Educate me on the aviation medical debate

Half Fast said:
Regarding “You've already eliminated the really problematic group from the numbers for either group,” I contend just the opposite. Remember that over 99% of applicants get a medical eventually. Basic Med collects that problematic group. If anything, Basic Med pilots as a group are more likely to have conditions that the FAA is worried about, since pilots (like me) go Basic to avoid unnecessary FAA tests and hassles.
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But I assume it’s the “hassles” and associated expenses that you’re avoiding, not that you’d be permanently grounded by the FAA without BasicMed.

While I have made the statement several times recently that the Honor System fails, I still believe it’s a minority of the time.

As to eliminating 99% of the problem, I assume that number is one of the 87.4% of statistics that are made up on the spot.
 
Anthem said:
So let’s clean things up. Let’s say mosaic goes through - would that satisfy people ? Doubtful. People are always pushing for basic med to be class 3 privileges. So where is the line ? Are we saying basic med /IS/ class 3 or is or should they be different or differentiated. Or do we enable sport to have more privileges with Mosaic and get rid of basic med ? And finally - is the application and denial of a class 1,2,3 medical eliminate the applicant from basic med or sport as it is now ? Because people will still have issue with that and get caught up - but the FAA aeromedical has gone one record saying - if they know of a medically unsafe condition in an applicant - they will continue to take action and prevent that person from operating. So you can never win here.
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Here's my half-fast recommendation, worth only slightly less than you paid for it:

1 - For pilots who don't have one of the Big Three conditions (mental health disorder, neurological disorder, cardio problem), eliminate the Class 3 pre-requisite for Basic Med. For pilots who do have one of the Big Three, continue with the existing requirement for a one-time Special Issuance Class 3 medical.

2 - Increase (or eliminate) the speed and altitude limitations on Basic Med. There's no meaningful way to police them anyway. The size of eligible aircraft can probably also be increased, but leave that for another discussion.

3 - Leave Class 3 in place for those who need it (international flight, for example), but increase the CACI list to include everything except the Big Three (mental health disorder, neurological disorder, cardio problem). If any physician can issue a Basic Med for all those other conditions (sleep apnea, autoimmune disorders, diabetes, etc., etc.), there should be no reason an AME can't issue a Class 3 for the same conditions.

4 - Leave Class 2 and Class 1 as they are.

These recommendations should cut the number of applications OKC has to process down to only the most critical with no significant impact on safety. That would free up resources to process revenue airmen more quickly, and would allow time for additional scrutiny where needed.
 
From the Mosaic proposal:
"Since the 2004 rule, light-sport
category aircraft have shown a lower
accident rate than experimental
amateur-built airplanes. The FAA
considers that the successful safety
record of light-sport category aircraft
validates certification requirements
established in the 2004 final rule and
provides support for expanding the
scope of certification for light-sport
category aircraft and operations."

Most E-AB aircraft require a medical...
 

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MauleSkinner said:
…While I have made the statement several times recently that the Honor System fails, I still believe it’s a minority of the time...
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In the military space, we had a mindset of trust but verify.

The FAA administrative medical certification process and guidelines is not aligned with health insurance billing practices. Medical doctors prescribing antipsychotics either off label or without appropriate specialty care is another conflict. Not everyone has a medical history that can be certified. I wish the FAA stated that at the top of every page, required AME’s to disclose that at the beginning of each and every interaction with an applicant, and the required every applicant to sign an acknowledgement of that fact.

I don’t know what the answer is, but I do know it won’t be perfect.
 
Half Fast said:
For pilots who don't have one of the Big Three conditions (mental health disorder, neurological disorder, cardio problem), eliminate the Class 3 pre-requisite for Basic Med. For pilots who do have one of the Big Three, continue with the existing requirement for a one-time Special Issuance Class 3 medical.
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I may have said that the honor system mostly works, but I don’t think failures of the honor system can be resolved by relying more heavily on the honor system.
 
PaulS said:
There is mentally ill, then there is mentally ill. To start, going to get a pill because your dog died is kind of red flag IMO. Life sucks, then you die.... that's reality. If a person can't deal with what is a typical life stressor with out medical intervention, I'm not sure they are cut out to deal with the stress of being a pilot, especially a professional pilot where you have to sweat out a medical every 6 months, a schedule that really sucks when you are starting and check rides that can get you fired if you can't get it right. Note, I do not count seeking someone out to talk it out as medical intervention.

