AARP and the FAA

I’m now a card-carrying member of AARP. Well, I don’t think I actually carry the card around, but it’s at home somewhere. But AARP knows where to find me and I believe every other oldster and they keep our mailbox–both paper and electronic–full.

A headline on a recent AARP “Bulletin” caught my eye. It read “10 Medical Tests to Avoid.” Since I have devoted my life to avoiding as many medical tests as possible I read the story to see how the large panel of medical experts list of unnecessary and potentially harmful tests agreed with mine.

The very first medical test on the list to avoid is a nuclear stress test or other imaging tests, after heart procedures.

The second test on the list was yearly electrocardiogram or exercise stress test in the absence of any symptom or heart disease risk.

What jumped off the page at me is that those are two tests the FAA requires for pilots to get a medical certificate. Any pilot who has had a heart event or procedure such as a stent or bypass or valve replacement will be required to take these tests. Even reporting chest pain will be enough for the FAA to require the tests. And usually the FAA requires the tests to be repeated for each subsequent special issuance of a medical.

The reason the panel of experts recommends against these tests in the absence of symptoms is that they rarely result in any change in treatment. But the tests are invasive and they can yield false positive results that will cause the patient to have unnecessary treatment. In other words, the tests are adding risk with almost no reward.

According to the immediate past president of the American College of Cardiology the nuclear stress and other imaging tests can lead to unnecessary invasive procedures and excess radiation exposure without helping the patient improve. He told AARP readers that focusing on overall health issues such as weight control, not smoking and increasing exercise yield far more positive results than the tests.

But, still, the FAA will require pilots who have had a heart procedure to undergo these tests even though experts in cardiology recommend against them.

The FAA demands that any pilot over 40 undergo a yearly electrocardiogram to get a first class medical no matter what your overall health may be, or the fact that you have no symptoms or history of heart problems. The AARP reports that people between the ages of 40 and 60–which is the core group of pilots who get first class medicals– who have an EKG but have no known heart disease risks are 10 times more likely to get a false positive of a heart problem than for the test to actually find a true problem. This could lead to unnecessary heart catheterization and stents. A healthy pilot could be thrown into the heart disease treatment cycle and testing by a required test that has a high false positive rate.

The FAA is anxious to point out that nearly every pilot can–after undergoing its required tests–be issued a medical certificate with special conditions. And that’s true. But the tests the FAA requires for the initial special medical, and then the repeated tests it demands usually annually, are out of step with the mainstream of medical experts who are actually treating patients and helping them to live healthy lives longer.

AARP is hardly a fringe group and it has a long history of supporting all manner of advanced medical care for seniors. But it is also a sophisticated operation and AARP is willing and able to adjust its medical advice as new research develops.

The FAA isn’t in that group that includes AARP. The FAA is stuck clinging to outdated medical testing requirements and focusing on issues that now appear not to be critical and may be even harmful to a pilot’s health and performance. We tell ourselves that aviation is advanced technology, and in some ways it is, but the reality is change comes slowly for those of us who fly.

Since the majority of pilots are now AARP eligible I hope the FAA takes notice and applies the best medical practices instead of clinging to the way we’ve always done it attitude.

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22 Responses to AARP and the FAA

  1. Glenn Darr says:

    It seems the FAA has always been behind the times. Be it medical or aircraft certification. Experimental aircraft can have better electronics at lesser cost and be a safer airplane than certified aircraft. I doubt that the FAA will listen to any suggestions from AARP, as they don’t really listen to anybody.

    • Sarah A says:

      Getting the FAA to listen to AARP is a lost cause from the start but if can help fuel support for GAPPA. With the elimination of the 3rd class for most pilots these wasteful and potentially dangerous tests become a thing of the past for many pilots.

  2. stuart baxter says:

    Good luck on your last sentence. This agency needs to be blown up and start over.

  3. Donald DeLong says:

    I had a sudden onset of atrial fib. two years ago. Doctors think it was probably brought on by a virus. It was a serious event and my life was at risk at the time. I have since made a full recovery. Follow up tests have been extremely extensive including nuclear stress tests, ekg’s , cardiac ultra sound imaging , holter recorders , and just to be safe a complete cardiac cath to ensure that there was no blockages ( I had one artery with less than 20% obstruction, all of the others were completely clear. Not bad for 56 year old male). I have letters from three board certified cardiologists stating that I have completely recovered. In fact they state that I no longer even need future follow up as I am now no different than anyone who had never had such a problem. The faa bureaucrats think they know better than my cardiologists. The faa thinks that I should continue regular testing of my heart forever if I want to fly. Insurance will not cover these tests due to the doctors records noting that I have completely recovered with no after affects. ps I also canceled my AARP membership when it became apparent that the organization has no concern at all for its members when it pushed so hard to pass obamacare.

