FAA adds another hoop for medicals

[bbchien]

Is it too late to say it to the new guy Dr. Chien?

Even worse, the Aussies WON what we also should have had,a s I had proposed. They won it last (2012) summer!

I am out of energy. I spent 5 years plugging for, travelling to 800 indep., squiring officials, to get the SSRI special.

They can come to me. First thing they can do is reconstitute the board of advisors and actually use them for expertise...and not say, "we are going through with this, we didn't ask you. We want you to do the internet course....".

****

Now look at the current debacle they are about to perpetrate on the OSI screening. Heck, OSA is already grounding. A population which has a prevalence of 90% is proposed to be screened.

If they force it through the reg. process, it comes down on everyone. Henning is right, the Flight Physical will be like the Aussie physical- send out for the this, the that, pretty soon it's a $1,000 deal.

WTF?

The idea on the current project, is AOPA/EAA should get together to make it CHEAP to screen and treat. You DON'T have to force it through only Board Certified Sleep guys....any pulmonary/neurol or internist can read the reports.....order the overnight screening....etc etc etc....

 

[Palmpilot]

The idea on the current project, is AOPA/EAA should get together to make it CHEAP to screen and treat. You DON'T have to force it through only Board Certified Sleep guys....any pulmonary/neurol or internist can read the reports.....order the overnight screening....etc etc etc....

That makes a lot of sense.

 

[TMetzinger]

I don't understand why rulemaking would eliminate the proposed screening standards of BMI>40 and Neck > 17".

 

[Matthew]

Just found this:

www.faa.gov/pilots/safety/pilotsafetybrochures/media/Sleep_Apnea.pdf

"It has been suggested that people with mild-to-moderate OSA can show performance degradation equivalent to 0.06 to 0.08% blood alcohol levels, which is the measure of legal intoxication in most states."

 

[weilke]

I don't understand why rulemaking would eliminate the proposed screening standards of BMI>40 and Neck > 17".

It won't. The validated criteria are BMI > 35 and neck > 40cm (16in) which is what we will end up with after the rulemaking process is done.

 

[bbchien]

It won't. The validated criteria are BMI > 35 and neck > 40cm (16in) which is what we will end up with after the rulemaking process is done.

Like I said, this bunch of 15 year olds who are trying to argue their way out of doing the lawn.....just got to do to the neighbor's lawn as well.

 

[Unregistered]

Already keeping my eyes open for an office suite that would work for this .

You still have to hire a sleep medicine guy to do the interpretation, but they are available for rent by the hour.

I doubt that there are enough board certified sleep medicine specialists to interpret a large increase in the number of sleep studies. What qualifications does the FAA require to interpret these studies?
Gary F

 

[bbchien]

This is a bone of contention of mine. I think Pulmonary guys, Neuro guys, and ABIM Internists ought to be able to do this. The focus should be on keeping this affordable and available.

 

[weilke]

I doubt that there are enough board certified sleep medicine specialists to interpret a large increase in the number of sleep studies. What qualifications does the FAA require to interpret these studies?
Gary F

Lol, I thought that would be a problem. Last night I accompanied my wife to a fundraiser for the local community hospital where she operates. Our table neighbor was a independent neurologist with neurophysiology fellowship and sleep medicine certification. Problem solved .

 

[Gary F]

This is a bone of contention of mine. I think Pulmonary guys, Neuro guys, and ABIM Internists ought to be able to do this. The focus should be on keeping this affordable and available.

If I passed the Internal Medicine recert (results should be out in a month or two) test and take a couple of CME courses I wonder if that will make me eligible to interpret the studies.

Lol, I thought that would be a problem. Last night I accompanied my wife to a fundraiser for the local community hospital where she operates. Our table neighbor was a independent neurologist with neurophysiology fellowship and sleep medicine certification. Problem solved .

After 2009? you need to have a one year formal sleep medicine residency to be able to sit for the sleep medicine board certification test so the supply of certified specialists may not be able to keep up with demand after the grandfathered physicians have retired.


All first-time applicants for admission to the examination after 2011 must fulfill the requirements of the Training Pathway below.

Training Pathway

The Training Pathway for ABIM candidates requires 12 months of satisfactorily completed clinical sleep medicine fellowship training* which meets the following criteria:

• Sleep medicine fellowship training undertaken July 1, 2009, and after must be accredited by ACGME. Sleep medicine fellowship training taken prior to July 1, 2009, must be conducted within an accredited residency or fellowship program.
• Training experience must be consistent with guidelines established by ACGME.
• ABIM will require substantiation by the training program director that the fellow’s clinical competence as a sleep medicine consultant is satisfactory. Fellows must obtain satisfactory ratings of their ability to interpret results of the following diagnostic tests: polysomnography, multiple sleep latency testing, maintenance of wakefulness testing, actigraphy, and portable monitoring related to sleep disorders.

