AircraftOwner Online

The FAA may be improving your health and extending your life without either of you knowing it!

    John Abramson MD, in his book Overdosed America, makes compelling and referenced arguments about how the pharmaceutical industry is pushing as many drugs as possible on the American public—whether they do nothing, hurt, or even kill people. Fortunately, the FAA does not allow many of these medications for use by pilots so we may be inadvertently helping ourselves by avoiding medications.

    Antidepressant medications are an example. Many studies show that for mild depression, common antidepressant drugs do not do anything more than placebo. In addition, many of these medications have serious side effects.

    Unfortunately, the FAA does not prevent all medications which have potential harmful effects. Cholesterol lowering medications are a classic. In spite of all the pharmaceutical company advertising, both direct to consumers and physicians, the studies of cholesterol lowering medications effect on heart disease in people without documented coronary artery disease already is absent. Thus, we are poisoning a lot of people’s livers without helping their hearts.

    Claritin, the antihistamine drug approved by the FAA because it is not sedating, is an example of a drug which does not work because it is under dosed. The effective dose of Claritin is four times the standard tablet dose but the manufacturer did not want to test that dose because it is sedating at the higher, actual working level. Thus, they made a fortune on a drug (now non prescription with generics available) that was non-sedating and did not work very well. You might as well be taking M&Ms every morning.

    A place where a lot of people (and many pilots) get into trouble is with prescription pain medications. Many of the new medications such as Oxycotin do not work any better than generic narcotics, but because of their formulation, are much more addicting. It really breaks my heart when a professional pilot loses his medical due to narcotic abuse that was precipitated by a physician prescribing these new, expensive, and highly addictive narcotics. A truly despicable example is Tramadol which is a semi synthetic narcotic which was promoted as non addiction by its manufacturer. Unfortunately, after the drug was introduced, independent studies showed Tramadol was more addicting than non synthetic narcotics!

    The Center for Medical Consumers ( http://medicalconsumers.org/ ) and Evidence
Based Drug Therapy ( http://www.ti.ubc.ca/ ) are good sites for unbiased information about drugs. Unfortunately, the FDA ( fda.gov), is hard to navigate and the most important data is very, very hard (or impossible) to find. That important information is the results of 18 months and/or 10,000 patient uses of drugs and the summary of adverse drug events reported by consumers and physicians (which is under reported).

    What about “ask your doctor” which is promoted by the direct to consumer (DTC) advertisements that you are bombarded with on TV, magazines, and newspapers? (I enjoy seeing these advertisements and thinking “I am doctor and I do not have a clue what that medicine is indicated for or what its’ side effects are!” Do not ask me, I do not know!) The first problem is the DTC advertisements have miss information and omissions that the FDA has monitored at levels as high 65% of the time. The second problem is that most physicians get their new drug information from drug representatives (actually, they are salesman) which drop sample off at their office. These folks are there to sell drugs, not to provide totally impartial information.

    The next source of information for your doctor is from continuing medical education (CME) courses. Unfortunately, CME courses have been hijacked by the pharmaceutical industry by providing physician speakers who are paid handsomely for their promotion of the industry’s drugs. (If you want to see if your physician is a pharma hired gun, check them out at ProPublica
( http://projects.propublica.org/docdollars/ ).

    I frequently tell patients “Stay away from doctors, they just make you sick.” There is truth in jest, especially when drugs and profit are involved. Maybe the FAA is smarter than we thought!

MedXPress is the FAA’s new system that allows pilots and student pilots to input their normal flight physical into an electronic database.  In the past, pilots would have to hand fill out the 8500-8 medical certificate form and then, the AME would have to type it into the system.  MedXPress now allows for the pilot to input this data directly saving time and insuring accuracy.  There are some “got ya’s” so read on!

A pilot starts the process by finding the site which is not necessarily an easy task. The easiest way to find MedXPress is to Google it or by remembering https://medxpress.faa.gov (don’t forget the https://). All the common browsers will work with the system except Chrome which I am sure will in the future.

