
"Climbing Everest is risking one's health, no question," he says. "To take one's own children and subject them to deliberate severe hypoxia is tantamount to criminal child abuse. Taking someone else's child and subjecting them to this is just as bad or worse."
And even though the children will not be scaling Everest all the way to the peak, levels of oxygen at the altitude of the Everest Base Camp are only about half of what they are at sea level -- a situation that Dr. Alasdair Conn, chief of emergency services at Massachusetts General Hospital in Boston, says could entail health risks.
"At this height, people can experience one of the three types of illness, apart from cold and frostbite," he says. "These are acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema."
Conn says the health effects associated with these illnesses range from headaches and fatigue in the case of acute mountain sickness, all the way to hallucinations, coma and even death.
And while those susceptible to altitude illness may experience mild symptoms at 9,000 to 10,000 feet, Conn says, the more severe effects can be seen in a small percentage of those ascending 15,000 to 16,000 feet -- a full 1,000 feet shy of the altitude at Everest Base Camp.
"If it were my children, I would, of course, worry," Conn says.
Trek 'Would Be Disastrous'
And even Shlim says there may be reason for concern. The group is scheduled to begin the ascent up Everest on March 27, and the older children are scheduled to arrive at Base Camp on April 2.
"That would be much too rapid an ascent," Shlim says, adding that the plan "would be disastrous, unless the trek is specifically designed to induce altitude illness."
He adds, "We ordinarily recommend that at a minimum, people would take eight or nine days to cover this terrain. With children, I would push for an even longer acclimatization schedule. At eight days, 30 to 40 percent of people walking this route will get some acute mountain sickness."
And such a risk may be too much to justify.
"From the little that I know, the degree of risk of this 'study,' as well as the vulnerability of the children to serious immediate and long-term harm, make this excursion unethical," bioethicist Rhodes says.