* Sleep medicine fellowship training which was credited toward the training requirements for admission to another ABIM examination, e.g., the Pulmonary Disease Examination, cannot be used to fulfill the training requirements for admission to the Sleep Medicine Examination through the training pathway.

 

[weilke]

After 2009? you need to have a one year formal sleep medicine residency to be able to sit for the sleep medicine board certification test so the supply of certified specialists may not be able to keep up with demand after the grandfathered physicians have retired.

Yeah, the sleep mafia is working hard to keep the moolah flowing.

She used to run the sleep lab for one of the competing hospitals and is out for a while, easily prior to 2009.

 

[Unregistered]

I don't understand why rulemaking would eliminate the proposed screening standards of BMI>40 and Neck > 17".

A penchant of the rulemaking process is the cost/benefit analysis (it's the government, we're only 50 years behind everyone else). The problem with the sleep apnea fight is that it's going to be expensive for the pilot and, like it or not, the criteria is discriminatory.

Why don't we require all African-Americans to be tested for sickle cell?
Why don't all applicants over 65 need alzheimer's screening?
Why don't all applicant between ages 15-24 go for a full STD screening?

All of these pools are more likely than others to have the thing we'd be looking for, BUT in the rulemaking process we need to look at the cost of doing it to everyone.

Eye charts for colorblindness and depth perception are cheap. Any AME can read them and vision is a serious, cross population issue. They pass the rulemaking process.

A sleep test that varies in cost, introduces a doctor not familiar with the FAA requirements, is of questionable necessity, and is focused on a small (undefined) portion of the population? Get outta here.

 

[ifconfig]

“When Arnold Schwarzenegger was Mr Olympia he weight in at 113 kg, his height is 1.85m which calculates to a BMI of 33

That means he was SEVERE obese with less than 4% bodyfat.”

 

[Everskyward]

“When Arnold Schwarzenegger was Mr Olympia he weight in at 113 kg, his height is 1.85m which calculates to a BMI of 33

That means he was SEVERE obese with less than 4% bodyfat.”

Does sleep apnea have anything to do with the ratio of body fat to muscle or does it just have to do with having a big neck or a lot of mass for your height? As far as I can see, none of the people protesting about being mostly muscle rather than fat have addressed this.

 

[Matthew]

Does sleep apnea have anything to do with the ratio of body fat to muscle or does it just have to do with having a big neck? As far as I can see, none of the people protesting about being mostly muscle rather than fat have addressed this.

I think OSA has to do with the internal structure of your throat more than anything else.

I'm pretty sure it's neck size and BMI (height to weight ratio) related and not so much % body fat. But there are always exceptions.

 

[bbchien]

“When Arnold Schwarzenegger was Mr Olympia he weight in at 113 kg, his height is 1.85m which calculates to a BMI of 33

That means he was SEVERE obese with less than 4% bodyfat.”

Nobody is saying anything about % body fat.
The correlation is between BMI and sleep apnea.

Do you understand statistics?
Understand also, that Sleep Apnea is already a DQ condition.

We can get Sickle cell just on the history.
We do, do a mini mental status exam, for dementia. You're just not aware that we do it.
STDs are no disqualifying until they affect the neurology of your legs and feet, or you start having pneumocystis carinii pneumonias and we WILL find AIDS.


Never mind the facts.

 

[ifconfig]

… But there are always exceptions.

Not according to the FAA.

 

[ifconfig]

Nobody is saying anything about % body fat.
The correlation is between BMI and sleep apnea.

I was quoting something I'd read. BMI, it seems, isn't that great a standard for this stuff. I'm sure you'll agree.

Do you understand statistics?

I do. And I also understand that correlation is not causation.

 

[Palmpilot]

Nobody is saying anything about % body fat...

I think some of us are troubled by the fact that the BMI tables can classify people who are muscular and not fat as obese.

 

[Matthew]

Not according to the FAA.

Sure there are exceptions. Not everyone with BMI >40 and neck size > 17 has OSA. But most do, and it's DQing and FAA medical wants to catch the undiagnosed and unreported cases.


How much of this is due to pilots WITH a diagnosis who have decided not to report it?

 

[ifconfig]

Sure there are exceptions. Not everyone with BMI >40 and neck size > 17 has OSA. But most do, and it's DQing and FAA medical wants to catch the undiagnosed and unreported cases.