During the first site visit, an account will need to be set up and a password established. The FAA will send you a temporary password which you will need to use to log immediately back in the system to change to a self chosen password explained below.

The account name is your Email address but the password has to be between eight and twelve characters containing three of the four character groups (upper case, lower case, numerals, and non alphabetic characters). Since most of us do not have a regular password that meets these criteria, I use my month and year of birth (e.g. August2010). There is a mechanism for recovery of a lost password but you will have to answer three security questions correctly to do it! You will also be locked out of the system for 15 minutes if you enter the wrong password three times.

Fill out the 8500 form as you normally would. Just remember, if it does not allow you to input some data, you have not checked something above it correctly. For instance, if you do not check “yes” for “Do you currently take any medicine…,” you will not be allowed to enter any drugs.

If you are not sure of what you should put down, you can call an AME or save you work and complete it later. You have 30 days to finish an application or it will disappear from the system. If you do put something down that is incorrect for whatever reason, your AME can correct the mistake but he must explain why the change was made. Thus, if you put down that you use heroin and then tell the AME is was a mistake, his explanation might appear “interesting.”

When you finish the form, the system will give you a number. Print out or write this number down. DO NOT LOSE THIS NUMBER. Take the number with you to your AME exam. Without the number, the AME will not be able to import
your data.

You have 60 days from the time your form is submitted to see your AME. During that time period, your form is in electronic “never, never land” and will evaporate in 60 days. If you do not see your AME in 60 days, you will have to re-enter all the data.

What if you have put something in the 8500 that you decide you did not want to put down on paper? Before giving your AME the MedXPress confirmation number, you can discuss the issue with him. If you decide that you do not want the data to become part of your record, do not give the AME the confirmation number. Your data will disappear in 60 days and you can do it all over again. However, it the AME is given the number, the data will be in your file forever.

Technical help with the MedXPress site can be obtained via Email at 9-NATL-AVS-IT-ServiceDesk@faa.gov (got to love those easy government addresses) or by calling 877-287-6731. 

Many pilots ask what the different criterions are for First, Second, and Third Class Pilot Medical Certificates. Interestingly, there are not very many. In fact, for healthy individuals, there are basically three—vision standards, the electrocardiogram (EKG) requirement, and the frequency of the exams.

The main purpose of the pilot medical exam is to predict sudden medical incapacitation. Since the world wide medical community has never been successful predicting incapacitation or death, the FAA does not have a chance. Thus, the medical exam is really a method of screening out pilots who have already had medical issues.

First Class Medicals are required for the pilot in command of a scheduled airline or in other words, a pilot exercising the privileges of an airline transport rating. A Second Class Medical is required for pilots who fly aircraft for hire including passenger transport but not on a scheduled basis, thus exercising commercial pilot privileges. This also includes freight dogs and sprayers. Third Class is for pilots who are not being paid for any
pilot services.

First Class Medicals are good for one year for pilots under age 40 and six months for pilots over 40. Second Class Medicals are good for one year regardless of age. Third Class Medicals are good for five years for those under 40 and two years for those above 40.

The distant vision required for First and Second Class is 20/20 in each eye with or without correction but Third Class only requires 20/40 in each eye with or without correction. Near vision is the same for all classes—20/40 corrected or uncorrected. However, for First Class Medicals, pilots over 50 have to have 20/40 corrected or uncorrected vision at the intermediate range o f 32 inches while there are no intermediate requirements for the other class medicals.

The only other difference between medicals is the requirement for resting electrocardiograms for First Class Medical Certificates for pilots once at 35 years of age and annually starting at 40. This rule dates from an age when EKGs were the only objective way to evaluate the heart and the requirement persists only because no one has the guts to stop it. Resting EKGs have no predictive value for sudden incapacitation. Stress (otherwise known as treadmill) electrocardiograms are far better. However, stress tests are more expensive and require more time. The FAA has yet to move to require stress testing and probably never will due to all the flak it gets for requiring anything that costs more money and time.

