Time for FAA Psychiatric Illness Reform

Discussion in 'Medical Topics' started by ProjectInfinity1, May 12, 2019.

  1. mryan75

    mryan75 Cleared for Takeoff

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    Or they haven't interviewed him. Or they have and think he's completely off his rocker but can't do anything about it because of our "freedoms". I wouldn't take anything at face value here.
     
  2. Warmi

    Warmi Pre-takeoff checklist

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    You are missing the fact that majority of people purchasing LSA planes , according to dealers , were folks with PP or higher certificates with expired medical flying these planes under the Sport Pilot rule.
    If dealers claim that his is their key market for LSA planes , it follows that there is a significant group of people flying LSA planes that is not captured just by the SP certificate holders numbers.

    In any case, there have been a lot of people flying planes without medicals , and not just ultralights , since a typical LSA will often outperform a Cessna 172 - we have not seen an increase in accident rates.
     
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  3. Half Fast

    Half Fast En-Route

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    Agreed, and if anything the group has self-selected into a worst-case sampling across pilots, as the group tends toward those with difficult medical situations (me, for example) or those who can't qualify for a 3rd class at all. If such a group has an accident rate similar to the general pilot population, that would seem to indicate that the 3rd class medical serves little purpose.
     
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  4. apr911

    apr911 Pre-takeoff checklist

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    Lubitz presents an interesting question in my mind... Would he still have done it if the diagnosis didn't mean the end of not only his career flying but his flying career?

    It's impossible to tell what was going through his mind, why someone decides to commit suicide is usually a very personal matter/thought process; why someone decides to commit suicide and take 149 people with them is even more difficult to understand but it seems like all everyone who ever knew the guy had to say in the wake of the incident (in terms of intent; accident to me implies a lack of intent i.e. accidental) was that he was a guy who truly loved and was passionate about flying.

    Maybe its wishful thinking on my part but I'd like to think he might have been more willing to disclose his medical condition, seek help and perhaps even avoid taking his own life as well as the lives of 149 others, if the world did not look so bleak on the other side, if there was a light at the other end... He was facing the loss of his livelihood (career flying) and the loss of his ability to do the one thing he was passionate about and loved doing (flying career). By all accounts flying was his entire identity so rather than accept the loss of identity, he decided to end it. Now maybe instead of painting such a bleak picture, you leave him something... End his career flying (or at least flying passengers) so that he's not a threat to the 149 others on board the plane but let him keep his flying career and his identity as a pilot. Maybe that keeps him from reaching the precipice and deciding to end his life, maybe it doesnt...

    Maybe he ends his life anyway but all we can ever do is work to mitigate the risk posed and burying our heads in the sand and pretending that pilots are automatons that dont suffer the full range of human emotions and yeah, sometimes even get depressed doesn't seem to me to be the right answer.

    I dont agree with the idea of sport pilot medical accidents being used as a comparative to medical accidents of higher certificate levels but I understand what @Warmi was getting at. The numbers you pulled shows only the number of sport pilot certificate holders and does not include those with "inactive" PPL/CPL/ATP certificates, flying under the sport pilot authorizations due to an expired medical.

    So the hard numbers show 6,000 sport pilots but the statistics published dont show the attrition rate of Sport pilots or PPL/CPL/ATP holders or the cause for that attrition. Things get nebulous from there and difficult to track... I'm fairly certain we're producing more than 5,000 new PPL/CPL/ATP pilots per year but I dont know exactly how many... If we go by the growth in the number of student pilots, it's been close to 20k for the last 3 years. If we assume half of them wash out and never make it to a certificate, we're still talking about producing 10k more pilots per year which means we're losing 5k pilots per year to attrition. If we assume 60% of those had their medical revoked, retired from flying altogether or are now deceased that leaves 2,000 pilots per year that are no longer listed on the "active" pilot roles but may be exercising privileges under Sport pilot rules (or rolling the dice and still flying non-sport aircraft with expired/revoked medicals). That easily makes 10k sport pilots. Admittedly it doesn't account for the attrition of sport pilots who no longer fly at all but it also completely ignores the Ultralight category of aircraft and pilots therein.

    From there the comparison gets more dubious as it assumes that the majority of people flying under LSA or Ultralight rules are doing so because they would not qualify for a medical. Allowing your medical to expire certainly suggest this but its definitely a situation where all widgets (ineligible for a medical) are gadgets (non-holder of a valid medical) but not all gadgets are widgets but if you take your cross section of 10,000 LSA/Ultralight pilots and look at the number of inflight medical incidents and compare it to any cross section of 10,000 PPL/CPL/ATP (or possibly the entire group of 425,000) you find that the per capita rate of medical incidents is the same... So you have 10,000 people, many of whom the FAA says shouldn't be allowed to fly by virtue of their medical status and inability to obtain, legally flying under another set of rules with a similar rate of incidence as those flying under the stricter ruleset. At least that's the theory; I dont have the actual numbers to back it up and like I said, I believe there are several stretches in this argument that I dont entirely buy it but I do understand what @Warmi is getting at.

