The Federal Air Surgeon recently announced that Aviation Medical Examiners would soon be required to screen for obstructive sleep apnea (OSA) on all pilots by measuring neck circumference and calculating body mass index. Anyone who meets the criteria, neck size of 17 inches or over and a BMI of 40 or over, will not be granted a medical until they have been tested by a “sleep specialist” and either do not have OSA or have it adequately treated.
Since the FAA does not show any significant number of accidents caused by OSA, what are they thinking? Are they now responsible for the overall health of pilots? If that is true, let us consider some other issues.
Aviation Medical Examiners do not ask, nor does the 8500 application form ask, if the pilot uses tobacco products—the greatest cause of preventable medical disease in the world. In addition, AMEs cannot require cholesterol history, family history, or exercise frequency. When it comes down to longevity, family history is the number one predictor. Number two is tobacco use. Exercise and weight control are tied for three and four.
So a pilot can come into my office for an AME exam, be 50 pounds overweight, be a two pack a day smoker, have parents who died from heart disease in their 40s, have a cholesterol of 300, and never exercises and all I will know about is his weight. And there is no weight limit for pilot medical qualifications!
So let us say this pilot has a neck size over 17 inches and a body mass index (BMI) over 40. (BMI was developed and only supposed to be valid for use with populations of people, not individuals. Use with individuals has been shown not to be valid. Tom Cruise’s BMI is 26 putting him in the “fat” category. LeBron James is 27.5—fat as well!) Now the FAA says that I must delay his medical until he sees a “sleep specialist” and either does not have OSA or is treated successfully. Now in either of these situations, we may have solved his sleep problems and that does lower his risk of high blood pressure and heart disease but he is still a flying time bomb. Other than the OSA, as his AME, I do not know it nor can do much about these other serious risk factor since I have no authority to force an answer and even do anything with just a risk factor.
A “sleep specialist”, usually a pulmonologist or neurologist who are into the high profit sleep centers, will require a full sleep study in their center—usually starting at $2,000 a pop. The frustrating part is most sleep apnea can be screened with a $200 nocturnal pulse oximetry study ordered or administered by your primary care physician. If your oxygen level does not drop when you sleep, it is highly unlikely you have OSA. If the oxygen level does drop, it may indicate a full sleep study in the sleep center.
So now the FAA is taking on sleep apnea as a risk factor even though it is low down the totem pole of risks which pose a hazard to aviation. Where does the FAA decide to stop? General aviation is already in a crisis with the slow economic recovery and the cost of fuel. Are potential pilots now going to have to go through more testing due to risk factors than life insurance companies require? (By the way, I have never had to measure someone’s neck for any life insurance physical in over 30 years. However, some life insurances do rate applicants on the basis of their BMI.) The FAA may be just trying to bury general aviation.
I am liberal Democrat who supports the Affordable Care Act. However, the Civil Aerospace Medical Institute’s (CAMI) Office of Aerospace Medicine job is to make sure that pilots are “safe” and they will not become “suddenly incapacitated” while piloting an aircraft. They are not mandated to make sure pilots are healthy specimens across the board. This is clearly an overreach of the FAA’s purpose utilizing the excuse of promoting aviation safety.
Keeping patients healthy is my job as their primary care physician and I am as aggressive as any doctor. Keeping people healthy is not the FAA’s job.
What is even more disturbing is CAMI cannot keep up with the paperwork for all the current special issuances and other non-routine medicals. With new rules like this, this back log will only increase in an agency whose budget is tight and getting tighter.
Just make sure you are wearing a 16 ½ inch shirt next time you see your AME!
*Dr. Brent Blue is a Senior AME based in Jackson Hole, Wyoming. He introduced pulse oximetry and digital carbon monoxide to general aviation through his company, Aeromedix.com.