An interesting fact is although First Class Medical certificates are the most stringent, sudden incapacitation has not been an issue given almost all circumstances where a First Class Certificate is required also requires a second crew member. The most risky area for medicals may actually be a Second Class pilot who may be flying single pilot charters without the benefit of crew time limits and other organized labor efforts.

The number of medical related accidents is so small that there have been proposals to drop the medical requirement for Third Class similar to the Sport Pilot situation which does not require medicals. My prediction is that once Sport Pilot has ten or so years under its belt, the medical related accident rate will be similar to the third class private pilot experience and may spur the FAA to drop requirement for Third Class Medicals completely.

We now have a more “enlighten” aeromedical certification group in Oklahoma City, so only a minute portion of pilot applicants with medical problems that are turned down permanently. There are various hoops to jump through and more stringent testing requirements for pilots with health for First and Second Class Medicals than Third, but in the end, most pilots get their medical back.

One brief note about drug testing-- The FAA only looks at urine glucose and protein during a FAA physical. However, for Second and First Class, the DOT requires drug testing on a random basis. The logistics of this testing can be nightmarish so many single pilot and other small operations use third parties to administer their drug test “program.” I do not see this changing anytime soon so if you are flying for hire, avoid those trips to Amsterdam!

    I was shocked to hear that I was only one of two physicians in the small community of Jackson Hole that admit their own patients to the hospital. The other doctors admit to the “hospitalist” which means the patient is taken care of by someone they probably have never met and that person changes every day.

    Now why is that important in an aviation medicine article? The biggest problem is these dedicated “in hospital” physicians have no vested interest in your privileges to fly. Plus, once you are discharged, you are no longer their problem.

    Since the hospitalist never knows your detailed history, they also order more testing and imaging studies than you probably need. The problem with more tests is the risk of false positives which are frequent.

    So let’s say you have pneumonia with some chest pain—not an uncommon associated symptom. The hospitalist, in the name of being complete (and liability, and easy, and produces money for their hospital employer), orders an echocardiogram. They echo comes back with a “hypodynamic wall motion” abnormality which is not an uncommon finding in normal folks but “could” mean a cardiac problem.

    When you go for your next FAA medical and report the echo results, regardless of whether you are a competitive 30 year athletic or a 70 year old smoker, you are going to have to show the FAA you do not have a heart problem which will involve more testing. And the cycle goes on. Trying to unravel false positive results can be an expensive and time consuming proposition.

    Although physicians will imply that you do not, you do have a choice. You can refuse testing. You can ask for a second opinion. You can call your primary care doctor. You can call your Aviation Medical Examiner (AME).

    Over diagnosis and over prescribing is rampant in profit driven medicine. Aside from the inherent problems with this medical culture, it can wreck havoc with your medical certificate. It is not unusual to have pilots come in on high blood pressure medications only to find that their blood pressure was high normal and the doctor “just wanted to make sure it did not go higher.” There is no data to show this is appropriate medical care and will force you to provide information to the FAA to show you are OK!

    Sometimes, even explaining why a person had a specific test can be problematic. A classic scenario is the person who has stomach problems that gets a cardiac cauterization to “prove” it is not a heart problem. Then you get into explaining to the FAA the abdominal pain which was stated as “chest” pain in the medical record to justify the cauterization to the insurance company.

    Modern medicine can be a valuable tool in preserving health and prolonging life. It also can cause side effects and premature death with unnecessary treatments. Being a discerning user of the health care system is extremely important. Asking the question “why?” and “what are the options” and “what if I do nothing?” will produce valuable information. If a doctor ever refuses to answer those questions, change doctors.

    The more informed you are, the better but beware of where you get your information. The Internet has lots of information and much of it is tainted by the pharmaceutical industry and other vested interest. Just because it is on line, do not trust it as fact.

    To pilots, our medical certificates are very close to our heart and soul. Obviously our health is primary but there is no reason not to consider both when making health care decisions.

