In 1950, Maurice Herzog and Louis Lachenal became the first climbers to reach the summit of an 8000m peak (Annapurna, 8091m). In the half century since that pioneering climb, mountaineers have increasingly sought to climb the fourteen '8K peaks' of the Himalayas and Karakoram, with remarkable success; they have made 5085 ascents of those peaks up to the year 2000. While seeking adventure on those great peaks, mountaineers are inevitably exposed to hypoxia, cold and dehydration as well as to the physical hazards of climbing. Those few mountaineers who successfully summit an 8K peak are likely to be at or near their physiological limits and probably confront an elevated probability of dying during their descent. We will briefly review some of the physiological challenges climbers face at extreme elevation and then compare success rates and death rates on mountains of different heights (Rainer, Foraker, Denali, K2, Everest). Success rates decline with summit height, but overall death rates and death rates during descent from the summit increase with summit height. Although these patterns are based on non-experimental and uncontrolled data, our findings are consistent with the hypothesis that increasing altitude is associated with decreased success and with increased risk of death.