On Friday, July 22, 2016 at 5:01:05 PM UTC-4, wrote:
wrote:
On Friday, July 22, 2016 at 12:46:03 PM UTC-4, wrote:
Um, the plaque test should pretty much do it for a read on
arterial calcification. An MRI wouldn't be a bad idea if one
has a family history of Intracranial Aneurysm Rupture, but
otherwise it's a waste of money. The former is worth paying
the deductible as it answers a lot of questions.

The average cost of a MRI in the US is $2,600. How often do you
recommend doing this?

If you can't afford medical insurance, you can't afford to fly.

Medical insurance will not pay for a MRI "just because"; there would
have to be some indication of an issue to justify insurance paying.

Mine does. And without referrals.

And the point here was hidden condtions that don't show up in any but
the most extensive of physicals and certainly not in a 3rd class physical..

No, my original point was that the efficacy of 3rd class medicals is
such that you cannot quantify how many airplane crashes they prevented
because data on non-pilots isn't tracked, and speculation as to what
may have happened is just that, speculation. So, MANY candidates have
failed their 3rd class medicals, and if that made us all safer cannot
be proven.

My plaque test after deductible was about 35 bucks. As they said
there wasn't even a hint of any, I figure check again in about
10 years. Unlike most Americans I'm not overweight, don't smoke,
don't drink, exercise daily, and eat very healthy.

And a fair number of people who are not overweight, don't smoke, don't drink,
exercise daily, and eat very healthy drop dead every day from something
that did not show up in a routine physical.

Hardly. Unless you're counting old age, which is 100% fatal.

So what does that have to do with 3rd class physicals?

What it has to do with 3rd class physicals is CFR Part 67.311 which
states the following, and any individuals who failed their medicals
for these reasons, and then died of cardio problems as non-pilots,
never appeared on a statistical review of medical wash-outs.

Cardiovascular standards for a third-class airman medical certificate are no established medical history or clinical diagnosis of any of the following:

(a) Myocardial infarction;

(b) Angina pectoris;

(c) Coronary heart disease that has required treatment or, if untreated, that has been symptomatic or clinically significant;

(d) Cardiac valve replacement;

(e) Permanent cardiac pacemaker implantation; or

(f) Heart replacement.

A clinical diagnosis can be an E.K.G. in any doctor's office.

You can save a loved one or yourself by finding out if you're
afflicted with atherosclerosis and/or vascular plaque, as this
is what causes a sudden myocardial infarction which has caused
numerous plane crashes.

As there has never been any test for such things in a 3rd class physical,
it is irrelevant to the issue.

My understanding is that it is the responsibility of an AME to establish
that part 67.311 is carried out, often by a simple, in office EKG if
the candidate reports or presents any reason to be concerned.

There never has been any test of mental stability for civilian pilots.

Well, not directly. But if their history of prior diagnosis by another
doctor gave indications or prognoses of such, then it may be an
insurmountable hurdle. And might should be.

If what history?

Very few people go to mental health professionals unless there is a
big problem.

Then they've probably not been hospitalized or incarcerated,
and aren't a known risk. This doesn't mean unstable people don't
quietly walk among us. The problem in this category seems to be
a lack of identification. (most "terrorists" lately may actually
be psychotically disturbed folks wearing that label.) My GP knows
very little about mental health beyond a Wikipedia education.
Addressing this gap is something that could solve several problems.

So how many crazy GA pilots are crashing their airplanes per year?

Attention deficit and lack of concentration go with depression, and
cognitive rigidity. You don't have to be suicidal like that
commercial pilot that intentionally nose grounded a passenger jet.
I'm not saying it's statistically a big problem today. Substance
abuse is a mental issue, including flying intoxicated.

And the relevance to a 3rd class physical is?

The relevance to a 3rd class medical is that as per CFR Part 67.307,
it is the responsibility of the AME to assure the following, and any
individuals who failed their medicals for these reasons and didn't
crash a plane, have not been tallied. Therefore it isn't established
that the 3rd class medical is ineffective.

Mental standards for a third-class airman medical certificate a

(a) No established medical history or clinical diagnosis of any of the following:

(1) A personality disorder that is severe enough to have repeatedly manifested itself by overt acts.

(2) A psychosis. As used in this section, “psychosis” refers to a mental disorder in which—

(i) The individual has manifested delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition; or

(ii) The individual may reasonably be expected to manifest delusions, hallucinations, grossly bizarre or disorganized behavior, or other commonly accepted symptoms of this condition.

(3) A bipolar disorder.

(4) Substance dependence, except where there is established clinical evidence, satisfactory to the Federal Air Surgeon, of recovery, including sustained total abstinence from the substance(s) for not less than the preceding 2 years. As used in this section—

(i) “Substance” includes: alcohol; other sedatives and hypnotics; anxiolytics; opioids; central nervous system stimulants such as cocaine, amphetamines, and similarly acting sympathomimetics; hallucinogens; phencyclidine or similarly acting arylcyclohexylamines; cannabis; inhalants; and other psychoactive drugs and chemicals; and

(ii) “Substance dependence” means a condition in which a person is dependent on a substance, other than tobacco or ordinary xanthine-containing (e.g., caffeine) beverages, as evidenced by—

(A) Increased tolerance;

(B) Manifestation of withdrawal symptoms;

(C) Impaired control of use; or

(D) Continued use despite damage to physical health or impairment of social, personal, or occupational functioning.

(b) No substance abuse within the preceding 2 years defined as:

(1) Use of a substance in a situation in which that use was physically hazardous, if there has been at any other time an instance of the use of a substance also in a situation in which that use was physically hazardous;

(2) A verified positive drug test result, an alcohol test result of 0.04 or greater alcohol concentration, or a refusal to submit to a drug or alcohol test required by the U.S. Department of Transportation or an agency of the U.S. Department of Transportation; or

(3) Misuse of a substance that the Federal Air Surgeon, based on case history and appropriate, qualified medical judgment relating to the substance involved, finds—

(i) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(ii) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.

(c) No other personality disorder, neurosis, or other mental condition that the Federal Air Surgeon, based on the case history and appropriate, qualified medical judgment relating to the condition involved, finds—

(1) Makes the person unable to safely perform the duties or exercise the privileges of the airman certificate applied for or held; or

(2) May reasonably be expected, for the maximum duration of the airman medical certificate applied for or held, to make the person unable to perform those duties or exercise those privileges.


Most crashes are pilot error. Most errors are mental lapses. Why?

Lots of reasons and well documented such as "Hey, guys, watch this",
get home-itis, lack of proper planning, etc.

So, then, mental.

---


--
Jim Pennino