Pilot and controller fatigue has been making aviation headlines in recent years, punctuated by the February 2008 incident in which the crew of a regional jet fell asleep at the controls on the way to Hilo, Hawaii. Although it’s usually airliner mishaps that make front page news, general aviation pilots are subject to the same fatigue-related risks and potential for disaster.

Consider this example and ask yourself (honestly) if it seems familiar: After a full workday in a distant office, a pilot flies his/her aircraft home and shoots an instrument approach to minimums at night. Or, the flight instructor who agrees to take just one more student after a full day of flying, pushing the limits of Title 14 Code of Federal Regulations section 61.195, which prohibits instructors from teaching more than eight hours in a given 24-hour period.

Fatigue is part of our workaholic American culture, which is known for too much of the wrong food, too little of the right exercise, and insufficient or poor quality sleep. Pilots are not immune to developing such bad habits. In its annual sleep survey for 2009, the National Sleep Foundation found that 20 percent of Americans sleep fewer than six hours and that only 28 percent sleep more than eight hours per night. We report more sleep than we actually get, so the data perhaps

underestimates the actual amount of sleep loss experienced by most Americans.

In the spirit of “know your enemy,” human factors research is making progress toward making us wiser in the wearying ways of fatigue. The FAA offers a brochure for pilots titled “Fatigue in Aviation,” which offers some useful tips on staying healthy and alert, but each pilot needs to be aware of his or her own unique habits and physiological limitations.

Avoid Becoming a Headline

As a pilot, one of the best ways to avoid becoming an NTSB accident statistic is to ask yourself, “If this flight goes badly, what would the NTSB report say about me? How would the headline read the next day? ‘Sleep-Deprived Pilot Avoids Fatigue Warning Signs and Crashes, Killing All.’” If it’s bad, maybe you should reconsider flying and take a nap.

When there is an accident, an incident, or a close call, trained investigators seek to determine the cause in an effort to prevent such events from happening again. The best investigations identify not just the obvious cause, but rather the numerous factors in the overall chain of events.

The following are a list of simple questions that investigators may ask during an incident or close-call investigation. Pilots can benefit from pondering these questions before they leave the ground, to assess whether they are suffering from fatigue that could lead to an embarrassing incident or a deadly accident.

Example of Investigative Fatigue Questions for Work Task Mishaps (adapted for GA operations)

- How long were you awake prior to the mishap?

- How long was your last “major” sleep period (more than two hours sleep) prior to the work

task mishap?

- How much additional sleep did you obtain through nap(s) since your last “major” sleep

period?

- How much did you sleep in the 24 hours prior to the work task mishap?

• How much did you sleep in the 72 hours prior to the work task mishap?

• How many hours did you work in the five days prior to the work task mishap?

Squeezing in More Sleep

Avoiding fatigue is not rocket science, yet we as humans continue to challenge conventional sleep wisdom by drinking too much caffeine, consuming too much refined sugar, not getting enough exercise, and engaging in other sleep-preventing behaviors, all while working long hours often under great stress. Our jobs have reduced the requirement for extensive physical work, and child’s play is now more likely to involve a computer game than a ball field. This vicious cycle drives us to exercise less, eat more, and sleep less—and the cycle continues.

The solution is amazingly simple, yet often difficult to implement: Get more sleep. Humans need about eight hours of sleep in a 24-hour period. It takes about 15 minutes in bed to fall asleep, and your last 15 minutes of sleep is not healthy, restorative sleep. That means that you should spend eight and a half hours in bed, dedicated to sleeping, each night. Don’t allow television, radio, or food in bed. If you miss sleep one night then you must sleep extra the following night to catch up.