Sure, but at what cost?

 

[Matthew]

Sure, but at what cost?

Govermnent agencies and cost?

 

[bbchien]

I think some of us are troubled by the fact that the BMI tables can classify people who are muscular and not fat as obese.

Doesn't matter how you label the group, Richard. The correlator is BMI>40 and the correlation is r>.90.

Let's be politically correct and rename that group "svelt". Same correlation applies, however you name it.

Quote:
Originally Posted by Matthew
… But there are always exceptions.

Not according to the FAA.

Sure there are. If you have a negative screening, you're done. period. Just like CAD. The Issue is GONE.

Quote:
Originally Posted by ifconfig
I was quoting something I'd read. BMI, it seems, isn't that great a standard for this stuff. I'm sure you'll agree.



I do. And I also understand that correlation is not causation.

It's not. But we can make the presumptive diagnosis in a group that has a 90% prevelance, just like the hypertensive 35 year old who is taken to the ER with chest pain. That group gets the stress treadmill. Nobody has a problem with that....or maybe you do. In which case you are showing your true stripes like Jbarass, that the medical has to go away. Which is adminirable, but it ain't happening. So think something PRACTICAL, Like I'm trying to do- let keep this inexpensive.

All the same counter arguments for that can be made...but strangely nobody does. Because that danger is recognized.

 

[Matthew]

Dr,

Do you think there was something that happened to trigger this? Or has this been building for a while?

 

[Henning]

I was quoting something I'd read. BMI, it seems, isn't that great a standard for this stuff. I'm sure you'll agree.



I do. And I also understand that correlation is not causation.

I'll tell you what, for every every person in America with a BMI of >40 who is so because they are so muscle bound, I will give you $5, but, for everyone that is >40 and morbidly obese, you just have to give me $1.

Who do you think will be a millionaire at the end of the day?

 

[ifconfig]

It's not. But we can make the presumptive diagnosis in a group that has a 90% prevelance[sic], just like the hypertensive 35 year old who is taken to the ER with chest pain. That group gets the stress treadmill. Nobody has a problem with that....or maybe you do.

All the same counter arguments for that can be made...but strangely nobody does.

By that 90% presumptive diagnosis standard, let me change topics slightly here and ask a question if I may, doc. Has sleep apnea ever been shown to negatively impact safety of flight?

 

[Everskyward]

It's like the EKG for first class at 35 then yearly over 40. Now you're singling out people by age!

I think the difference here is that the AME can do the EKG and, although they charge more, it's not a huge expense. Of course some pilots might think anything over the cost of a normal medical is unreasonable.

 

[ifconfig]

I'll tell you what, for every every person in America with a BMI of >40 who is so because they are so muscle bound, I will give you $5, but, for everyone that is >40 and morbidly obese, you just have to give me $1.

Who do you think will be a millionaire at the end of the day?

You sure you haven't worked with a fat millionaire in the past who crashed his boat while having OSA? I'll give you $10 if you have another of your fantastic anecdotes.

 

[bbchien]

Dr,

Do you think there was something that happened to trigger this? Or has this been building for a while?

2006. See attachments. Particularly see Reference #1 in the OSA report. That working group was 2006.

You, too, ifconfig.
And yes, INdigo, yes they do.
An innumerable number of airmen try to get help for free, which I supply in limited quantity. Folks I have never met, doing it by email. And they get ****ed off when after five email exchanges, I tell them, "no more, you need an account....".

 

[ifconfig]

2006. See attachments. Particularly see Reference #1 in the OSA report. That working group was 2006.

You, too, ifconfig.

You didn't answer my question, doc. At least in the attachment you provided, it didn't address this: Has sleep apnea ever been shown to negatively impact safety of flight?

 

[Fearless Tower]

You sure you haven't worked with a fat millionaire in the past who crashed his boat while having OSA? I'll give you $10 if you have another of your fantastic anecdotes.

Fat millionaires don't drive their own boats much (or planes for that matter). They pay others to do it for them.

 

[Matthew]

From the letter:

"OSA inhibits restorative sleep, and it has significant safety implications because it can cause excessive daytime sleepiness, cognitive impairment, cardiac dysrhythmias, sudden cardiac death, personality disturbances, and hypertension, to cite just a few."

 

[ifconfig]

Fat millionaires don't drive their own boats much (or planes for that matter). They pay others to do it for them.

Wait wait, let's give him time. I'm sure he's got one example from his bag of stories.

