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.