If you want to avoid fatigue, these simple rules are not negotiable. If you are uncertain of your sleep duration, then you should try keeping a sleep diary. This may be the first advice you would get from a clinical sleep professional. The FAA developed a chart (see previous page) that you can use to track your sleep patterns over a 14-day period. Do you need more sleep? Go to www.mxfatigue.com and find out. Numerous scientific studies have matched the performance of fatigued drivers to the performance of drunk drivers. The next time you are awake for 20 hours straight remind yourself that your performance level is equivalent to that of a legally drunk driver. Fatigue can affect not only your ability to drive the car, but your decision to drive in the first place. Should you be flying an airplane when you are in that condition? Write the next day’s page-one

headline in your head, and then lay it down on your pillow to sleep.

William B. Johnson, Ph.D., is FAA Chief Scientific and Technical Advisor for Human Factors in Aircraft Maintenance Systems. He joined FAA in 2004 after 30 years of private sector experience in academia, safety engineering consulting, and airline/MRO training. He is an Aviation MaintenanceTechnician and a 40-year pilot.

Katrina E. Avers, Ph.D., is a research scientist in the Human Factors Research Division at FAA’s Civil Aerospace Medical Institute. Her research focuses on organizational assessment, fatigue education, fatigue reporting systems, and fatigue risk management programs for flight crew, cabin crew, and maintenance technicians.

Pilots are taught to follow the “IMSAFE” checklist to evaluate their mental and physical fitness before each flight, but how do pilots get and stay fit? FAA offers a brochure titled “Fit for Flight” (http://www.faa.gov/pilots/safety/pilotsafetybrochures/media/FitFor_Flight.pdf) that provides some basic information for pilots on how to adopt and maintain a flying-friendly healthy lifestyle.

Get with a Program

While you don’t need the body of a professional athlete in order to fly, maintaining strength and flexibility is important. Muscles that aren’t used tend to atrophy and weaken—even that big one in your right leg that helps you keep the airplane on the centerline during takeoff. A healthy cardiovascular system helps you avoid potentially life-threatening conditions, such as heart disease and diabetes. One of the other important benefits of physical fitness is that your body is better prepared to cope with the various emotional and physical stressors that are encountered while flying.

Of course, we’d be remiss if we did not remind pilots to check with a physician before beginning any exercise program. If your FAA Aviation Medical Examiner (AME) is also your primary care physician, he or she may even be able to tailor a program to your specific needs and flying lifestyle.

Eat Right, Fly Smart

The “Fit for Flight” brochure suggests that pilots who want to improve their overall diet eat well-balanced meals that offer a combination of proteins, fats, and carbohydrates. Keep your energy up, but avoid eating a big nap-inducing meal right before a flight. While many studies have shown that moderate consumption of alcohol can be good for your heart and possibly reduce the risk of some types of cancer, pilots need to be mindful that the “eight-hour bottle-to-throttle” rule is the absolute minimum. Some individuals may require a longer period between drinking and flying depending on the amount of alcohol consumed and their personal metabolism.

Drinking enough water throughout the day is important for anyone, especially if you work out. Remember, dry air aloft can also make you thirsty, so always have bottled water available in the cockpit—and a good alternate in mind in case you or your passengers need a bathroom break.

    This month in AircraftOwner Online, my colleague Dr. Brent Blue has written about the surprise announcement made on April 2nd by the Administrator of the FAA that has removed the absolute bar to holding a medical certificate if the pilot is taking certain anti-depressant medications (click here to read his article). While Dr. Blue concludes, probably correctly, that few pilots will actually take advantage of this change, I viewed this announcement differently, and very personally.

    A few years ago, a local neurosurgeon wrote a letter to the editor, in one of the many aviation magazines I read, complaining that it is perfectly lawful for him to operate on peoples’ brains while taking anti-depressants as prescribed, but that it was absolutely illegal for him
to fly a 172 around the patch. I could relate to that. I travelled to the Civil Aeronautical Medical Institute (CAMI) in Oklahoma City and spoke with several of the doctors there about the rumors that the FAA would approve anti-depressants for pilots and was told that, while the idea was not off the table entirely, it might take years. This was hardly good news for me.