Then you get into things like adhd, ocd, clinical depression, substance dependency, things that I think of as milder illnesses (unless you are the one suffering from it) but still with a range that can be dynamic. Do we want people with these issues in the cockpit of an airliner? I have my inclinations, the answer is way above my pay grade, but I think people with these issues need to be vetted.


Then you get into the more serious mental illness IMO, like bi polar, schizophrenia, things like that. I don't think people with those issues should be flying. If you've ever lived through one of these people with these issues having an episode or crisis, you would understand.

We are all subject to having issues that can ground us, such as cardiac issues, strokes, injuries, whatever. Part of being a pilot is acting like an adult, which means seeking out help if something is up and grounding yourself, even if it can end your career.
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And that is the kind of thinking, and stigma that exists that keeps pilots from getting the help they need. "I'm sad that my dog died, but I need to suck it up and be a man!". Well, it might not be that you're feeling that way cause your dog died. Its cause your dog died, and you have bad schedule this month, and one of your kids is struggling in school, and your mom is sick.....etc. It might not be one thing, but a whole bunch of things that are piling up that makes it hard to get out of bed every day. Someone people have the bandwidth to handle all that stuff, some people don't. It has no bearing on your abilities as a pilot. That person probably doesn't need drugs, but a few sessions with an experienced therapist could give them the tools they need to deal with their stressors. But in order for your insurance company to pay for it, you have to be diagnosed with something. If you're diagnosed with something, you have to put it on your medical. And depending on your AME, you might end up without a medical. So now not only are you dealing with all of the above mentioned issues, you're now out of work. Sure, you can pay cash to see the therapist, but that is expensive. Plus with the attitudes like what PaulS has, there is a stigma that goes along with seeking professional health. "I'm a man I can just push through this!!!" works great till it doesn't.

Now, honest to god bi-polar, schizophrenia, yes you shouldn't be flying. But there is a ton of space between needing a little bit of mental health support and being full blown crazy.
 
Groundpounder said:
But in order for your insurance company to pay for it, you have to be diagnosed with something.
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I have realized that health insurance is not to keep you healthy, it’s for fixing something that’s broken. If you want insurance to pay for counseling, everyone involved will assume you’re broken, and act accordingly.
 
Anthem said:
The line needs to be drawn somewhere. Perhaps people who don't have the bandwidth to handle normal day to day life should not be certificated to fly other people around. . .
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Right now the line is drawn at zero. The line needs to move a little further out.
 
Groundpounder said:
And that is the kind of thinking, and stigma that exists that keeps pilots from getting the help they need. "I'm sad that my dog died, but I need to suck it up and be a man!". Well, it might not be that you're feeling that way cause your dog died. Its cause your dog died, and you have bad schedule this month, and one of your kids is struggling in school, and your mom is sick.....etc. It might not be one thing, but a whole bunch of things that are piling up that makes it hard to get out of bed every day. Someone people have the bandwidth to handle all that stuff, some people don't. It has no bearing on your abilities as a pilot. That person probably doesn't need drugs, but a few sessions with an experienced therapist could give them the tools they need to deal with their stressors. But in order for your insurance company to pay for it, you have to be diagnosed with something. If you're diagnosed with something, you have to put it on your medical. And depending on your AME, you might end up without a medical. So now not only are you dealing with all of the above mentioned issues, you're now out of work. Sure, you can pay cash to see the therapist, but that is expensive. Plus with the attitudes like what PaulS has, there is a stigma that goes along with seeking professional health. "I'm a man I can just push through this!!!" works great till it doesn't.

Now, honest to god bi-polar, schizophrenia, yes you shouldn't be flying. But there is a ton of space between needing a little bit of mental health support and being full blown crazy.
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You should read the full post before you comment on it as you did, you obviously didn't understand what I posted. You are saying pretty much exactly what I said in my post. You obviously missed this line :"Note, I do not count seeking someone out to talk it out as medical intervention." I was very clear in what I wrote, really, read it again.

Just to spell it out again for you, talking it out and feeling better is one thing, and a good thing, pilots should not be in fear of their certificate for that. Being prescribed medication for depression is another , especially for revenue pilots, that requires vetting. Hiding that from the FAA is a sign of a really ill person, or a person with crappy morals. We all know what is required to fly passengers for compensation, we may not like it, but we need to abide by it.
 
