Medicine's Lack of Scientific Knowledge on Nutrition
By Robert TuckerI think most readers understand that, as a group, physicians are not particularly knowledgable on the topic of nutrition. That is changing with the younger MDs and with the other health care providers who now have a large share of the primary healthcare responsibility.
Dr. Blue however, is clearly from the old school. He regales us with his "n = 1" generalizations (all blonds have blue eyes, at least the one I saw did) self-selected to serve his bias that nutritional supplements are worthless, while ignoring the real evidence on all sides of this large and complex issue, evidence based on replicated clinical trials.
It is not my intention to open a debate on nutritional supplements. I do want to point out that when Dr. Blue cites a single incident where "X" occurred to one individual "because" he took supplement "Y," he is reasoning out of superstition and/or bias. I would invite anyone interested in furthering his knowledge on the topic to scan the titles of 100 or so articles in the Journal of Clinical nutrition. Read the abstracts of a few that interest you.
Stick to what you know Brent.
Residential Through-the-Fence: Hearing in the Transportation and Infrastructure Committee September 22, 2010
By Brent Blue MDI never thought that my founding www.throughthefence.org would land me in front of a Congressional committee but that is exactly what happened on September 22, 2010. I had the honor and privilege to testify before the House Transportation and Infrastructure Committee about the FAA’s newly released and updated FAA-2010-0831 (http://edocket.access.gpo.gov/2010/pdf/2010-22095.pdf) policy on residential through-the-fence access. (Hearing can be seen at: http://transportation.edgeboss.net/wmedia/transportation/20100922fc.wvx)
The FAA’s “revised” policy essentially allows for all current and “shovel ready” residential through-the-fence (rTTF) properties but codifies a ban on all future rTTF. This is an important distinction since the current policy (FAA 5190.6B) (http://www.faa.gov/airports/resources/publications/orders/compliance_5190_6/) had only been an interpretation by FAA personnel that rTTF was “incompatible airport adjacent land use.”
The Democrats lined up the FAA and three supporting witnesses while the Republicans selected me and Mitch Swecker who is the States Airport Manager for the State of Oregon which is very support of rTTF access.
Catherine Lang (http://www.faa.gov/about/key_officials/lang/), who is the Acting Assistant Administrator for Airports at the FAA in Washington, was the first witness after Congressman Kurt Schrader from Oregon spoke favorably as a panel member himself. Ms. Lang did not go into her background as a member of Chicago Mayor Richard Daley’s Aeronautical staff. We certainly know how much Daley’s organization loves general aviation with its undying support of Meigs Field!
Ms. Lang sported the FAA’s previous points, all of which have been proven to be non factual, not supported by data, and/or not on point, except for a new one—some hangar homes enter the runway in the middle and require aircraft to back taxi. It seems that the FAA has to keep coming up with new rTTF problems at every turn just to stay ahead of the truth. The FAA office of Airport Compliance and Field Operations has be the model of “don’t let the facts get in the way of our policy!”
Ms. Lang was followed by Carol Comer (http://tomcat2.dot.state.ga.us/Aviation/Contact_Us/staff.cfm), Aviation Programs Manager of the Georgia DOT, who proudly announced she was a pilot who lived on a private airpark but supported the fact that no federally funded Georgia airport had rTTF access. Ms. Comer may have neglected to mention that her property was made more valuable by her prohibition of rTTF access at public airports!
Mr. Swecker (http://www.aviation.state.or.us/Aviation/staff.shtml) was next and discussed how rTTF helped Oregon airports stay economically viable and active. He was followed by Ann Crook (http://www.ecairport.com/AboutELM/airport_manager.asp), Manager of the Elmira Regional Airport, who stated her airport, did not have rTTF access nor did it want it. Crook was followed by James Coyne who heads the National Air Transportation Association, the trade organization of FBOs, which is mostly concerned about off airport competition to on airport FBOs.
I was the last speaker and I had to mention that even though I was a Republican witness, I was the Democratic candidate for coroner in Teton County Wyoming. I continued that just like the coroner’s office, the rTTF policy should be a non partisan issue.