    Eleven years ago, following a great many horrible events, my doctor advised me that I would have to take anti-depressant medications for the rest of my life if I wanted to avoid the possibility of another depressive episode. He advised me that the psychiatric literature indicated that adults over 40 who had experienced major depressive events, should be placed on low doses of anti-depressants as a prophylactic measure to prevent future depressive episodes. As much as flying had become the central point of my life, I knew that I would do anything I had to NOT to have another bout of out-of-control depression. At that point, I understood that I might never sit left seat solo in an aircraft again. I sold my interest in a beautiful aircraft, and I tried to satisfy myself with hitching rides with others. It didn’t work. There has been a huge hole in my life for over a decade. On April 2, 2010, for the first time, I got new hope, and that hole has begun to close.

    There is now a procedure available for me to be able to demonstrate that I am no longer depressed, although I take anti-depressants to make sure that I my serotonin levels will not allow any situational depression I may experience to spiral out of control. I can now apply to an AME for a medical and start along the long path to a special issuance from Oklahoma City. It may take a year or more to get my medical back, and I may have to spend a lot of money and subject myself to a lot of tests, but now I know that I have a fighting chance to get back in the left seat again.

    I must confess that there were many times over the past decade when I considered whether to attempt to obtain a medical certificate by “forgetting” that I was on anti-depressants. I might have gotten away with it, but my enjoyment of flying would have been tarnished by a constant fear that I would be found out and have my licenses revoked for intentionally falsifying my medical information to the FAA. I chose to simply endure the situation and to try to work for a change in the policy.

    Whenever possible, I have attempted to demonstrate that the FAA’s former position making anti-depressants automatically disqualifying was an absolutely prehistoric view of the current state of medical knowledge. I pointed out that having a pilot – particularly an airline pilot – who really should be on anti-depressants because of his or her chemical imbalances and resulting mental state of depression, refusing to have them prescribed for fear of losing his or her job and ability to earn a living and to support a family, was a lot more dangerous to the flying public than having someone who has been properly diagnosed and treated, whose symptoms are under control, exercising the privileges of his or her certificates. [When Administrator Babbitt made his announcement, he closed by saying that perhaps, if the pilot who flew his Piper Dakota into the IRS building in Texas had been taking the anti-depressants he may have required, we might not have had this tragedy which focused tremendous negative attention on private aviation.]

    Most of the FAA doctors with whom I have spoken over the years knew that the official position did not make sense. They even identified Canada and Australia as having very successful programs where anti-depressants were commonly used in the pilot population without problems. It appeared to me, however, that there really wasn’t any institutional momentum for the FAA to add the United States to these countries in this regard, and, knowing how long it takes this bureaucratic entity to get things done most times, I was not optimistic of any change to the policy.

    Dr. Blue is probably correct that not many pilots will take advantage of this change, but I know of at least one, and probably several more – including one neurosurgeon – who are deeply grateful for the opportunity to demonstrate our qualifications to fly safely. Kudos to the FAA and to all of those advisors who helped make this new policy a reality. I usually spend a lot of time doing battle with FAA and criticizing the things that I feel they do wrong. It actually feels great to be able to compliment the FAA for at least one thing that I feel they got right.

    Thank you FAA. Thank you CAMI. Thank you Administrator Babbitt.

In a surprise announcement, the FAA announced April  2nd, that for the first time, it will allow pilots to fly on anti- depressant medications. There are multiple caveats and “gotchas” but it is a remarkable forward step for the normally conservative bureaucracy in understanding this disease.

I am one physician and AME that is glad to see this change. I have always said that I would rather be flying with a pilot with depression controlled on medication than a pilot who is depressed and needs medication.

Mild to moderate endogenous depression is very responsive to antidepressant medications mainly because it is a medical disease with psychological symptoms. Endogenous depression is due to an inadequate level of serotonin in the brain. When this chemical is below normal levels, a person will be depressed regardless of the life events around him. Unfortunately, serotonin does not cross the “blood-brain” barrier so it is not measurable in the blood. If it were, the diagnosis and treatment of depression would be immeasurably easier.