Anthem said:
Sorry, not even close. There are plenty of people who have had or continue to have recurrence with depression, people who are on SSRI's, etc etc that are holding medical certificates flying people around. That number is not zero. Perhaps the line should be moved further in. . .
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OK

PaulS said:
You should read the full post before you comment on it as you did, you obviously didn't understand what I posted. You are saying pretty much exactly what I said in my post. You obviously missed this line :"Note, I do not count seeking someone out to talk it out as medical intervention." I was very clear in what I wrote, really, read it again.

Just to spell it out again for you, talking it out and feeling better is one thing, and a good thing, pilots should not be in fear of their certificate for that. Being prescribed medication for depression is another , especially for revenue pilots, that requires vetting. Hiding that from the FAA is a sign of a really ill person, or a person with crappy morals. We all know what is required to fly passengers for compensation, we may not like it, but we need to abide by it.
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OK
 
MauleSkinner said:
I may have said that the honor system mostly works, but I don’t think failures of the honor system can be resolved by relying more heavily on the honor system.
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I don’t think the percent of dishonorable people will change no matter what the FAA does.
 
Anthem said:
The line needs to be drawn somewhere. Perhaps people who don't have the bandwidth to handle normal day to day life should not be certificated to fly other people around. . .
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Or fly period. Even a PPL is on the low end of safety critical positions due to the increased likelihood of death to self or others, as evidenced in the actuarial tables.

Most safety critical jobs, and some hobbies - many sports leagues and SCUBA diving - come with some type of health check, albeit less with various levels of rigor.

Keep in mind 40% of adults in the US are obese, another 31% overweight, and 7% are morbidly obese. I’d wager most also either don’t know or don’t care about their health or the impact of those conditions on their general health, much less the impact of those conditions on aerospace physiology.

I’d wager if 78% of Americans got down to and stayed at a healthy weight, there would be second and third order effects that would manifest in mental wellness as well.
 
I saw this posted on Reddit. I assume the white new balance wearers in this thread will vehemently disagree, but it makes a lot of sense. If you have ADHD and you're on meds for it, you cannot fly.
 

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Anthem said:
The line needs to be drawn somewhere. Perhaps people who don't have the bandwidth to handle normal day to day life should not be certificated to fly other people around. . .
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Most people here differentiate between class 3 (which should be eliminated) and class 1/2 which are for people "certificated to fly other people around"

You seem to lump them together too much me thinks. Commercial vs private seems to be a good place for the line.

The FAA needs to focus.
 
Groundpounder said:
I saw this posted on Reddit. I assume the white new balance wearers in this thread will vehemently disagree, but it makes a lot of sense. If you have ADHD and you're on meds for it, you cannot fly.
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Asics, not New Balance, but...

The FAA seems to think that if you are in the bottom 15th percentile of their home-brew baseline you have ADD and can't fly, but if you are in the 16th+ percentile you do not have ADD and can fly, but not take meds to make you "better". Regardless what any real doctor says.

In real life, if you are in say the 16th percentile, many doctors (the real ones that actually examine patients) may see a med that brings you from the 16th percentile to the 50th percentile may improve quality of life and will prescribe. Not broken to fixed, but better. I really don't have any issue with this approach and it seems it would improve safety, not lower it.
 
Half Fast said:
So the situation won’t get worse with my suggestion, but the burdens on OKC and airmen will be eased. Freeing up OKC resources might actually improve things.
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Why wouldn’t the situation get worse when you increase trust in dishonest people?
 
MauleSkinner said:
Why wouldn’t the situation get worse when you increase trust in dishonest people?
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You’re not “increasing” anything; you already rely on honesty from those people, whether it’s being honest with an AME or regular physician.
 
jbarrass said:
Asics, not New Balance, but...

The FAA seems to think that if you are in the bottom 15th percentile of their home-brew baseline you have ADD and can't fly, but if you are in the 16th+ percentile you do not have ADD and can fly, but not take meds to make you "better". Regardless what any real doctor says.

