Comment by godelski | Hacker News Reader

Comment by godelski | Hacker News Reader

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> E.g. If you have been professionally diagnosed with ADHD, the FAA bans you from any pilot's license ever, even a student license

Not quite true. They just need you to be evaluated where you've been off medication for at least 90 days. But if you're on Adderall, you're shit out of luck. Which is pretty dumb since the medication resolves issues.

Other dumb things that will/can prevent you from getting your license: AIDS, diabetes, obesity (BMI >35), anemia, depression, gender dysphoria (they more recently updated for trans, but hormones or surgery can make it difficult), color blindness (not that impactful these days, and there are many types of color blindnesses), and many more.

Side note: I was working on my pilot's license before I went to grad school. No problems, despite a history of depression too. In grad school I got diagnosed and Adderall really made a big difference (even helping with my depression). So gotta make the choice of being able to fly or being able to do productive work which I'm passionate about. Private pilots are a dying breed, and the FAA is only doing things to accelerate this.

https://pilot-protection-services.aopa.org/news/2015/septemb...

The FAA's Office of Aerospace Medicine is actively researching can improve or rethink the aeromedical certification process. We need to do a substantial amount of research with very limited resources, especially when we have limited data to conduct safety risk management and safety assurance. It's a tough nut to crack, but there's a lot of smart people working tirelessly to make this better.

With all due respect, "tirelessly" might be an understatement.

Six years ago, they added BasicMed. And they've been updating the SSRI list. But that's it. For years of work.

Why don't they just relax the third class medical requirements specifically? Only affects private pilots, nothing for hire.

Currently, the FAA makes zero distinction between health conditions/medications for a Cessna 150 and a Boeing 747.

BasicMed is a step in the right direction but still a bit of a joke in itself. And you have to go through the regular medical first to even be eligible for it.

1000% agreed that they should relax third class and how absurd it is that private pilots flying a little 2 seater are held to pretty much the same standard as someone commercially flying a passenger jet.

I had two loss of consciousness episodes very close together a number of years ago due to some very extenuating circumstances (and never had an issue before that or since) and was told I will never pass a medical to get a private pilot cert. Want to barrel down a busy highway at 70 MPH in a 6500 lb SUV where you are pretty much guaranteed to hurt multiple people in an accident? No problem! Fly an 800 lb Kitfox over fields in a rural area? No way, you could hurt someone!

Funny enough, practically everyone in aviation I talked to more-or-less told me to just lie about it and pass my medical. It seems like quite a common trend for pilots - the FAA almost certainly is doing far more harm than good with these oppressive restrictions by forcing pilots away from treatment they need for fear they may be permanently grounded. I'm certain I'd pass with flying colors if I just "forgot" that one detail but I'd rather be honest about everything.

We know the system is far too conservative and encourages pilots to conceal their medical conditions, and I'm thankful you're choosing to be honest. For loss of consciousness, you can be granted a Special Issuance since you have not had one since (see Unexplained Loss of Consciousness (ULOC) [0] in the AME Guide).

My personal viewpoint: If we cannot show a condition or treatment is unsafe, why is it disqualifying? If we cannot analyze risk or determine whether a risk control is effective [1] due to inadequate data or pilot concealment, we need to re-think the way we do things.

Surface transportation (e.g., vehicles) has a ridiculous accident rate, but the public views car accidents very differently from aviation accidents. When there is a car accident, we blame the driver. When there is a plane crash due to a medical, we blame the FAA for certifying them.

0: https://www.faa.gov/ame_guide/app_process/exam_tech/item46/a...

1: https://www.faa.gov/about/initiatives/sms/explained/componen...

It was determined to be vasovagal syncope. One AME said 1 event is the limit 2 events means I'm out of luck. Later, I paid a senior AME to review my case and they first said the vasovagal period was too long but then changed their mind and said I could try getting a loop recorder implanted. I haven't gotten a straight answer as to how long I'd have to do that but it must be quite a while if they don't want to do a patch / Holter monitor.

Everyone seems to have different opinions, no local AMEs are apparently qualified for this and I'd need to drive hours / fly to one that is. I'm apparently just destined for deferral limbo as the FAA can just defer and let you spend more money and time trying to fight it. I'm out thousands already and there is no clear path forward. It's really remarkable considering the things pilots I've known have been through (e.g. heart surgery) and then me, perfectly healthy and never any serious medical conditions or on any medications, gets the end around. Truly disappointing and frustrating.

Unfortunately, many AMEs are not quite correct in the guidance they offer (hence the AME Guide), especially as the guidance updates and improves regularly. Vasovagal syncope is not necessarily disqualifying unless a cause cannot be determined (and therefore, risk of recurrence cannot be determined). There are plenty of commercial and private pilots flying who've experienced vasovagal syncope.

I absolutely empathize with the significant cost associated with getting endless tests and deferral limbo (in part due to a shortage of AMEs). Pilots who have the benefit of really good aeromedical teams (e.g., through their labor representation) are better informed and more successful. We really have to weigh the cost and effort associated with the tests against the information gained around safety. Too many pilots are deciding they don't want to deal with the hassle, and ultimately that results in _less_ data about the true safety risk!

I help lead this work because I agree with you! And we have been working hard on this for the last couple of years (and most of the research is publicly available). Historically, aircraft are certified for a generic pilot, pilots are certified for a generic aircraft, and procedures are built with these generic assumptions in mind. Tailoring aeromedical certification to the type of operation, the actual aircraft, the procedures flown, and the number of hours in the air would be great. We want as many people to be able to fly as possible. But relaxing requirements isn't necessarily straightforward because it requires data to show we aren't negatively impacting safety and fundamentally rethinking the we analyze and control for risk. Commercial aviation hasn't had a hull loss in more than a decade, but private pilots are crashing every few days.