    As several actual accidents have shown, the idea that the issuance of a medical certificate, whether it be a 3rd class or a 1st class, in some way makes us safer is just a lie we tell ourselves and in fact since many dont use their AME as their Primary Care Physician, it in some ways makes us less safe.

    If it weren't for the lack of ability to track (and the loss of the cottage industry that has sprung up around medicals both issuing, reviewing and fighting denials) the entire AME structure could be gutted and replaced with "visit your PCP regularly" and would probably actually be safer as a result (a doctor that knows you, your medical history, your family's medical history and see's you regularly is more likely to catch changes).

    True, every situation could well be different and I cant speak to the Ops situation but if we include and extend the discussion beyond psychiatric disorder and guns, I do know people who would be automatically disqualified from an FAA medical but are considered qualified and possess licenses issued by other government agencies that seem similarly incongruent.

    Those situations certainly extend beyond the right to bear arms under the second amendment. They're not my stories to tell though.

    Since we're discussing rights vs privileges though, what about the right to liberty and the pursuit of happiness? For that matter what about the right to privacy? What business is it of the FAA that I "ever" saw a doctor for XYZ, especially if I was not over 18 at the time? Heck even getting a top secret security clearance for the federal government limits its scope to the last several years. There are parents with munchausen's that they project on to their kids or parents with drug issues that they project on to their kids to score prescription drugs and there are 18 year-olds today who are going to the doctor to get vaccinated for the first time because their parents were part of the anti-vaccine crowd.

    Regardless of cause or situational nature, we've all generally agreed that 10 years without treatment/medication seems to be the FAA's requirement for them to classify you as having "recovered" from a depressive episode... So why does it matter that if a pilot had one 10+ years ago? What exactly are you looking for?

    The generally accepted advice when it comes to finding an AME's seems to be "find an AME who's a pilot advocate, one that will look for reasons to pass your medical, not reasons to deny it" in addition to "visit the AME for a consult first; dont turn over any paperwork until you are sure you pass." I posit that this would be almost wholly unnecessary if the FAA were to themselves start treating the medical process as "reasons to pass, not deny."
     
    Last edited: Jul 3, 2019
  5. Clip4

    Clip4 Final Approach

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    First, there is no way to determine the % of the less than 7000 sports pilots who are active. Assuming private pilot retention, >1/2 of the sports pilots certified are active pilots today. Nor can anyone determine how many private pilots or higher certificates are flying light sport without a medical.

    What we do know is there are not enough sport aircraft in the US to support anyone’s 10s of thousands claim. Assuming they are all airworthy, there are less than 10,000 SLAs in the US. You can throw in the few legacy aircraft that qualify for LS, but you get no where near the aircraft needed to support a 10s of thousands claim.

    Basic Med has severed the >private pilot LSA cross overs unless they have cardiovascular conditions, neurological disorder, or mental health disorder and many of these pilot may have gone back to non LSA. I suppose one can argue they don’t have an FAA medical, but they have had an examination and a physician signing them off

    Next, where are the 10s of thousands of LSA pilots? I fly in a very GA active state with a lot of airports. I fly > 4 days a week instructing. I rarely see an LSA. Divide the number of LSA aircraft by the 3000 counties in the US you end up with less than 3 per county. In a populated county, maybe there are 10 LSAs compared to
    > 150 non LSA single engine.
     
    Last edited: Jul 3, 2019
  6. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    The data here are definitely soft. Nonetheless, I think suggestive that the 3rd class medical rules do not improve the safety of flight. Certainly the data available do _not_ support the contention that the 3rd class rules do improve the safety of flight.
     
  7. Half Fast

    Half Fast En-Route

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    Agreed that we don't have detailed data regarding those flying under Sport rules, but we can still draw reasonable conclusions even without quantification.

    Can we at least conclude that the pilot population flying under Sport is very likely to have more medical difficulties than the pilot population at large? If we can agree that's true, and if LSA accidents aren't way out of family with general aviation accidents overall, then it's reasonable to conclude that a 3rd Class medical is not providing any benefit.
     
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  8. ProjectInfinity1

    ProjectInfinity1 Pre-Flight

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    You know, I made this account under a name I rarely use out of attempting to keep anonymity.


