Diamox is a drug which can be taken to assist the body by improving the efficiency with which oxygen can be absorbed from the thin air. There is no disputing the efficacy of the drug. There is however a big debate as to whether and how Diamox should be used.
There are three ways to use Diamox on the mountain ...
The first way is to use it as a preventive throughout the trip starting from the day before the climb. The conventional arguement against doing this is that it conceals the symptoms of body underperformance, thus increasing the chances of a failure if one does occur being catastrophic.
The second way is to "listen to your body" until day 3 (6 day climbs) or day 4 (7 day climbs) and then, if you are not demonstrating any severe symptoms, to take Diamox as directed above to boost your performance at higher camps. The arguement against is teh same as previous.
The third way is to only use Diamox as a treatment for altitude illness. This is reasonable, but severe symptoms can only be treated by removal from altitude.
We carry enough Diamox in our medical boxes for the second and third options. This should not be taken as an indication of our advocating this course of action. The choice is yours and we suggest that you consult your doctor and do some background reading on the subject if you remain unsure.
We estimate that of American climbers, perhaps as high as 75% take Diamox in some form during the climb. Of non-American climbers this number probably drops to 25% or below.
Here are some notes from Jim on the subject of Diamox :
"Diamox 750 mg is the proven medical dosage. That is not to say that a lesser doseage will not work, but that for the manufacturers need this doseage to prove its efficacy 100%. Our practical "recommendation" is 500 mg. It seems to work. More importantly you don't need to pee ALL the time (only most of the time) with this dosage. Quite a lot of clients are still recommended only 125mg or 250mg by their doctors."
"As far as we can see and from what the medical literature says, Diamox does not actually disguise serious symptoms of altitude sickness, as is the conventional counter agruement to taking the drug. The consideration of whether or not to take it is more to do with the climber's individual attitude towards taking drugs as preventatives. If you never have been to altitude, the you do not know how your body is going to react. Do you want to take drugs for something that might not even make you sick? This is where the cultural difference comes into play ... Americans are in general more generous in their drug consumption than Europeans, so tend to be more willing to take Diamox just to be sure."
"We do not use Diamox as treatment if the climber is going to descend, but we may recommend it to climbers who are still going up. If our guides suggest that you take Diamox, then you may well wish to take them up on it."
"Last more general comment. Doctors back home might have very little idea about Diamox, therefore the advice that climbers gets varies enormously. If you really want to get the full information, then ask your doctor to refer you to a specialist."
To summarise, The African Walking Company approach to altitude illness is to attempt prevention through pacing, drinking, and good itinerary planning. Medication is available if needed and staff are trained to high levels of knowledge and have good experience on the mountain.