the conversation between the potential entrepreneurs or those on the ground and those who are looking to invest or looking to create growth. because if we look at it from the growth perspective, i think we would all agree this is paradise. the growth rates in africa are huge. and it's been sustained for quite a period of time. so i think sometimes the pair dime of which people -- paradigm of which people look at investment is something we need to worry about. the second point just to close is the nature of the investment, and there's a very big gap between seed capital and angel investment and then the venture capital and the institutional investment. and that gap needs to be bridged. and there's, i think, an opportunity with the african diaspora, there's an opportunity of looking at ways of bridging that gap p and putting some -- you know, a venture capital investment of $5 million is very difficult for most african start-ups to consume. there isn't the liquidity, and there isn't the size and the market. but if that's the u.s. standard, there's a mismatch.

and so we need to probably look further down and understand that. >> it's changing. i speak to international investors particularly here in the u.s., and the success stories are speaking for themselves. strive has a very successful business in zimbabwe. we are running a very successful business. if you'd invested in my company two years ago, it was worth about $1.6 billion, today it's worth about $6 billion two years later. investors are happy to come. my shares are, happily, oversubscribed. and people are going past the african risk thing. >> absolutely. >> thank you, sir. >> we are active in some 17 african countries. >> 17? >> yes. we have people, we have offices, we have boots on the ground. we're africans. we don't see a lot of these problems. maybe -- that's not to say they're not there, but i think

the way we look at it is is it easier for me to invest in knew year ya that -- nigeria than russia? knew year ya any day, any day of the week. [laughter] and, you know, it's a perspective. it's a perspective on risk, it's a perspective on the issues. we're long term. so i'm not concerned about currency in burundi or the cfa in ivory coast. because we are there as africans for the good. regional inte be gration -- integration, it's happening. not because of the politicians, because africans are beginning to invest with africans. today i see more nigerians in johannesburg and doing business than my fathers could ever have dreamed of. >> true. >> it's africans. and that's what will drive the policy changes.

so if you want to do business in africa, find african partners and work with africans. i think that probably works in brazil too. [laughter] but i'm only talking about africa. [laughter] >> yeah. there's a hand up -- >> there's more over here. >> yeah, i can't see them, unfortunately. >> you have a bias. >> you have a left-hand bias. >> and he's looking right there. >> that's right. >> so somebody has to -- >> i'm going to take the opportunity. >> maybe you can have -- [laughter] anyway, okay. that's the last i'm going to go from -- >> okay. >> to that direction. >> my name is leroy wilson jr., and i'm an attorney from new rochelle and botswana. it seems to me that one of the reasons that the perception of americans into africa as an entire continent is so skewed is because our media doesn't really l cover africa on a fair basis.

and so the question is, is there anything that one can do about that? and if so, what? >> okay. maybe we'll collect two or three questions and then -- yeah. in the meantime, strive, can you help me there? there's a -- >> right in the middle here. >> okay. >> hello. i'm mark johnson from astra capital management. we're an emerging technology investor in both the communications space and in growth companies in america with international aspirations. i see there's a lot of partnership between large businesses and sort of countries and entrepreneurs on the ground in africa, but could you speak a bit about the opportunity for growth companies with great ideas particularly in the communications space that might be more ready partners for strive and different businesses in africa that they could kind of partnership with and help facilitate growth in the communications world? >> maybe we'll take those two,

the media question and this one. >> so very vibrant market. i give you a couple of examples, mcopa is one of my favorite products, and it's a simple product, right? so we work with a very small company. a couple of guys, jesse moore and nick hughes, they came together and developed a product which has a solar panel. it has some add lights, it has a lithium battery and a sim card and, now what we're delivering is we're delivering renewable energy right to the grassroots at an affordable rate of about 40 or 50 cents per day. and there is a guy who, you know, when they first came to me is and said do you want to scale up, how much money do you need from us, he said, no, no, i'm good. it was very easy for him to find the funding. and there are lots more of those companies around. you know, the start-up companies, i.t. companies working with the big partners like us and also with ge. ge had, first of all, had the confidence of coming into, onto

the continent and investing and putting senior guys like jay. but he thoughs he -- [inaudible] so he's working with people like seven seas technology, for example. so lots of smaller companies. the opportunity is there. the media thing -- [laughter] you're american. you answer that. [laughter] >> also used to be in the media business. [laughter] i think it's a question of really understanding, understanding africa and having people, you know, when people come and, come -- they see what it's like. it's a perception. people think it's all, you know, grass huts, and others think it's nothing but big cities. no one understands the size. people ask about, you know, i've been questioned what about has boko haram impacted your business in leg goes? -- legos?

is i say boko haram's in maine and i said that's the dynamic. they go, really? it's very, you know, that's -- and everyone that comes and vicinities and we typically -- visits, and typically they'll go to legos and then go to to nairobi. they're, like, this is like flying across america. yeah, no kidding, it's a long way across these countries. what happens in one doesn't mean it happens in the other. and i think it's, you know, bob talked about his company and the success stories. there's an unbelievable amount of success in companies, in people, in, you know, in innovation that's occurred. and that doesn't necessarily get selected for stories. i think, hopefully, this week it will. maybe that'll change some of the perceptions by some of the media. you've already seen some of them in the press pre-event over the

weekend and stuff where they're focusing on the positives. and so hopefully, and we try to -- i travel back here quite a bit, and my sole goal is to change the perception of investing in africa. >> but i think -- >> yea, we have to -- jay, we have to take people into africa. >> absolutely. >> and strive was sharing his thoughts about taking americans into africa to show them what it looks like. to come to washington to talk about africa, actually, doesn't make a lot of sense. [laughter] and if you look at a, name the media houses, but, you know, they don't have much in the way of local viewers in africa. >> no, they don't. >> so that'll never change unless they come into the continent. >> we were talking with strive -- go ahead, first. >> you know, i was just going the say, look, on the media side for us as africans we're perhaps at the moment more concerned about africans developing their media than talking about themselves.