    However if I’m not lying, and I’m not “completely” off my rocker.


    What community am I most active on with reddit? https://www.reddit.com/u/duza9999/?utm_source=share&utm_medium=ios_app

    NFA DEDCDD9A-770A-46EE-BD6F-859AFA341A4E.png


    I’m getting a homebased FFL the day I turn 21, (assuming zoning doesn’t change in a year).



    A single FBI agent visited me the Friday before Memorial Day, once I knew he was legit, I was surprised he came alone. However he stated do to the holiday and the fact they just caught a bank robber recently which lead to a lot of long hours, he gave his guys an extra day off. However they viewed my case as pressing enough to warrant further inquiry instead of waiting until the following Tuesday. Once we had chatted for a few min he got a phone call from someone asking if he got in ok.


    Biggest takeaway was, given the fact of socially awkward and mentality struggling 19 year old White Male. Honestly it fits the bill of past profiles of perpetrators of shootings.


    However we talked for an hour, hour and 15 minute, very nice gentleman even invited me to lunch which I’m taking him up on when his schedule permits.


    This sets off all the red flags, yeah I agree, however if I sat down and chatted with you I personal for an hour or two, I may come off a bit weird, but NOT a danger to others.


    53D3450D-6C9C-4612-9354-25CDD4A0312B.jpeg 51E529D9-BAE7-4324-9F34-8A7E7F608010.jpeg 197E1EF2-20BE-47DB-BDCD-109EACEE4259.jpeg 83681C55-3D07-4EE2-A18C-A1A96463C3E5.jpeg B797D741-39D6-42C9-89CC-3A2B357D340B.jpeg A413D1E1-8BF2-4300-A19A-E24C6B5813D5.jpeg




    First photo was back in 2015 flying a pattern with my instructor near my high school, last photos were back in 2012.

    This is a passion going back to a kid.
     
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  9. tspear

    tspear Pattern Altitude PoA Supporter

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    Actually, the data does not even meet the standard for a correlation.
    I can argue all day about the 3rd class medical being unneeded. However, using the sport pilot or the basicmed numbers does not help make the case. At all.

    Tim
     
  10. Tantalum

    Tantalum Final Approach

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    Just three things

    A.) Sorry man. Flying is a passion of mine too (honestly, everyone here), and one my three greatest fears is losing my ability to fly for something out of my control, IE, some medical condition I can do little about

    B.) It seems like you have a path ahead of you as the doctor pointed out on one of the first responses to this thread.. you are young. I am 33 and the last 10 years went by frighteningly fast. It gives you something to work towards, and may be a good long term motivator for you

    C.) Take your mental health seriously, our greatest gift as a species is our minds. Be kind to your brain, don't beat yourself up, go with the flow, and if you need help, go get it. Not worth putting off mental health for fear that you won't be able to fly. There's other ways to get in the air as others have mentioned. What about sky diving? Hang gliding, even just avid flight sim work. Aviation is a passion with many areas

    Hang in there, get the help you need, take care of yourself
     
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  11. Palmpilot

    Palmpilot Touchdown! Greaser!

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    Here's an article on the LSA safety record so far (as of last year). While The LSA accident rate compares poorly to legacy certified aircraft, at least there's this:

    "On the medical front, our review of more than 200 accidents revealed little evidence of medical incapacitation as an accident cause."

    http://www.aviationconsumer.com/iss...ident-Review-Nothing-to-Celebrate_7228-1.html
     
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  12. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    I suspect if one obtained the actual datasets one might be able to make a case.

    If there are several thousand sport pilots accumulating hours at roughly the same rate per capita as 3rd class holders and the accident rates are the same per hour, is there some reason to think that does not argue having the 3rd class has no effect on the accident rate? Even with significant power to detect a small difference?

    I guess one could run the power calculation explicitly, but my sense of it is that power would not be bad.

    Is there some other reason to deny there is even a correlation there? Or are my assumptions about the size and rates likely to be off above?
     
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  13. Morgan3820

    Morgan3820 Pattern Altitude

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    you need to find God, seriously he can help. He is your only hope.

    *Yes I am being overtly religious. I don’t do it often. To those that are offended. Oh well.
     
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  14. tspear

    tspear Pattern Altitude PoA Supporter

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    As I said before; the supposition is that the group of pilots are equal. They are not. Many have posted on here about switching to BasicMed to drop the AirMed SI process, or going LSA. These pilots are self selecting; and are generally pilots trying to be legal; and are aware of their health complications. There is no published study of which I am aware which shows how this self selection process affects the data.