    • Sarah A says:

      The push by AARP for Obamacare was because it would force the Young Invincibles to buy health insurance and thus lower the costs for the more mature pearson who usually has multiple medical concerns. It was just good politics to save their members some money without regard to the overall effects.

      • Roger Halstead says:

        It was in AARPs financial interests to see Obama care passed, not that it’d keep rates low for older people and there are much better places for those over 50 to get insurance than AARP. Problem is, that the ACA is driving all rates up.

      • John White says:

        Spoken like a true LIBERAL!

  4. TedK says:

    Remember that your Doctor and your Flight Surgeon have two different objectives.

    Your Doc wants you to live long. Your Flight Surgeon only wants to make sure you don’t die at the controls of an airplane within the next few years. The FAA cares nothing about the long term effects and would be happy to use toxins, radioactives and leaches if that increased the keeping you alive in the short term, regardless of the long term effects.

  5. Carter says:

    I welcome the annual EKG. A few years back the technician who wired me up made a mistake and then sent the results to Oklahoma City. I was grounded, but being a senior airline captain I welcomed the news, because I was now elgible for LTD, (Long Term Disibility), and could finish up the remainder of my career doing those things I wanted to do. (I’ve been flying professionally for 38 years). But, alas, I knew nothing was wrong with me, and because the insurance pool would want to reverify my test results I had another test done and sure enough I was fit for duty.

    At least I got to live the retirement dream for a week.

  6. Dan Vanderm says:

    Uh oh Mac. Your post is spot on target. But wait till the leadership at AOPA sees it.
    I had an email exchange with an AOPA staff medical expert after receiving a solicitation from them urging members to take part in a for-profit health screening battery. In my view and in the view of public health experts, some of the screening was not recommended for reasons similar to the AARP logic. In addition I pointed out that a false positive screening result might endanger a pilot’s medical certificate as well as taking an emotional and financial toll. AOPA disagreed.
    I hope the folks at AOPA take your message. AOPA loses credibility when lobbying against the proposed sleep apnea screening while benefiting from advocating for other possibly contraindicated testing in the general aviation pilot population.
    Thanks for your cogent opinion on this matter.

    • brett hawkins says:

      Dan, well-noted. A lot of pilots believe that AOPA is trying to promote too many commercial enterprises with conflicting goals from the pilot’s perspective. Recognize it for what it is ($) and exercise your good judgment when deciding whether to particpate.

      What I want to know is whether AARP can be enlisted as a lobbyist for mature GA pilots. It is easy for an uninformed politician to ignore a small group of “fatcats” (represented by AOPA) or “daredevils” (represented by EAA). Not so easy to be viewed as pulling the rug out from under our seniors, many of whom fought for this country in various wars (where was “safety first” then?) and simply want to continue to enjoy a cherished hobby without unnecessary overregulation.

  7. Sarah A says:

    A good article and even more reason to get Congress to push through the GAPPA and thus eliminate the majority of 3rd class medicals. That is no help for those that require a 2nd or 1st class but at least it is a start. All I can say is that I would never want our Federal Air Surgeon or any of his cronnies as my own Primary Care Physician given their propensity to require such pointless testing. And of course with all that screening not pilot with a 1st class would ever drop dead at the controls. Opps, strike that remark as it has happend in recent history and more than once.

  8. A.M.S. says:

    Several years ago I had cataract surgery. This was performed by a world class ophthalmic surgeon and university medical school professor. After the surgery I brought in the FAA require tests and forms for her to fill out. She looked over the tests and her jaw dropped. I inquired why, and she told me that the medical profession had not used many of the required tests in about 10 years. She said they had two of the test devices to do two of the tests but would have dig them out of the clinic basement. She looked at the letter and noted that the FAA doctor that signed the letter was a podiatrist.
    Are we getting the best medical opinion from the FAA? Or even current medical opinion? From specialists?

    • Sarah A says:

      I had a similiar experience years ago when I needed an exam to get a Certificate of Demonstrated Ability for a 2nd class medical to allow for my uncorrected vision being outside of the standards. The doctor said he had not had to do such a detailed exam in many years and had to fudge it some because he did not have all the materials that were required. It seems that any medical condition that exceeds these strict standards or reflects some past pathology requires every test in the book be thrown at it regardless whether it really makes any sense. As I said in a letter to my Congressmen in support of GAPPA, if these standards were applied to the state Drivers License than our streets would be a lot less congested and yet these drivers are not constituting any undo hazard under the present situation.

  9. Roger Halstead says:

    My Dr ran an EKG with every, yearly physical and I never had an abnormal one, right up to the day I had a heart attack. I asked the EMT who had just finished an EKG that was immediately radioed in to the hospital, “What’s it look like?”. H paused and then said “Not too good!” As I was blissfully drifting into and out of consciousness, I was well aware of that likely hood, but at the moment I didn’t attach a lot of importance to that statement.