You may see the full text of my prepared comments at www.throughthefence.org but to summarize, I pointed out the lack of data and supporting information for the FAA’s position. The FAA policy represents lots of “what if’s” and “maybe’s” that are not realistic.
I also could not let Ms. Lang get away with her written testimony comment where she characterized rTTF home owner’s input at a public airport board meeting as “influence” that was an “inappropriate process.” Apparently Ms. Lang forgot the FAA is a part of the administrative branch of the United States, a representative democracy based on public meetings and individual input to government representatives.
My most important point is local airport authorities know who their best neighbors are and these local agencies should be allowed to make those decisions, not the FAA.
It is important for all pilots and those with an interest in aviation to contact their Congressman and Senators to support Representative Sam Graves’ house bill HR 4815 (http://www.govtrack.us/congress/bill.xpd?bill=h111-4815).
Mis-Diagnosis: The bureaucratic side of insurance and the FAA
By Brent Blue MDI was diagnosed with rheumatic fever when I was five years old. When I was in medical school studying rheumatic fever, I just did not remember having all the signs and symptoms described in the text books. I searched my hospital records on microfilm and realized I never had rheumatic fever and confirmed that with my pediatrician who was fortunately still in practice. However, it was an incredible chore to get this mis-diagnosis off my medical record but absolutely hell to get off my medical and life insurance records.
Now think what would have happened with the FAA! I would have probably been required to have a cardiology consultation, an echocardiogram, and other expensive testing to prove a negative. In addition to money, it would take a lot of time and paperwork collection.
I have pilots come into my office on a regular basis carrying diagnoses on their record for conditions they have never experienced. Seizures are a classic example.
Many people pass out when they see blood and many times, will jerk their arms and legs for a short period during the brief unconscious period. Non medical observers may report this as a seizure and unfortunately, this may become part of a medical record. However, it is incumbent on any treating physician to ask the appropriate questions to insure that it was a seizure as opposed to a “vasovagal” reaction that many do experience when they see blood. Those questions may be simple ones like “was the person confused when they came to” (in medical terms, was there a post ictal period). If there was no post event confusion, it is unlikely to have been a seizure. However, if it goes into the record as even a possible seizure, driving ability may be in jeopardy and flying is out.
Physicians may or may not understand the importance of certain diagnosis on pilots. There is, for instance, a big difference between a “bad headache” and a true “migraine headache.” A true migraine syndrome is usually disqualifying for flight. Once “migraine” is in the pilots’ medical record, he may have to spend lots of time and money to prove that he does not have migraines.
Depression is another common diagnosis that is thrown around by physicians without attention to the collateral damage it may cause. When your family doctor says to take this Prozac because “it will make you feel better during your divorce,” look out because you will feel worse because you are grounded.
How do you avoid miss and over diagnosis? Always ask your doctor if they are sure of the diagnosis enough to testify at your NTSB appeal hearing. That usually gets them thinking about the potential consequences.
Pilots may also call their AME and ask if the medication that has been recommended is copasetic with the FAA. I recently had a pilot ask me about a medication that was recommended for a non hearing affecting ringing in his ears. The medication was a tri-cyclic antidepressant and is used in this case to “calm” the auditory nerve. If he had consented to the medication, he would be grounded. When he stopped the medication, he would have to prove it was not for depression by providing medical records and a letter from the treating physician at a minimum.
From a medical record point of view, George Orwell is alive and well. Unless you pay cash for every visit at any individual medical office or facility and never tell any insurance company about those visits, those encounters will all show up at some point in a national data bank when you buy medical or life insurance. (Not giving the correct Social Security number and birth date helps as well.) Once in the data bank, every insurance company you apply to will have opportunity to see the records.
Are there people out there who do this? Absolutely. If they get caught by an insurance company, their claims could be denied. Do they get caught if they do it right? Not very often.
What about those folks who do not report medical issues to the FAA? Since that is a federal offense, it is more than a denial of an insurance claim. It is a potential fine and jail time. Do people omit items on their FAA medical? All the time. Do they get caught? Rarely. Is it worth the risk? You will have to answer that question for yourself.
