MEDIA RELEASE

Sunday 19 September 2004

PILOT HEALTH SCREENS INADEQUATE

Health screening for pilots, air traffic controllers and others in critical decision making positions in the aviation industry is inadequate and needs to change, a leading Aviation Medicine expert has told aviation doctors attending a major Australasian conference. 

Addressing the Annual meeting of the Australasian Society of Aerospace Medicine, which concludes today in Adelaide, Dr Adrian Zentner, a former Manager of Medical and Safety Services with Australian Airlines, said yesterday that a lack of awareness amongst aviation doctors of the impact on cognitive function in men caused by androgen deficiency (low testosterone) meant that vital warning signs affecting flight safety are currently being missed.

Highlighting the fact that 80 percent of aircraft accidents are caused by human error whilst less than 0.1% are due to medical incapacitation*, Dr Zentner pointed out that doctors examining pilots are required to focus on risk factors for physical disease, whilst simple hormonal screening that could have a major impact on flight safety is ignored. 

Dr Zentner said that screening for low testosterone levels in men could detect those susceptible to impaired memory and thinking skills that are critically linked to human error accidents. 

Dr Zentner cited evidence from the published medical literature linking low testosterone levels to impaired thinking and even Alzheimer’s disease and said that it was a nonsense to screen regularly for cholesterol levels in pilots that may relate to 0.1% of aircraft accidents whilst ignoring hormone levels that could be impacting on 80%. 

Required health screening for pilots which omits hormonal factors is an important safety issue, he said.  What is currently being measured is inaccurate and a poor indicator of the actual level of risk.  In relation to public safety and the prevention of accident, current health screening requirements are unrealistic. 

Whilst dedicated medical examiners need to continue to address those physical factors which could result in in-flight incapacity such as heart attack or stroke, there’s an even greater need, he said, to address the medical physiological issues that are without doubt embedded within  human factor accidents. 

To ignore testosterone levels which affect thinking, decision making, tolerance to stress, spatial awareness, reactive thinking time and emotional stability is a glaring omission, particularly as senior pilots age.  This neglect is an open invitation to potential tragedy and unwarranted loss of life, he said.

Dr Zentner said that in any case, it is now widely recognised overseas that low testosterone levels are linked to significantly increased risk of a number of chronic diseases such as atherosclerosis and cardiovascular disease, type 2 diabetes, osteoporosis and bone fracture, as well as impaired cognitive function, depression and Alzheimer’s disease. 

In his presentation, “Is Low Testosterone a Flight Safety Risk?”, Dr Zentner urged doctors to look at diagnosis and treatment according to international rather than Australian guidelines, which have a political/economic rather than medical basis. 

Australian authorities have adopted a “head in the sand” attitude to assessing and managing such hormonal issues in men because of short term costs implications for the Pharmaceutical Benefits Scheme, he said. 

That the undeniable symptomatic benefits of treatment could possibly be due to a placebo rather than a real effect, is put forward as their only justification in spite of international medical opinion to the contrary and overwhelming research data linking low testosterone to a range of high risk factors. 

Dr Zentner called for authorities in both the health and transportation industries to re-evaluate their attitudes towards hormonal assessment in the interests of public safety and medium to long-term economic responsibility.  

Studies published recently have put to rest fears that testosterone replacement therapy in men may increase the risk of developing prostate cancer, he said.  Appropriately screened and monitored men can therefore safely embark upon treatment to restore testosterone levels to those of a healthy “young male”, considered the desirable target for normal functioning by international medical consensus. 

ends

Note: A former Manager of Medical and Safety Services with Australian Airlines, Dr Zentner has spent the last 7 years focusing on male health issues and is currently Medical Director for the National Well Men Program.  In February of this year he co-chaired a number of sessions at the 4^th World Congress on the Aging Male in Prague. 

Reference papers:  

Testosterone Levels Decline in Aging Men

Feldman et al.  J Clin Endocrinal Metab 2002, 87:589-598 

Low testosterone Linked to Depression in aging Men

Barrett-Connor et al.  J Clin Endocrinol Metab. 1999 84:573-577 

In Older Men Thinking Ability related to testosterone levels in most studies.

Morley et al.  1997

B arrett- Connor et al.  1999