In real life, if you are in say the 16th percentile, many doctors (the real ones that actually examine patients) may see a med that brings you from the 16th percentile to the 50th percentile may improve quality of life and will prescribe. Not broken to fixed, but better. I really don't have any issue with this approach and it seems it would improve safety, not lower it.
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Serious question. If symptomatic ADHD adults are <7% of the population, should their medical history (which is now an outlier) not receive additional oversight? Especially if, as an adult, medication is required to control behaviors?
 
Anthem said:
I think the class 3 should be there. Otherwise there are zero limits. So you are saying that someone can fly say a personal citation CJ1 without a medical at all ? You have already broken down the < 6000, < 6 pax < 18K ft in Basic Med. . so the class 3 potentially alleviates those restrictions in a non-commercial manner.
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Sure I do. I trust the insurance companies more than I do the FAA med branch, which says something. Many already do.

But honestly, this red hearing could be put to bed by requiring aircraft requiring a type-rating to need a class 2.
Anthem said:
As for the overall grouping. Im ok with the Sport Pilot, 2 seat without a medical stance.
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OK, we agree here
Anthem said:
I dont think you should be able to carry 5 potentially unknowing about what you are dealing with friends/people without them knowing. Because if some freinds or acquintances invite you to go along for a $100 hamburger - Id sure like to know whether that pilot is dealing with depression, or has ADD or is bipolar - because honestly speaking, neither I nor my family would entertain going on that flight if that was the case.
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OK, your call. Do you need the Government to vet your friends and acquaintances though? I think that's the question. Generally my friends and acquaintances scare me driving more sometimes.
Anthem said:
But that isnt the issue - the question is whether that knowledge should be public with everyone you carry onboard with you. Should they have the right to know before getting on - and I think that applies for commercial or private.
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Commercial? Sure.

Private? No. Not a single non-pilot I know knows the standards of the class 3? The few that know it even exists, think it's way different than it is. And none would even have a clue how to check.

Value added = 0.
 
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Anthem said:
I think the class 3 should be there. Otherwise there are zero limits. So you are saying that someone can fly say a personal citation CJ1 without a medical at all ? You have already broken down the < 6000, < 6 pax < 18K ft in Basic Med. . so the class 3 potentially alleviates those restrictions in a non-commercial manner.

As for the overall grouping. Im ok with the Sport Pilot, 2 seat without a medical stance. I dont think you should be able to carry 5 potentially unknowing about what you are dealing with friends/people without them knowing. Because if some freinds or acquintances invite you to go along for a $100 hamburger - Id sure like to know whether that pilot is dealing with depression, or has ADD or is bipolar - because honestly speaking, neither I nor my family would entertain going on that flight if that was the case. But that isnt the issue - the question is whether that knowledge should be public with everyone you carry onboard with you. Should they have the right to know before getting on - and I think that applies for commercial or private.
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Likewise, how is it possible that there is no extra scrutiny medically for driving a class A motorhome down the road at 80 miles an hour with a driver having a pacemaker. At least in the airplane there’s two yokes.
 
Morgan3820 said:
Likewise, how is it possible that there is no extra scrutiny medically for driving a class A motorhome down the road at 80 miles an hour with a driver having a pacemaker. At least in the airplane there’s two yokes.
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Driving is a basic right. :rolleyes:
 
Anthem said:
:rolleyes1:Not sure how that is relevant. Im sure that its "safer" to have a driver with a pacemaker on the road than in the air. Its all relative and if you're arguing that flying is safer than driving then Im not sure you're making a relevant point.

Also some minor things to note - said driver could be 16 with a pace maker driving the same. So 80 doesnt add anything to the argument unless you are saying that 80 year olds shouldnt be operating machinery because they are old. Well then the argument becomes - at what age are you driving this cut off. Second - not all planes have two yokes. Many Bonanzas come to mind. So then you're saying two yokes is required for flying ??? or maybe you're saying two yokes are safer for flying with an 80 year old with a pacemaker. . ..
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I thought what I said, was pretty obvious. But if you reread my text, I didn’t say anything about 80 year olds. I said people goin down the road at 80 miles an hour. So that would include your 16-year-old driving $100,000 plus motor home with a pacemaker. I’m sure that happens a lot. And aside from a handful of old bonanza’s what other planes only have one yoke. Ford trimotor? De Havilland otter? I guess for the pedantic among us I had to put the word ‘most’ in front of airplane.
 
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Go to Mexico. Cheaper and no record in the US for the FAA to search.
 
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