Time for a Shakeup

Posted by in Opinion Leaders, Safety

Last November the Federal Air Surgeon, Fred Tilton, unilaterally declared that mandatory screening for obstructive sleep apnea (OSA) in pilots would begin “shortly”.

The initial BMI threshold would be 40, with an ominous vow that “once we have appropriately dealt with every airman examinee who has a BMI of 40 or greater, we will gradually expand the testing pool by going to lower BMI measurements until we have identified and assured treatment for every airman with OSA.”

Tilton noted that “up to 30% of individuals with a BMI less than 30 have OSA”. Between the fact that people with normal-range BMIs have been diagnosed with sleep apnea and his apparent zest for uncovering “every” airman with OSA, logic dictates that the eventual threshold would be in the mid-20s, if not lower.

The aviation community was up in arms pretty quickly, and for good reason. For one thing, the mid-20s are the upper end of the normal BMI range. It’s also worth noting that even the World Health Organization acknowledges that the BMI scale was never designed for application to individual people, but rather for statistical modeling of entire populations. BMI is based solely on weight and height, so it does not account for differing body types. Nor does it obey the law of scaling, which dictates that mass increases to the 3rd power of height.

In plain English, a bigger person will always have a higher BMI even if they are not any fatter. This penalizes tall individuals, as well as bodybuilders and athletes who are in prime physical shape by assigning them absurdly high BMI numbers. Likewise, short people are misled into thinking that they are thinner than they are.

Nevertheless, Tilton declared his intention to press on anyway, without any industry input or following established rulemaking procedures despite the fact that this scavenger hunt would break invasive new ground in aeromedical certification.

Then, even the Aviation Medical Examiners objected to the new policy, noting that “no scientific body of evidence has demonstrated that undiagnosed obesity or OSA has compromised aviation safety” and that providing long term prognoses is not part of the FAA’s job. The medical certification exists soley to “determine the likelihood of pilot incapacitation for the duration of the medical certificate.”

Without the support of the civil aviation medicine community, Tilton was literally standing alone. At that point, Congress jumped into the fray on the pilot community’s behalf and eventually forced the Air Surgeon to back down… for now.

While the battle may have been won, the war is far from over. Mark my words, this is not the last you’ll hear about this bogeyman. Tilton may be forced to consult with the aviation community or follow a rulemaking procedure of some sort, but his zeal for the topic means OSA screening will be back in one form or another.

To effectively combat such overreach, we’ve got to attack the problem from it’s true source. In this case, the Air Surgeon’s ammunition came from National Transportation Safety Board recommendations issued in the wake of a 2008 regional airline flight which overflew its destination by 26 miles when both pilots fell asleep.

… the National Transportation Safety Board recommends that the Federal Aviation Administration:

Modify the Application for Airman Medical Certificate to elicit specific information about any previous diagnosis of obstructive sleep apnea and about the presence of specific risk factors for that disorder. (A-09-61)

Implement a program to identify pilots at high risk for obstructive sleep apnea and require that those pilots provide evidence through the medical certification process of having been appropriately evaluated and, if treatment is needed, effectively treated for that disorder before being granted unrestricted medical certification. (A-09-62)

The NTSB serves a useful purpose in assisting transportation disaster victims and investigating accidents, but when it comes to safety recommendations, the agency operates in a kind of vacuum, divorced from some of the most pressing realities of the modern general aviation world. The reason is simple: their mission statement. It calls for the Board to “independently advance transportation safety” by “determining the probable cause of the accidents and issuing safety recommendations aimed at preventing future accidents.”

While there’s nothing objectionable about their mission, note how there’s no mention of the cost these recommendations impose on those of us trying to make a go of it in the flying industry. Since it’s not part of their mission statement, it is not a factor the Board takes into account. It doesn’t even appear on their radar. The Board’s federal funding and their lack of rulemaking authority negates any such considerations. So a sleep apnea study costs thousands of dollars — so what? If it prevents one pilot from falling asleep in the cockpit in next half century, it’s well worth the decimation to an already down-and-out sector of the economy.

That’s been the logic for the NTSB since it was conceived by the Air Commerce Act in 1926. It worked well when aerospace safety was at its nadir — but that was nearly ninety years ago. As air transportation evolved during the 20th century, attempts at increasing safety have reached the point of diminishing returns and exponentially increasing cost. At some point the incessant press toward a perfect safety record will make aviating such a sclerotic activity that it will, in effect, cease.

It’s a problem for any industry, and it’s especially so for one that’s teetering on the edge of oblivion the way ours is. The good news is that this can be fixed. It’s time to shake things up at the NTSB by revising their mission statement to make cost analysis a major part of the Board’s function. They should work with stakeholders to carefully study the long-term effect each recommendation would have on the health and size of the aviation industry before they make it.

For what it’s worth, the FAA needs this mission statement adjustment just as much as the NTSB. More, in fact, because the NTSB can recommend anything it wishes, but the regulatory power to act upon those suggestions is outside their purview and rests with the Federal Aviation Administration. From medical approval to burdensome aircraft certification rules, the FAA is the hammer. We have to start somewhere, though, and the NTSB is in many ways the top of the heap, the place where these ideas get their start. It would be nice to see the industry’s lobbyists in Washington, D.C. suggest such a bill to members of Congress.

One final thought: if government’s power really does derive from the “consent of the governed”, this should be an idea even the NTSB (and FAA) can get behind. Otherwise, they may convene one day and find that there’s not much of an industry left for them to prescribe things to.


This article first appeared on the AOPA Opinion Leaders blog at http://blog.aopa.org/opinionleaders/2014/01/22/time-for-a-shakeup/.