A journal has retracted a study that sought to dispel fears about the risks — real and inflated — associated with travel to high altitudes after receiving complaints from a group of experts who found fault with the paper.
That’s the official version. The backstory is somewhat more complex.
“Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema: A view from the High Andes” was published online in February 2021 in Respiratory Physiology & Neurobiology, an Elsevier title. The authors were Gustavo Zubieta-Calleja and his daughter, Natalia Zubieta-DeUrioste, of the High Altitude Pulmonary and Pathology Institute in La Paz, Bolivia — which, at nearly 12,000 feet above sea level, is no stranger to hypoxia.
According to the abstract:
We present how to diagnose and treat acute high altitude pathologies (hypobaric hypoxic diseases) based on 50 years of experience in both: high altitude physiology research and medical practice as clinicians, in La Paz, Bolivia (3,600 m; 11,811 ft), at the High Altitude Pulmonary and Pathology Institute (HAPPI – IPPA).
Acute Mountain Sickness, High Altitude Pulmonary Edema, and High Altitude Cerebral Edema are medical conditions faced by some travelers. These can occasionally present after flights to high altitude cities, both in lowlanders or in high altitude residents during re-entry, having spent more than 20 days at sea level.
Their conclusion:
Traveling to high altitude should not be feared as it has many benefits; Acute high altitude ascent diseases can be adequately diagnosed and treated without descent.
Evidently, that rather optimistic assessment didn’t sit well with at least some readers — prompting 17 of them, led by French physiologist Jean-Paul Richalet, to write a letter to the editor complaining about a slew of issues with the paper, which the elder Zubieta had posted to ResearchGate on its acceptance.
According to the unpublished letter:
We wholly support the idea of disseminating information to the medical community and general public about acute and chronic altitude illness. However, our efforts to educate others are harmed by publication of misleading and inaccurate information such as was contained in this review. Given the myriad of problems in this manuscript, it should be considered as the personal point of view of Drs. Zubieta-Calleja and Zubieta-DeUrioste and not as a general point of view of all Andean scientists since most of Bolivian, Peruvian and Chilean experts in this domain, as well as those outside this region, disagree with their theories. Equally, experts in other mountainous regions of the world (some included as signatories of this letter) find this paper problematic on many levels.
The Zubietas attempted to rewrite their article to accommodate the critique, which, in a letter to Elsevier’s publisher, Helen Hodak, they called one of “the big scandals” in the history of science:
This is certainly analogous to the Pope’s attack forcing Galileo to deny his support of the Copernicus concepts stating that the Sun and not the Earth is the center of the Universe. It also reminds us of Charles Darwin’s suffering similar “attacks” due to his correct evolutionary theories that are now majorly recognized by scientists, thanks to genetics. Ignaz Semmelweis, whose ideas of washing hands for physicians could prevent puerperal fever, was mocked and rejected by the physicians at the time, although it reduced mortality to 1% with this procedure. Ironically, one of the fundamental COVID-19 prevention strategies, advertised around the whole world is to “wash our hands”! Moreover, the Nazi tried to erase Einstein’s Theory of Relativity by summoning the top 100 Physicist to refute his work. Fortunately, in our case, it is only 17 individuals!! Nonetheless, quoting Einstein “it only requires one scientist if he is right!” We should add: Science should be based on trying to understand what is effective. Shoudn’t [sic] we try to explain why more than 200 million people live at high altitude worldwide instead of trying to show that only life at sea level is possible?
Hodak’s response: Retraction was inevitable, but the journal would allow the authors to submit a revised version.
But the insistence on a retraction that called the original article deeply flawed angered Gustavo Zubieta. Wrting back to Hodak, he declared:
please understand that we will never admit to having written a wrong or threatful, or misleading paper. Our prestige is well extended throughout the world, and we work treating these patients successfully for more than half a century! To have a RETRACTION stamp with the following epithets: “serious concerns in regards to the accuracy or misleading nature of the statements” is denigrating, discriminative, and ill-intentioned looking for our unjustified personal and scientific discredit. It is by no means acceptable.
Zubieta told us that he proposed an alternative retraction notice to the journal — whose editor, Mathias Dutschmann, has not responded to a request for comment — which read:
After its publication, a number of international recognized doctors and scientists in the field have raised concerns in regards to the accuracy of the statements related to the physiology and treatment of high-altitude pulmonary edema (HAPE). Other international doctors and scientists working in the field, many at high altitudes have supported the article. The journal has offered to the authors to resubmit an updated version of the article.
That, too, didn’t fly. Which leaves us with the retraction notice (which has a “many people are saying” ring to it):
This article has been retracted at the request of the Editor-in-Chief. After its publication, a number of international recognized doctors and scientists in the field have raised serious concerns in regards to the accuracy or misleading nature of the statements related to the physiology and treatment of high-altitude pulmonary edema (HAPE). The authors of the article do not approve the retraction and stand by their statements.
Zubieta, who has blogged about the controversy, told us that:
The retraction of our article is a truly ludicrous and preposterous story, worthy of a good analysis of human behavior.
Furthermore, this retraction is truly a shame for medical science! We have had 100% success treating those patients in over 51 years of medical practice in the city of La Paz, Bolivia at 3,500m above sea level. But this peer-pressure-reviewers sea level self-proclaimed “high altitude experts” (18 [sic] teamed up in total with a high suspicion that they were strongly induced by one of them not in the list, who was the first to read our paper at ResearchGate), simply prefer to erase us from planet earth. Ha ha.
They all live at sea level or near sea level. Only one is at high altitude but he is a cardiologist who participates as the first author only in a paper on other fields in chickens. And the truth is that I know many of them personally. We organized the First World Congress on High Altitude Medicine and Physiology back in 1994 here in La Paz and several came and have been doing this type of thing since then. In fact, observing their unethical behavior gave rise to the creation of the Science, Honor, and Truth Award.In any event, I asked other international colleagues like real high altitude practicing intensivists and other doctors in many fields what they think of our paper and they all supported it and were against its retraction. Around 50 M.Ds, scientists, and PhD students signed a letter asking that our article not be retracted.
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