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A New Approach to Very-High-Altitude Land Travel: The Train to Lhasa, Tibet

John B. West, MD, PhD
[+] Article, Author, and Disclosure Information

From the University of California, San Diego, La Jolla, California.

Acknowledgment: The author thanks Tianyi Wu, High Altitude Medicine Research Institute, Xining; Bozhou Liang, Physiological Research Group of the Ministry of Railways, People's Republic of China; Yingshu Liu, University of Science and Technology, Beijing; and Zhong Tian, Qinghai Public Health Bureau, for discussions.

Potential Financial Conflicts of Interest: None disclosed.

Grant Support: From the National Heart, Lung, and Blood Institute, R01 HL 060968.

Requests for Single Reprints: John B. West, MD, PhD, Department of Medicine, University of California, San Diego, 0623A, 9500 Gilman Drive, La Jolla, CA 92093; e-mail, jwest@ucsd.edu.

Ann Intern Med. 2008;149(12):898-900. doi:10.7326/0003-4819-149-12-200812160-00009
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The Po2 of the inhaled air is determined by 2 factors: the barometric pressure and the oxygen concentration. The only way to alleviate hypoxia is to increase one of these. In passenger aircraft, this is accomplished by increasing cabin pressure such that the cabin altitude does not exceed 2440 m. Some advocate decreasing cabin altitude to 1800 m. From an engineering perspective, it is impractical to pressurize an entire train, which typically consists of 16 separate cars.

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Grahic Jump Location
Figure 1.
The Qinghai–Tibet Railway route from Beijing to Lhasa.

Map by Jeffrey L. Ward. Originally published in The New Yorker (16 April 2007). Reprinted with permission.

Grahic Jump Location
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Figure 2.
The Fenghuoshan tunnel, altitude of 4905 m.
Grahic Jump Location




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Few more points to Very-High-Altitude Travel: The Train to Lhasa, Tibet
Posted on December 29, 2008
Matiram Pun
Mountain Medicine Society of Nepal (MMSN)
Conflict of Interest: None Declared

Dear Editor,

It is great to read from Dr West about the Golmud-Lhasa Railway, its pathophysiological aspects and approaches to address them (1). However I think, with due respect to Dr West, should have mentioned few more points regarding the project, its effects and approaches.

First of all, I think it is important to consider the approaches to the group of travelers who have different kinds of co-morbid conditions e.g. those who have diseases of heart and lung problems (2). Similarly, the effects of long, high altitude and sedentary travel on the blood coagulation profile and its effect on the conditions like deep vein thrombosis (DVT), Antiphospholipid Syndrome (3), Sickle cell, Protein C and Protein S deficiency and others.

Secondly, as there will be people in the developing countries like Tibet who have been infected with tuberculosis (TB) which can be dangerous and infective to other fellow travelers(4) due to crowded and closed setting of the Cabin to maintain oxygen concentration. Thirdly, the train starts from Golmud (2808m) reaches to maximum altitude of 5074m and travels with an average of 4500m (> 14 hours over 1142Km distance) finally coming to the destination Lhasa (3658m). Practically, the idea is to climb high but sleep low above an altitude of 3000m and do acclimatization hiking. Is it a good aspect from that point?

Finally, I respect Dr West's opinion on the political aspect regarding Tibet, effect of train and present scenario of globalization (in his interview in with the Journal). But the article should have mentioned little bit about migration of low land people (especially Han Chinese) to the Tibet (altitude) and effect of long term exposure to chronic hypobaric hypoxia. This is, of course, another effect of this railway.


1. West JB.A new approach to very-high-altitude land travel: the train to Lhasa, Tibet. Ann Intern Med. 2008 Dec 16;149(12):898-900.

2. Luks AM, Swenson ER. Travel to high altitude with pre-existing lung disease.Eur Respir J. 2007 Apr;29(4):770- 92.

3. Basnyat B, Graham L, Lee SD, Lim Y. A language barrier, abdominal pain, and double vision. Lancet. 2001 Jun 23;357(9273):2022

4. Saito M, Pan WK, Gilman RH, Bautista CT, Bamrah S, Martín CA, Tsiouris SJ, Argüello DF, Martinez-Carrasco G. Comparison of altitude effect on Mycobacterium tuberculosis infection between rural and urban communities in Peru. Am J Trop Med Hyg. 2006 Jul;75(1):49-54.

Sincerely yours, Matiram Pun, MMSN, Nepal

Conflict of Interest:

None declared

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