But even if we were able to make the changes we'd like to make, we still need to ensure compliance with ICAO. For example, we could not conduct aeromedical exams during the pandemic due to lack of telemedicine. However, ICAO does not even allow telemedicine to be used.

It's not for lack of trying. There are very real barriers that take significant time, resources, and willpower to solve.

> Commercial aviation hasn't had a hull loss in more than a decade, but private pilots are crashing every few days.

Oh boy wait until you hear about automobiles. Gonna blow your mind.

The goal is not (should not be) maximum safety at all costs. It's a balance of safety, cost, and convenience.

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Come on, man.

Of course a 400 million dollar jet at 35,000 feet with top-of-the-line avionics, redundant systems, IFR flight plans, and professional co-pilots with thousands of hours of flight time is going to be safer than Grandpa Bob in his Glastar.

The question is whether a private pilot with an Aderol prescription presents a public safety risk significant enough to revoke his license. What's the FAA's data to prove that it does? Non-existant?

I can't make this any clearer: we agree!

The goal isn't maximum safety at all costs. It is finding that appropriate balance.

Good to hear, thanks.

At the end of the day it matters what effect it has, and especially on GA pilots here. Which we know that this are is on the brink of extinction, and this has real downstream effects, especially in commercial. I'm not trying to say the people at the FAA aren't working hard. I'm sure that the person given a spoon to dig a ditch is working harder than the person given a backhoe, but either way, that ditch needs to be dug.

Why discriminate against diabetes. Of the things listed, this is probably the most common one & a lifestyle disease. This can have a onset in mid-40s to 50s for some genetically predisposed people. Are they not allowed to fly then?

Diabetic shock while flying would be pretty bad. They seem to do individualized assessments, it's not an instant removal. https://diabetes.org/tools-support/know-your-rights/discrimi...

Yeah, in undergrad I worked with a guy who was very bad at managing his blood sugar levels. One weekend he was alone in the lab and up on a ladder adjusting a ceiling-mounted camera; he passed out, fell, ripped the $30k camera out of the ceiling, caught the PC it was connected to on fire, and woke up on the floor a while later with no recollection of any of it. Another time he was biking home in the winter and passed out, luckily to be discovered in the snow by another colleague who happened to be walking home.

This is the reason. Nuance is also common for some things on the list (e.g. HIV/ADHD but not all things, e.g. AIDS/Color blindness). But all these things are still lacking of a lot of nuance and things like diabetes has only recently been partially resolved due to large lobbying efforts of the ADA: https://diabetes.org/tools-support/know-your-rights/discrimi...

Difficult to see what the “nuance” would be for HIV. If someone knows they have HIV, is receiving treatment, and passes other general health checks, then there’s really no risk. It smells of 80s prejudice.

I'm diabetic. Not too bad, if I forget my meds I get sleepy.

I think they are trying to cut out those people who, when they don't get their meds, literally pass out.

Because the diagnosis doesn't specify a severity, all they can do is deny all diabetics.

I don't think, under the current way that diabetes is diagnosed, that these rules are especially unfair.

Wait until you want to get a driver's license in Europe. You'd be surprised how much bs you'd have to go though to get one in some countries as a diabetic.

Also funny sidenote where I live: if you got type 1 diabetes before getting your license you are legally bound to report it, if you got if after getting your license you have to make your own assesment if you should report it (my not legal advice: never do that, it shortened the license from 10 to 5 or 3 years and puts you though whatever the approving person wants to put you though which can be extensive)

Because diabetes events (both hypo and hyperglycemia) due to human error can and regularly do lead to accidents. It's bad enough in cars, but a plane? Hell no.

I think they focus on type-1 not the type-2 that is likely common even in professionals. Type-1 can cause many immediate issues. And thus likely they don't want pilots with it.

I can't recall all the specifics, but if you are evaluated and disqualified, it can be worse than if you were never evaluated.

Often the doctor's office will try to prescreen to prevent this.

I don't understand the 90 days part. Why would someone discontinue the medication that controls their symptoms?

I have ADHD and take Adderall, and plan to pursue a recreational/personal license next year.

I'm guessing because a Google search of "Adderall side effects" immediately returned this:

"Rare but severe side effects of Adderall can include emotional instability, psychiatric disorders and cardiovascular events. Adderall misuse can lead to seizures and death."

It's worth mentioning that people who take Adderall medicinally are taking substantially lower dosages than those who take it recreationally. Medicinal users take on average 20mg and can have dosages down to 5mg where a recreational user is taking 40mg and maybe up to 100mg. Sure, Adderall can cause the things you mentioned, but the same is actually true about sugar (a highly addictive substance, high potential for abuse, and limited medical usage).

These bins are arbitrary and dosage matters. It would be perfectly acceptable for the FAA to require 3 months of usage, at a specific dose, wherein a pilot is stable on their meds and an FAA doctor (which they must visit anyways) approves them. You can get a good idea of risk factors and stability by doing this.

There are rare but terrible side effects for virtually all medications. What is your point?

That you don't want people with suicidal ideations flying planes.

There are plenty of medicines that warn against operating motor vehicles or heavy machinery, off the top of my head some blood pressure meds like Losartan and HCTZ because they can make you dizzy/prone to blacking out. I imagine there's similar logic here for pilots.

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