 

[timwinters]

I'll tell you what, for every every person in America with a BMI of >40 who is so because they are so muscle bound, I will give you $5, but, for everyone that is >40 and morbidly obese, you just have to give me $1.

Who do you think will be a millionaire at the end of the day?

Change that dollar to a dime and you'd still win.

I wonder how many of those whining in this thread have a BMI > 40...or at least very close to it.

Nearly all I presume.

I'm 6'-1', 205# and I'm overweight. I really don't look it but I am. My "fighting weight" is 185# and that's what I was until I was about 45 years-old. After that things started to slow down...well, I guess except for my consumption of calories.

 

[bbchien]

ifconfig: Wrong attachment, sorry, see the side bar box on this one. He got the ability to get his suspended ATP back (for lying to the agency about "playing with their computers", contingent on agreement to get his disease recognized and treated



With AOPA's regulatory approach we are certainly going to get mandatory screening at BMI 36, and maybe even BMI 30. Yeesh.

 

[Henning]

You sure you haven't worked with a fat millionaire in the past who crashed his boat while having OSA? I'll give you $10 if you have another of your fantastic anecdotes.

No, lets not change the subject, lets stay on track. You get $5 for every American BMI > 40 due to muscular physique, I get $1 for every American BMI > 40 due to morbidly obese. Who will be the millionaire at the end of the day?

How many pilots do you think are BMI > 40 due to highly developed muscle structure? How many pilots do you think are BMI > 40 due to being morbidly obese?

As for accident statistics, lets do it the other way around, how many accidents occurred because the pilot was thinking clearly? The fact of the matter is, we don't really know why a heck of a lot of accidents occur.

OSA has a detrimental effect on cognitive function, that's why it's being screened for. I'm guessing you have OSA....

 

[ClimbnSink]

It is hilarious. Bring back fat shaming. America will be a prettier place, and healthier. OSA aside I wonder how SI and BMI > 40(or even > 30) correlate. But, but, Arnold is fat by BMI standards. Yeah all the fat pilots have Arnold's weight problem. Simple truth if you are fat just add a few years and something will git you. Bad judgement got you there, good judgement can save you(maybe.)

Change that dollar to a dime and you'd still win.

I wonder how many of those whining in this thread have a BMI > 40...or at least very close to it.

Nearly all I presume.

 

[ifconfig]

From the letter:

"OSA inhibits restorative sleep, and it has significant safety implications because it can cause excessive daytime sleepiness, cognitive impairment, cardiac dysrhythmias, sudden cardiac death, personality disturbances, and hypertension, to cite just a few."

Perhaps it seems like I'm arguing against inductive probability, epidemiology and pilots' good health. I'm not (not that I care what you think necessarily). My point is I don't like government overreach exemplified by this policy. It will lead to a boondoggle as even doc Chien verifies re its increasing latitude & scope; even more important, it will serve as the first step in a long slide towards what may be now taken as insane but will then be For The Greater Good.™ Government knows of no other way to be. Ask the Founders.

But meh. As has been said, the only way to tackle this is for pilots to get in good shape. Dodge this particular regulation, don't worry there are more on the way.

 

[Fearless Tower]

I wonder how many of those whining in this thread have a BMI > 40...or at least very close to it.

Nearly all I presume.

Well, I'm not. As mentioned earlier, I am at 28 (Navy won't let me get any bigger), but I am opposed to it, but my reasons are based on the way they are going about implementing it. The cost and inconvenience is ridiculous compared to the threat to aviation and the way they are trying to rig it stinks of big financial gain for some in the 'sleep'industry.

I agree with what Mari suggested. If this was more like the EKG requirement, yes, some would still *****, but it would be much easier to swallow.

 

[ifconfig]

No, lets not change the subject, lets stay on track. You get $5 for every American BMI > 40 due to muscular physique, I get $1 for every American BMI > 40 due to morbidly obese. Who will be the millionaire at the end of the day?

I will.

I think it's time for another of your delicious stories, no?

How many pilots do you think are BMI > 40 due to highly developed muscle structure? How many pilots do you think are BMI > 40 due to being morbidly obese?

As for accident statistics, lets do it the other way around, how many accidents occurred because the pilot was thinking clearly? The fact of the matter is, we don't really know why a heck of a lot of accidents occur.

Oh but you do, Baron Manfred von Richthofen Henning. You do. All your bloody anecdotes notwithstanding.

OSA has a detrimental effect on cognitive function, that's why it's being screened for. I'm guessing you have OSA....

Of course, it must to be that, mustn't it? If I dislike this policy it's because I have OSA. What an uncomprehending dolt.