Unicom

January 2001 Issue




Sick Logic

FAA’s approach to mental disorders is insane

In reference to “A Better Mousetrap” [Reality Check, November], logic fails to explain the complete prohibition on antidepressant medication for aviation. Depression is common, especially among middle-aged men and people who have given up smoking, which is why Zyban – an antidepressant – is often prescribed as an aid to smoking cessation.

Depression is treatable but, as with most mental illnesses, it is prone to widespread misconception. Prozac, for example, is widely equated with Thorazine – a tranquilizer that turns agitated people into placid, happy zombies.

Prozac, Zoloft, Paxil, Celexa, drugs that combat the most common forms of depression and anxiety disorder, are selective seratonin reuptake inhibitors – an overblown way of saying they allow a brain hormone to flow normally once again.

In most instances of physical imbalance – high blood pressure, high cholesterol, acid reflux, allergies and so on – a long list of medications are approved by the FAA. Many of these meds have potential side effects equivalent to, or more pronounced, than common antidepressants. The rule here is to stop flying for a few weeks until you and your doctor can assess the effects these medications are having on you. If they don’t influence the safety of flight, then go fly.

Why, then, are antidepressants dismissed with the inflexibility expected if a pilot were to show for a flight physical with total blindness in both eyes? Why can a pilot with a known and stable physical deficiency undergo a medical test flight and gain a waiver, but not a pilot who is being successfully treated for depression?

Where in the medical literature does it state that antidepressants slow reaction times, diminish coordination or impair mental processes in all or even the majority of cases? Do we want depressed pilots to ignore helpful medication in order to stay in the cockpit? Do we want pilots giving up their careers due to a treatable condition that, in the vast majority of cases, simply returns patients to the level of capability they had prior to the onset of the illness?

How many of those inexplicable rookie error accidents by high time pilots can be attributed to obeying a foolish and dangerous law? Where logic fails, other factors must offer the answer. Time may be one. We all know how over-worked the FAA’s Aeromedical branch is. Public perception may be another. Perhaps there is an element of traffic cop logic operating here; they may feel that if they allow people to fly who have been treated for depression, this could open the door to more serious conditions, such as bipolar disorder.

Finally there’s the factor I believe is at the root of this, because I have encountered it often in the FAA: bigotry.

-Name Withheld by Request

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I’m Not What’s Sick
Having become a victim of the FAA medical establishment I have to heartily agree with Paul Bertorelli’s assessment of the entire FAA medical program [Medical Matters, November].

I have been flying for 44 years and have accumulated approximately 5,400 hours on a Commercial ticket with an instrument rating and CFI in gliders. In 1996 I was diagnosed with type 2 diabetes. The best and most consistent means of control was a diet and small amounts of insulin. Of course, I was immediately grounded by the FAA rules.

Thanks to the efforts of the American Diabetes Association in cooperation with the AOPA, in 1997 I was finally able to get a third-class medical with the provision that I take a complete (and reportable) physical exam every 90 days, in addition to my regular exam every two years. Unfortunately, I can no longer charge for my flying services without a second class medical, which I held until the time the diabetes was detected.

Dr. Cowl’s assessment of the efficacy of the FAA program, “the fact that there are not more [incapacitations in flight due to a hidden medical condition] underscores the fact that the process works ...” reminds me of the story about the guy walking around Rochester, Minn., with a can of “Elephant Spray” and claiming that the reason there were no elephants in town was because of his spraying.

Medical science has advanced light years since Dr. Bauer designed the first criteria for medical fitness to fly. The question undoubtedly came up because, in those days, the general belief was that only superhuman specimens of mankind could survive the rigors of prolonged flight. That idea has long since been debunked, but the FAA seems not to have noticed.

The worst part, though, is the logical non-sequiturs in the labyrinthine rules. I can fly commercially in a 1,200 lb sailplane for hours on a cross country instructional flight and legally self-certify my fitness to fly, but I cannot tow a glider in a 1,200 lb tow plane for 12 minutes and get paid for it because the towplane has an engine and I need a Class II medical to get paid.

With my Class III medical I can do it for free, however, so the FAA’s major concern seems to be not how safe a pilot I am, medically speaking, but how fat my wallet might get. All this in spite of the fact that, due to the lifestyle changes I made and the care that I now take of myself, I am in the best physical condition I have been in since I was in my 20s and, in the assessment of my personal physician, a lot healthier than most people 10 to 15 years younger than me.

It’s fairly obvious that the FAA is missing the medical mark completely. What they really need to be doing is to give psychiatric examinations instead of physicals. Frankly, except for ATP, part 135 and 121 operations, I think they should be out of the medical business entirely. Bertorelli’s right! Junk the present system and build a new one based on modern day medical knowledge and an objective criteria of what is actually medically required for safety.

-Name Withheld by Request

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Tripped Up by Poor Decisions
I read “Educational Trip” [Learning Experiences, November] with great interest because I fly out of the airport where the accident occurred. As I started to read, I was pretty impressed that this guy had the courage to publicize his accident. That is, until he started trying to blame it on the airport and runway markings (or lack thereof).