The FAA’s policy allows for the use of four medications for depression. They are
fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These are very common, non-sedating medications, which have a long history of use with minimal side effects. In order to gain approval, the pilot must be stable on one (and only one) of these medications for 12 months. That means if a pilot was on non-accepted medication, he would have to change and then be stable for 12 additional months before he could apply for the certificate.

The initial consideration of a special issuance for depression also requires a consultation with a psychiatrist that describes the patient’s condition and full details of the treatment. As I interpret the written criteria, this evaluation could not be a primary care physician (PCP) who has been treating the patient but must be a psychiatrist. Since 90% of patients with depression are treated by PCPs, this is going to be a hurtle. I can assure you that a psychiatrist is not going to be excited about doing a consult on a well control, mild to moderately depressed pilot, in order to write a letter.

In addition to the consultation, the pilot will be required to take several psychological tests including COGSCREEN AE, Trails A/B, Stroop Test, CCPT, PASSAT, and Wisconsin Card Sorting Test. A psychologist usually administers these tests so a second consult will be required and the cost is attention getting.

The pilot will also be required to write a statement describing his history of medication use and mental health status.

Once everything above is all completed, a specially trained AME (HIMS trained) must review all the material and make a recommendation for a SI certificate to Oklahoma City. HIMS trained AMEs are part of a program to get pilots who have had drug or alcohol problems back in the cockpit. Unfortunately, there are not many of these specially trained AMEs. (I guess another FAA course is in my future.)

In an unusual twist to all this, pilots who have been taking antidepressants have six months of amnesty to admit their transgressions. Of course, they will be immediately grounded but will not be prosecuted. If pilot are on one of the accepted medications for a year or more, been stable and controlled, then they can apply for an SI by following the above criteria. In that situation and all goes well, the pilot would only be grounded for one to three months. However, if on a non-approved medication, the pilot would have to be switched to an approve one and the twelve month clock would start ticking.

What is the bottom line? Although there are many pilots out there who are taking antidepressant medication, my bet is there will not be many who are forthcoming since no one wants to be grounded for a minimum of three months and possibly permanently if they do not meet all the specifications.

The people who it will help most are pilots to be who have not started the training process because there has been a heretofore locked door prior. With time and experience with pilots flying under this new directive, the FAA may relax some of these requirements especially with regards to renewal of medical certificates.

As one AME wrote to the Federal Air Surgeon six weeks prior to this ruling, maybe the guy who flew into the IRS in Austin might not have if he had been on an antidepressant!

Pilots have a unique perspective. Flying lets us see the world in a different way, but our passion for aviation also gives many of us a different take on medical issues. For a non-pilot, a serious medical condition might first bring up fears of dying. For many pilots, though, diagnosis of the same medical con­dition might first arouse fears of not flying. There are aviators among us who may even perceive “not flying” as a fate worse than dying. That may be extreme, but most pilots can certainly empathize with the visceral “what-happens-to-my-medical” fear that shadows reporting any visit to a medical professional on the Airman Medical Application (otherwise known as Form 8500-8).

Truth…

Title 14 Code of Federal Regulations sec­tion 67.403 expressly prohibits falsification of the Airman Medical Application. Those who possess the skills and discipline to become pilots are gen­erally people of integrity, people who would not normally think of themselves as dishonest. Still, fear can lead to unwise decisions. Even though most conditions can be certified, the loss-of-med­ical concern has prompted some pilots to be less than truthful on the Form 8500-8.

The numbers are troubling. In a study of every fatal accident between 1993 and 2003, FAA researchers found toxicological evidence that nearly 10 percent of the 4,143 pilots in the study had a serious medical condition. Of these, only 22 percent of the medical conditions had been reported on the Airman Medical Application form. A National Transportation Safety Board (NTSB) review of more than 20,000 aviation accidents since 1995 found 327 accidents in which impairment, incapacitation, or a medical condition were identi­fied as causes or factors.