    As we passed through the ER at a run with my wife trying to keep up, I began to realize that “this might be serious!” Doubly so when they wheeled me into the Cath lab where all the DRs and nurses were standing there in full garb, with gloved hands held high. The main artery that feeds the heart muscle was over 98% blocked. I believe they call that “The Widow Maker”.

    Not that they were in a hurry, but my last conscious thought was…”Ouch!”

    Yah, I’m in the right age group, but exercised regularly, rode, road bike regularly and fairly fast, had a little battle of the bulge , and Blood Pressure a bit on the high side but was under control under control. Had no problems with my medicals other than the “White Coat Syndrome”

    Symptoms? Nope! I had gotten a pill caught in my throat that had burned me and was a bit obnoxious. After a couple days that was doing much better, but the sore throat started bothering again. Saturday morning I was out in my shop, neglecting the G-III project, to work on getting a table out that I had refinished for my wife. It was some pretty heavy stuff.

    The sore throat was getting really obnoxious, so I went over to my desk and fired up the computer. I’d been typing for a few minutes, when I realized I had a pain in my left bicep. That rang an alarm. My torch was just to my right. I grabbed the torch which had a #4 or 5 tip on it (big) and cranked up the O2 blowing in my face. In just a few minutes the pain was gone which pretty much confirmed my fears. My wife happened to come into the shop about that time and immediately called 911, which led to my ride to the hospital.

    Normal EKGs up to that point, so just how useful are they for predicting problems.

    • Sarah A says:

      Roger,
      Your experience and many others like it has shown that the EKG, required for the 1st class medical, is fairly useless at predicting the sudden incapacitation associated with heart disease. Considering the precedent of the Sleep Apnea screening, and it might just be intended as a precident setter, I would not be surprised to see the FAA start requiring a trip to the Cath Lab for anyone with the general inducators for heart disease. If we do not stop the Federal Air Surgeon now with the GAPPA there is no telling how far he might push us in his quest for eliminating all medical risk from pilots. Athat point very few of us might be left in the air with the exception of our little low performance LSA aircraft.

      • Roger Halstead says:

        Cath Lab? That’s place to avoid unless it’s absolutely necessary. It’s invasive, dangerous and carries risk!

        Three years previous, my pipes were so clean they sent me back for the internal ultra sound. It’s the one where they run the big hose down your throat to get a better look at the heart. They said I wouldn’t feel it. They lied!

        Unless it’s a different test, In the Cath lab they enter the artery in the upper leg and snake through your plumbing up and into the heart to look around. Not a real confidence builder.

        When they put the second stent in several months later, I was awake through the whole operation and watched it on the overhead monitor. I was home by dinner time.

        In the recovery room, a nurse came in to see if I needed anything. I said no, but how long before the pain killers wear off. She told that should have been hours ago. With no discomfort, you can go home as soon as the paperwork is done.

    • tbinva says:

      Same story here. Right coronary artery completely blocked, and for so long that the left descending artery had time to send out an offshoot that grew INTO the lower half of the RCA and was supplying the blood needed there! Went through private pilot training, flew for ten years and then had to stop ’cause I lost my career and suddenly didn’t have the money, and a further nine years went by before the blockage was discovered. Never had a symptom. But now I’m in better shape than I EVER was during the period before my bypass surgery: I’ve lost weight, I’m in the gym several times a week, I play racquetball and other sports, and see my cardiologist and regular physician regularly. Yet now the FAA wants — check that, demands — that I be tested annually; for what? They couldn’t detect the problems before — remember, they had at least three opportunities before the blockage was found — and that was detected on a normal physical at age 60, not on the FAA-mandated one.

  10. John Patson says:

    There is a reason doctors are now richer, as a profession, than they have ever been before.
    It is mainly due to being able to charge for modern tests (with most being paid directly through health insurance companies.)
    The machines used are incredible, some early diagnosis has certainly saved lives and improved the quality of life, but paying out for annual ultra-sound tests of varicose veins (for example) is silly unless you want to make your Phelbologist (sp?) even richer…

    • Sarah A says:

      And watch out for the use of services and facilities that your doctor has a financial stake in, just one more way they pad their pocket. When I had my last Colonoscopy the paperwork included a disclosure that the docotr was part owner of the facility. Obviously that was the only facility he would perform procedures at so good bye to any competative selectuions of where I went.

  11. tbinva says:

    Great article, Mac — keep it up! And congrats on reaching AARP status — feels like it’s too soon, doesn’t it? Did for me too. And it is — we’re both still youngsters!

  12. Rae says:

    Sara A.

    The push by AARP for Obamacare was because it would force the Young Invincibles to buy health insurance and thus lower the costs for the more mature person who usually has multiple medical concerns.

    How’s that working out?

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