He landed on a clear day. He had approach plates that do, in fact, show the taxiways. He was sitting on a compass rose with gas pumps a wingspan away and hangars and planes tied down directly behind him. He should have at least wondered why anybody would want their plane tied down directly in the propwash.

Personally, I’d want to look myself if I were PIC contemplating a takeoff in 0/0 conditions rather than send my son or anyone else.

It doesn’t take more than a minute or two to walk the entire taxiway. Another 10 seconds walking and he most likely would have seen the intersection. If all of these things combined weren’t enough to tell him that he wasn’t on a runway, I tend to wonder what kind of markings it would have taken.

He is probably lucky that he did crash before leaving the ground, because there is a 900-foot mountain about 6,600 feet off the end of runway 14 that, considering his lack of situational awareness on the ground, he may have ended up crashing into with even less pleasant results.

The airport is practically surrounded by the Connecticut River, and when there’s fog, it is thick as pea soup there. The mistakes in judgment this guy made went way beyond any deficiencies of the runway markings, weather conditions or anything else.

-Mike Regish
Via e-mail

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Save Your Postage
Please cancel my subscription to Aviation Safety. Why? I received November’s issue and just finished reading the “Editor’s Log.” Frankly, for a publication that claims “professionalism,” I found Ken Ibold’s comment on Sharon Stone’s IQ was out of line. Was Mr. Ibold jilted by a girl who looked like Sharon Stone in high school and never got over it?

-Richard Hopkins
San Pedro, Calif.


Sharon Stone’s IQ is reportedly well into the genius range. But even that ain’t much when it comes to flight hours. And for the record, Laura Mitchell was prettier and smarter.

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Physician, Fly Thyself
Prior to my making the decision to pursue my private pilot license in July 1999, I performed a literature review on the issue of safety and physician pilots.

I was concerned because several pilots had told me that physicians are inherently dangerous because of “get-there-itis” or because they “can afford all the fancy gadgetry and thus forget how to fly.”

The only FAA articles I could find on the subject were dated, to say the least, and include the following out of the Office of Aviation Medicine (reprints were obtained through the U.S. Dept. of Commerce’s National Technical Information Service):

• Mohler, S.R., et.al. Physician Flight Accidents. September 1966. (NTIS AD648768)

During the period of 1964-65 there were 30 fatal physician accidents. Comparing the number of physician fatalities and total number of flying physicians with the number of total general aviation fatalities and total number of general aviation pilots the physician group had a four-fold higher rate of fatal accidents.

The authors concluded, “The commonality is related to risk-taking attitudes and judgments. Of particular interest was the tendency of many of these physicians to fly at night in inclement weather over dangerous terrain, despite limited or no instrument flight experience.”

• Cierebiej, A., et.al. Physician Pilot-in-Command Flight Accidents 1964 Through 1970. March 1971. (NTIS AD724961)

The authors note there was a marked drop in the total number of fatal accidents among physician pilots during the years 1966 (13), 67 (13) and 68 (12) but an increase in 1969 (16) and a further increase in 1970 (18), noting that among all general aviation pilots, there has been a steady decline in fatal accidents since 1968.

“Weather appears most frequently as a primary factor with inexperience and mechanical failure well represented.” Weather accounted for 44 percent to 54 percent during the years studied.

• Booze, Charles F. Jr. An Epidemiologic Investigation of Occupation, Age, and Exposure in General Aviation Accidents. April 1977. (NTIS ADA040978) In looking at occupation specific rates (per 1,000 pilots) physicians showed a rate of 8.7. Lawyers (11.0), professional pilots (15.9), farmers (10.1) were all ranked higher and teachers (4.2), engineers (4.7), managers/administrators (5.7), sales workers (5.6), craftsmen (3.6) were lower with the lowest rate belonging to members of the armed forces (1.6) and academic students (3.2).

When looking at exposure (i.e. higher flight time) students, policemen, housewives and physicians had a rate 3.5 to 7 times higher than the experience of the total population.

Again the issues of recreational flying and risk taking attitudes/behaviors were put forward among the professional classification of occupation.

Current statistics, available through the Flying Physicians Association (FPA) indicate that times have, indeed, changed for the better among physician pilots.

Over 85% of all FPA members are instrument-rated. Their regular continuing medical education meetings focus on aeromedical and safety issues. As with most things in life, education and diligence to safety issues provide for the safest environment.

Ultimately, I joined the FPA, an organization heralded for its emphasis on safety, and took the plunge. Now my wife, also a physician, is following.

-John E. Latz Jr.
Mooresville, N.C.

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Horizon Makes VMC
After reading about the JFK crash in your October issue, my main thought was: Could this accident have been me?

I have a little over 300 hours (including around 30 hours of instrument training and around 20 hours of night flying). JFK and myself had similar experience, except I have more solo hours. I always make sure I can see the ground. I do not fly over large bodies of water (day or night) if I cannot see the other side. I consider the conditions to be IMC if I do not have a visible horizon.

I don’t like all the rules that the FAA make us fly under, but perhaps crossing large bodies of water and large unpopulated areas at night should be considered IMC. A common sense rule change like this would be much better than simply requiring any night flying to be IFR like many other countries do.

-Alan Lawrence
Nags Head, N.C.