Just to be clear, there is no “gray area” on matters of medical certification. Form 8500-8 is a legal document. It must also be complete: Skipping Block 17 on the Form 8500-8, which asks about medications, will simply cause delays. Neither the aviation medical examiner (AME) nor the FAA’s Aerospace Medical Certification Division can process an incomplete form.

…or Consequences

An applicant who knowingly misrepre­sents the facts on the Airman Medical Application form faces significant penalties. These can include revocation of pilot and medical certificates, fines up to $250,000, and even imprisonment for up to five years. Though offenses that merit imprisonment are rare, they are not unknown—and they usually stem from events in which someone suffered the consequence of an accident. Last year, for example, a judge sentenced a pilot to 16 months in prison and two years of probation for repeatedly lying about his insulin-dependent diabetes on the Airman Medical Application form. In this case, the pilot experienced a diabetic seizure while flying an aircraft with four passengers aboard. The incident ended with no injuries due to the actions of a passenger who also happened to be a pilot trainee, but the penalties meted out to the pilot reflect the narrowly averted potential for disas­trous consequences.

A pilot per­forming wolf survey flights for a state natural resources department was not as fortunate. The investigation into his fatal accident revealed no problems with the aircraft, but the pilot’s medical conditions included both diabetes and congestive heart disease—both of which he had consistently failed to report on the Airman Medical Application form. The NTSB concluded that pilot incapacitation was the probable cause of this accident, with false information on the Form 8500-8 listed as a contributing factor.

Cover-Ups Don’t Work

A final caution: It is something of a cliché that cover-up attempts are rarely successful, and that the consequences of a cover-up can sometimes be worse than those resulting from the original misdeed. Such is also the case in medical certifica­tion. Remember that your signature on the Form 8500-8 authorizes the FAA to search the National Driver’s Registry for violations involving alcohol or illegal drugs, which means that failing to disclose a conviction for driving under the influence of alcohol (DUI), or driving while intoxicated (DWI) will put you at risk for sanctions far worse than those associated with reporting such violations. In the event of an accident or incident, there is also the possibility that toxicology reports, e.g., blood and urine samples, will clearly testify to a condition that the pilot failed to report.

In another instance, a cooperative effort between FAA and the Inspectors General from the Department of Transportation and the Social Security Administration called Operation Safe Pilot uncovered cases in which some pilots were fraudulently collecting 100 percent Social Security disability benefits and/or falsifying FAA medical applications. Measures implemented to address this issue included modifying the Form 8500-8 to add a question about receipt of any form of disabil­ity compensation and adding a notice stating that the pilot’s signature authorizes the FAA to compare Form 8500-8 data with information from agencies that might be providing disability benefits.

Strategies for Certification Success

Now that we’ve talked about what not to do, here are some steps you can take to enhance your prospects for honestly and legally getting your FAA medical certificate if your health is an issue.

Get the facts. Use the many resources avail­able these days to learn as much as you can about the certification implications of your particular medical condition. A good place to start is the medical certification home page on the FAA’s Web site (http://www.faa.gov/pilots/medical/). You can also access the FAA MedXpress form from this page.

Use your resources. The Aircraft Owners and Pilots Association (AOPA), the Experimental Aircraft Association (EAA), and many other aviation organizations provide medical certification infor­mation, advice, and advocacy for their members.

Resolve the problem. If your fact-finding research gives you any reason to believe that your medical issue might be disqualifying, delay your visit to the AME. Instead, work with your physician to resolve the issue.

Document, document, document. Your fact-finding research should include learning exactly what the FAA needs to certify your condition. As you work with your physician, be sure to have him/her document the specifics of your condition, your treatment, and your prognosis in precisely the format and level of detail that the FAA requires.

Doing your part will speed the FAA’s evalua­tion and get you back into the cockpit as quickly as possible. Just remember, honesty is the only policy!

Susan Parson is a special assistant in Flight Standards Service’s General Aviation and Commercial Division. She is an active general aviation pilot and flight instructor.