    Tim
     
  15. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    While that is true, wouldn't this type of selection argue that the accident rate due to medical complications should be higher amongst the LSA pilots? I can't see how it would suggest the accident rate would be lower.

    Thus the existence of such self selection would seem to argue that the conclusion that the 3rd class medical requirements do not affect accident rates is even _stronger_, not weaker.

    Overall, no apparent evidence that the 3rd class medical requirements improve the safety of flight. And I would say some suggestive evidence that they have no effect. Though a real study based on the available data would be an improvement. Some reasonable general arguments and anecdotal evidence that the 3rd class requirements might actually hurt the safety of flight.
     
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  16. mryan75

    mryan75 Cleared for Takeoff

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    This point is made absolutely every time is subject comes up, and it is complete and total nonsense. Just because medical regulations don't prevent every single medical accident, does not mean that they don't prevent any. It is impossible to measure accidents not caused by pilots who don't fly because they're deemed medically unfit.

    There are so many reasons why these comparisons make no sense. The number of pilots, the number of planes (there are less than 3,000 LSAs in the US). The LSA accident rate is twice that of the rest of GA (unless you don't believe Aviation Safety). Then you look at the number of unexplained in-flight LOC accidents in LSAs - there are a lot. Average pilot age? 63.

    Whatever. Some people believe no laws is the answer. That's fine. But there is no possible way to assert that medical rules make no difference.
     
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  17. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    Would agree that the rates of accidents have to be compared, not the absolute number. A couple of thousand planes and pilots is a fairly decent sample in most cases, though the accident rates are low. With the actual data, the ability to detect differences, the statistical power, can actually be computed.

    Interesting about the number of unexplained in-flight LOC accidents in LSAs. If the rate of such is significantly different from the rate in certified planes amongst people with 3rd class or higher medicals, I would agree that that is concerning and would suggest that 3rd class requirements may improve the safety of flight. Do you have a source for those numbers handy?
     
  18. mryan75

    mryan75 Cleared for Takeoff

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    Anecdotal. I was reading the FAAs report on LSA safety.

    https://www.faa.gov/aircraft/gen_av/light_sport/media/2017_SLSA_COS.pdf

    I contend that the only way to truly compare would be to eliminate medicals for ten years and compare the rates. LSAs, both pilots and planes, are way too far between.
     
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  19. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    Thanks for the link. Agreed that would be the cleanest sort of study. And probably should be done, perhaps with continuous monitoring of results, given the lack of clear data that the 3rd class medical rules improve the safety of flight.

    I suppose BasicMed pilots over the years will provide another comparison group that is much larger.

    I think it would be great to do that sort of thing with the vast majority of these regulations. Some may actually be needed, but I suspect most are based on knee jerk reaction to an event with little or no actual data.
     
  20. Warmi

    Warmi Pre-takeoff checklist

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    Where do you see these unexplained in-flight Loss of Control accidents ?
    The data in the quoted article refers to RLOC accidents (46 % ) which are classified as runway loss of control which is understandable given that we are talking here about 1320 lbs , rudder and stick planes,and not flying minivans.
     
    Last edited: Jul 3, 2019
  21. apr911

    apr911 Pre-takeoff checklist

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    A little out of context but not entirely incorrect either. I should have framed my statement a little better. A medical review does make us safer than we are without. My point merely was that proper on-going medical review and treatment/management of a condition by a doctor familiar with their patient and patient history, is often times just as safe, if not safer than the periodic spot checks by an AME which is ultimately what I think the FAA was going for with the BasicMed requirements.
     
  22. Palmpilot

    Palmpilot Touchdown! Greaser!

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    The rules of BasicMed were 100% a creation of Congress, not the FAA. The FAA just copied what Congress wrote. That was the only way they could bypass the notice-and-comment period, which would have made it impossible to meet the Congressionally-imposed deadline.
     
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  23. bbchien

    bbchien Touchdown! Greaser!

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    The reason why Congress required a report in the fifth year after Basic med was because in the 5 years from 1945-1950, there were no medical requirements. the accident rate was astonishing.
     
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  24. Warmi

    Warmi Pre-takeoff checklist

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    I don’t see it ...

    upload_2019-7-3_19-58-33.jpeg
     

    Attached Files:

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  25. ProjectInfinity1

    ProjectInfinity1 Pre-Flight

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    I for one am not offended. While it doesn’t change my view, I am appreciative of the thought/well wishes. :D

    Dr. Chien, the lack of med requirement during that period, was it for just general aviation, or for every type including commercial?
     
  26. bbchien

    bbchien Touchdown! Greaser!

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    Just GA.
     
