Why requiring medical certificates may not improve aviation safety

[PeterNSteinmetz]

There are always the unintended side effects of regulations. In this case pilots not seeking medical treatment because of fears of losing their medical certificate. This could offset the intended benefit of sue requirements.

Pilots Hide Health Problems to Avoid Losing Certification, Survey Shows

May see disincentives to be truthful about their health

www.medpagetoday.com

 

[Rush]

There are ALWAYS unintended side effects, no exceptions! This was proven at the subatomic level. You cannot observe a particle without the observation itself affecting its behavior.

Look what happens when you decriminalize petty theft. Endless looting. When you give welfare to unwed mothers. An explosion in single parent households. Etc. Etc. Etc.

 

[Ron Wanttaja]

There are always the unintended side effects of regulations. In this case pilots not seeking medical treatment because of fears of losing their medical certificate. This could offset the intended benefit of sue requirements.

I've heard (and would be interested in any reference to confirm) that when medical requirement were instituted by the Department of Commerce in the '20s and '30s, the purpose was to identify pilots who would be medically fit to become Army or Navy pilots in a national emergency.

Made sense in an era where civilian airplanes were sometimes faster than Army fighters (Beech Staggerwing); doesn't make quite as much sense now.

Ron Wanttaja

 

[rotorwrench]

I've heard (and would be interested in any reference to confirm) that when medical requirement were instituted by the Department of Commerce in the '20s and '30s, the purpose was to identify pilots who would be medically fit to become Army or Navy pilots in a national emergency.

I had never read about any military connection only a safety connection as that is what drove the medical requirement along with all the other first regulations in 1926 with the implementation of the CARs. But below is a historical piece on the who and how the first AMEs came to be.
https://www.faa.gov/about/history/heritage/media/medical_examiners.pdf

 

[Jim Logajan]

I've heard (and would be interested in any reference to confirm) that when medical requirement were instituted by the Department of Commerce in the '20s and '30s, the purpose was to identify pilots who would be medically fit to become Army or Navy pilots in a national emergency.

Made sense in an era where civilian airplanes were sometimes faster than Army fighters (Beech Staggerwing); doesn't make quite as much sense now.

Ron Wanttaja

Medical requirements appear in the 1927 regs (see pages 29 and on): Air Commerce Regulations Effective December 31, 1926
But those regs appear to have been developed from the Air Commerce Act of 1926. As far as I can tell, prior to that act civil aeronautics was self-regulated.

Edit to add that it seems that so long as a plane and pilot did not engage in interstate transport they were not subject to the Federal regulations. If they stayed within their state they were subject only to any state laws, if such existed.

 

[PeterNSteinmetz]

I have previously tried to track this down and sort of ran into the same end of the trail that Jim did. So far as I can tell, the thinking when the the regulations were first put into effect was simply that they would duplicate what the military had been doing, even for private pilots. I don't believe there was any real scientific examination of the question of whether this was needed for safety or not.

 

[rotorwrench]

I don't believe there was any real scientific examination of the question of whether this was needed for safety or not.

You need to put this in context. 1920s context. First there were zero civil aviation regulations until December 1926 when the original Air Commerce Regulations were posted. And 2nd, there were no civil aviation experts to perform any scientific studies back then either.

As touched on in the document I linked above, the main purpose behind the 1926 Air Commerce Act was to foster safety (to include pilot medical requirements) and to regulate aviation across all facets not just air commerce. This started with the Air Mail Act in 1925 and then at the behest of this burgeoning industry, congress passed the 1926 act as the safety record of all flying was horrific when compared to more recent times.

As I recall, the only military connection with the process was one could receive credit from any military medical exam or training when applying for a civil pilots license and medical exam. There was no pilot medical license or certificate at that time as it was part of obtaining your pilot license. Same military experince applied to the mechanic side. And it was a license back then vs a certificate as today to include each aircraft was labeled as licensed or unlicensed.

A review of those original ACRs from 1926 will show you how things were then. Unfortunately, with the recent upgrade to the FAA DRS, all the links to the DOT library historical pages are gone. Best bet is to search the National Archives for those if interested. But keep in mind the scenarios and rules back then were very different than today and those rules changed on a regular basis. For example, the ACRs were revised almost monthly and by 1928 the Aeronautic Brach had expanded to include an enforcement division and various other divisions.

Regardless, when the legendary Knute Rockne was killed in an aircraft accident in 1931 the path was laid to the reorganization of the Aeronatics Branch, which led to the creation of the CAA/CARs and so on. There's a lot of historical info on this if interested

 

[PeterNSteinmetz]

It is true it was a different time. There is a history of this period “Bonfires to Beacons” by Komons. A bit dry but I have been reading it over the years,

It covers a lot of the various legislative and political concerns.

 

[rotorwrench]

There is a history of this period “Bonfires to Beacons” by Komons.

Excellent reference. Few people today know of its existence or historical significance, or the work Komons did at the FAA. But its the review of the actual 1926 ACRs that ties everything together. If you would like I can try and find a link to those original regulations?

 

[PeterNSteinmetz]

The portion pertaining to medicals is on pages 97-98 and states in part:

More specific and far more important to aviation safety was the requirement that applicants pass a physical examination. MacCraken made one of his happiest choices when he selected Dr. Louis Hopewell Bauer as Medical Directory of the Aeronautics Branch. Bauer had spent seven years in the Army Air Service, six of which had been devoted to organizing and directing the Army's first flight surgeon school. He had written a book on aviation medicine and was one of the foremost experts of his time in this infant field.

"There is no occupation in which physical condition is of such paramount importance as flying" Bauer believed. He also believed "a pilot physically fit today may not be so next week."

It also provides several footnotes which could be used to see what sort of evidence was actually adduced by Dr. Bauer. One can actually download his textbook at https://www.google.com/books/edition/Aviation_Medicine/eRx8QgAACAAJ?hl=en . Checking the first chapter on selection of airmen lists a lot of requirements, but as noted, this was a different time and not a lot of evidence base there.

I think this shows that basically this was adopted based on prior military experience and largely the opinions of one man. Unfortunately, like many things adopted by the Federal government, they just continue without being sunsetted or seriously examined. I guess Basic Med is a large step in the right direction though.

 

[PeterNSteinmetz]

But its the review of the actual 1926 ACRs that ties everything together. If you would like I can try and find a link to those original regulations?

I think I actually have the sections pertaining to medicals; however, another reference to them overall would be a good thing to have.

ETA - you know I don't think I have the actual 1926 regulations. So it would be much appreciated!

 

[rotorwrench]

I think this shows that basically this was adopted based on prior military experience and largely the opinions of one man.

From a historical standpoint, you'll find in that period it was the opinions and efforts of one person who pushed most things through especially on such a new industry. Look to any industry of that time period. Even the military aviation side was not settled or recognized until the same time period so I doubt there was much to adopt from. And if you have any experience with military specifications and standards of that era you'll see how the medical requirements for a civilian private pilot license in 1927 fail to compare as shown below. Plus an experienced pilot could also obtain a waiver from the Aero Branch for any "physical defect" that may disqualify him under this section. I also included the original Air Commerce Act link with the Air Commerce Regulations link which I found on the Archive.org site.

https://archive.org/details/aircommerceregul00unit/page/n1/mode/2up
https://archive.org/details/UnitedStatesAirCommerceAct1926/mode/2up

Unfortunately, like many things adopted by the Federal government, they just continue without being sunsetted or seriously examined.

Speaking strictly from the aviation side, you have to keep in mind after the Chicago Convention in 1944 a lot of those originally adopted rules and regulations were used to create an international set of standards along with the UK and French aviation rules. So to change most current national rules that may seem to be outdated to us, it will require either a change on an international level or those new national rules will not be accepted under ICAO or other agreements. For example, the Basic Med rule you mentioned doesn't meet ICAO standard so it can only used in the US or other countries that have a separate agreement with the US. Another example would be the TCCA Owner Maintenance category aircraft which have no option to leave Canada for the same reason. While it can seem the FAA rules are a bit firm, when compared to other country aviation rules, the FAA rules are the least complex and most flexible of any country within ICAO hands down.

 

[Jim Logajan]

I think I actually have the sections pertaining to medicals; however, another reference to them overall would be a good thing to have.

ETA - you know I don't think I have the actual 1926 regulations. So it would be much appreciated!

I believe this PDF is the entirety of the 1926 regs:
https://ia800904.us.archive.org/12/...t of Commerce - Air Commerce Regulations .pdf

 

[PeterNSteinmetz]

The rules certainly were simpler back then. 50 pages including the index.

While I do agree that the FAA is one of our more benign Federal regulatory agencies, regarding the requirement for a medical exam for private pilots, it does not appear this was grounded in good science to start with and still is not grounded in good science 97 years later.

Oh well, I guess we were only rid of the naval board for inspecting trees for ship masts in the 80s ...

 

[Jim Logajan]

It looks like that the proposed regulation changes in MOSAIC would pretty much eliminate the need for medicals for most of the flying done by pilots. A sport licensed pilot, having only a driver's license and self-certifying with respect to medical fitness, would be able to fly most common airplanes (e.g. C-172 or possibly even C-182) currently available only to pilots having had at least one third class medical exam. Only when carrying two or more passengers would a pilot need private certificate and a current third class or BasicMed exam.

Kind of an admission that there never was a lot of evidence to support the need for more than the medical requirements for driving a car.

 

[PeterNSteinmetz]

What about the chances of Mosaic with this change in LSA actually occurring? I am particularly interested to hear what @rotorwrench thinks.

 

[Jim Logajan]

What about the chances of Mosaic with this change in LSA actually occurring? I am particularly interested to hear what @rotorwrench thinks.

Since the EAA and AOPA have been backing it and the FAA has applied several years of effort into it, I'm guessing some variation of it has a better than even chance of being approved. Allegedly it is a consequence of the "FAA Reauthorization Act of 2018". Possibly under "Subtitle B--Aircraft Certification Reform" but that section appears somewhat vague to me. The FAA has been known to indefinitely hold up changes it didn't like. But in this case the legislated deadline for was allegedly by the end of this year.