  27. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    Is there some data we are not seeing here? Because looking at the graphs @Warmi posted (apparently from the FAA itself), I have to agree with him. There is not a hint of a change in the fatal accident rate in 1950 or 1951 that deviates from the general downward trend.

    In fact, I think you have to interpret the data in those graphs as arguing the 3rd class medical requirement makes no difference in the fatal accident rate.

    Maybe there is a study somewhere justifying this rationally, or maybe not...
     
  28. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    Interesting gap in the numbers during the war years, and then an apparent increase right after the war (though one has to wonder whether the methods changed during that gap). Then a downward trend starts in 1946 that just rolls along. Not deflection evident in 1950 or 1951.

    One wonders if the 3rd class was adopted due to the apparent jump during the war years?

    Another note on the graphs. The scale appears logarithmic, so a straight line is an exponential decay, but it contains 0 as the bottom label, which cannot be correct on a log scale. The line are labeled fatal accidents per mile, etc, but that also appears in error because the numbers would be way to high. The axis is labeled as some type of safety index. None of this is explained clearly in the text.

    I have looked for the history of the enactment of this and possible reasoning at the time, but have not been able to quickly find it.
     
    Last edited: Jul 3, 2019
  29. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    What is the source of those graphs? I tried tc.faa.gov but that doesn’t seem to resolve.
     
  30. Warmi

    Warmi Pre-takeoff checklist

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  31. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    From that report and regarding the graphs posted here “All of these indices showed progress over the 1940s and 1950s, although the air carriers results were erratic enough so that the “up ticks” could raise justifiable concern. With the exception of a postwar increase, nonairline flying showed the steadiest progress in safety, although in the longer run, this has also proven to be the slowest. In assessing this record, it must be recognized that safety oversight was not the only, or perhaps not even the most important, factor. Advances in air navigation and air traffic control, aircraft improvements, changes in traffic patterns, and improvements initiated by the air carriers themselves, all contributed to the gains in safety.”
     
  32. mryan75

    mryan75 Cleared for Takeoff

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    Proper ongoing medical review and treatment is the responsibility of the pilot/human being separate and apart from FAA medical certification. If you skip medical care out of worry for your medical... that's just not smart. As Bruce says, get healthy first, then worry about flying.
     
  33. mryan75

    mryan75 Cleared for Takeoff

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    From congress!? ;)
     
  34. Clip4

    Clip4 Final Approach

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    The fact is LSA rules and basic med have not been in place long enough to infer any safety claims.
     
  35. PeterNSteinmetz

    PeterNSteinmetz Cleared for Takeoff

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    I think it is a question of statistical power of the tests. That could be actually computed with the datasets. My feeling is there might be reasonable power for LSA and maybe BasicMed, given the larger numbers, but that is just a guess.

    But as others have noted, it seems unlikely the FAA would bother to rationally examine the effects of its regulations in this manner. So far, no one has been able to point to a study which has examined the effects of the 3rd class medical requirements on safety of flight, which have been in place for how long?
     
  36. Warmi

    Warmi Pre-takeoff checklist

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    Show me a study that examines effects of requiring various levels of medicals on the overall safety of GA flying and only then we can work our way down to LSA and basic med and their effects.
     
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  37. Clip4

    Clip4 Final Approach

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    Cli4ord
    Medical certificates have been required for over 50 years. One can not prove anything from data that doesn’t exist or data that is historically insufficient to provide for a meaningful study.

    But one area that has seen a large decline is alcohol related aviation accidents once the FAA started checking drivers records as part of the medical process.
     
  38. Warmi

    Warmi Pre-takeoff checklist

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    Warmi
    Alcohol related accidents were always pretty much statistical noise to begin with ...

    If we don’t have any data confirming that having valid medicals , as they exist now , ends up lowering accident rates , then the whole point is moot and requiring medicals is basically nothing more than a ritual protected by the usual suspects - a small auxiliary industry of people making money of out it and the natural inertia of an extensive bureaucratic system.
     
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  39. SToL

    SToL Line Up and Wait

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    SToL
    Guns are a right of US citizens. The 2nd Amendment is the protection which says the government can not infringe on that right.

    I don't recall the amendment which protects the right to get a Private Pilot Certificate.
     
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  40. Palmpilot

    Palmpilot Touchdown! Greaser!

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    Richard Palm
    The Ninth Amendment says that rights don't have to be listed in the Constitution in order to exist. The Supreme Court has opined that there is a right to travel, and that statutes, rules, and regulations must not unreasonably burden or restrict it. So while there is not a right to a private pilot certificate per se, the requirements for getting one must at least be reasonable.
     
    PeterNSteinmetz likes this.