things like we're more excited about what's happening with social media. >> yes. >> the interaction amongst africans, amongst our young people to one another. look, i can't speak for what people write in china or america about africans, and i guess if you came to an african newspaper, you might think the same about what they write about america. so, you know, that's what we're believing. and i'm not going to prescribe to somebody what they observe or not observe. we get on to very dangerous territory. i think what is important now is that you have a very confident africa beginning to talk about africa and inner energetic youth communicating about their lives with or without the international media. >> strive, we were talking before the meeting, i just want to add that dimension which i've observed. you know, i've been all over the world working on many economies

around the world and many societies, but there's one thing that strikes me, and i wonder whether, you know, you would agree with that. is the pragmatism and the forward-lookingness of african elites, business, young people and so on. i mean, i don't want to say anything negative about anybody, but there are places in the world now who are justifying current battles and killing by referring 1,400 or 1,200 or 800 years back. and, you know, some of them in the balkans were like that. so whereas in africa their problem, of course, ethnic tensions and there are all kinds of tensions, but it seems to me that it's a very future-oriented culture. is that correct? >> well, i wouldn't call it a culture -- >> i mean, or approach to life, let's say. >> you know? i've seen an index which says that the happiest people in the world right now are nigerians.

[laughter] >> that's carol graham from brookings. [laughter] >> so, look, there is an energy in africa today. there is, if you go into the bars and the coffee shops wherever you are, young people are, there are more young people discussing about the future and the things they are doing and want to do. and you only have to go -- you know, i asked one of our people once about the growth of day i that consumption. as bob will probably attest with me, broadband is the fastest growing part of our businesses. and i said, you know, what are they doing with the data? and came back a report that said 60% is social media. okay? they are interacting and talking

and sharing ideas. that's not to say we are not confronted with all the other challenges, and we have to deal with all the issues of terrorism just like everybody else. and the challenges of leadership and corruption and many other aspects. but, yes, there is a greater sense of energy this the future coming out of africa, and a good thing for the world. because half the world's youth had been living in africa over the next 25 years. and there's, you know, it's a great feeling to feel that the youth are busy. so i think we have to invest in this. jay is right to talk about skills, but we also have to think that the skills may not be the skills of the past.

we want to learn about china. we are observing china and brazil and everything else. but we are not china, and we are not brazil. we are africa. we'll go our way. but we will learn the good things that other people have. because 20 years ago everybody was saying what about japan? and before that they said what about the miracle of western europe after the war and so forth? and we can go on and on about this. but we will learn the good things. as a good friend of mine actually said, eat the meat and throw away the bones. so we will pick up what's good, and we will try and learn those lessons and take our people forward. >> fernando can, yep? >> perhaps just a moment on this. the testimony of the recent young afteror ca leadership which was looking to invest in

500 people and received more than 50,000 applications across africa. 50,000 young people in africa believe inherently that they are a leader, that they are a future leader, and they will have a future impact on the continent. i think -- and that has essentially resulted in the government, the white house, house,usaid has gone out and raised more investment -- >> more resources. >> -- for africa as a result of those 50,000 people on the continent. i think that's that energy that you feel. >> right. >> i think the strength, i think the biggest resource of africa is its people because the optimism, the continued perseverance, the patience and really getting things done has been unbelievable. and i can tell you for me personally in my office in nairobi, we -- you know, this is kind of an anecdote, but we threw a '60s costume party for christmas, and all these people, all our office guys came, and they all had, i would say, most of the stuff came from their

parents' closet that they were wearing. so the next day i said, so -- or monday i said, so -- pulled everybody together, wished them well for christmas, etc., said so how many of you people were born in the '60s? two. one of them was me -- [laughter] and then one of them was my cfo who was born in december of '69. so i go into work, and i'm with these young, dynamic -- i mean, the whole office is that way. our average age is in, maybe, 29, 30. >> yep. >> and, you know, i don't find that when i go to schenectady or fairfield or any of the other locations we have, gee, he's been around a long time. they all look at me and can't believe i've worked at ge for ten years longer than they've been alive. so it's kind of fun. >> there's the additional point that these young people are thinking about 2020, 2025 --

>> roe, yeah, they're optimistic. >> and not about 1900. >> they're using, to strive's point, social media, etc. they're excited, they do whatever. it's really great. >> we have one question from twitter kind of on governance, but maybe we'll take one more from somewhere where i can't see. okay, the lady here maybe i can see, and then we'll have to close. and the twitter question is really the quality of governance, do we see an improvement, less corruption, you know, more transparency. you know, we have problems with that all over the place in the world. any comments on that? but, me. >> thank you. my name is kate thompson, i'm from detroit. and for all the reasons that all of us in the room and you on the panel know, i think that until -- i personally believe until we see women as fully productive members of the economy and governance and social change agency and civil society, we won't really see that transformation that we've

been talking about across the continent. so i guess a question for you and your organizations and your sectors, what are you doing or what are you seeing happening to bring women and girls into your sectors and into your organizations as really on equal footing to men and boys? thank you. >> all right. so those are the two question, the governance and the very important question of the role of women in africa. >> okay. so let me have a go first. >> okay. >> because governance is still a challenge. it was nice to hear moe inrah him said this morning he was seeing an improvement over the past ten years, but it's still not good enough. it still has a long way to go, and it takes big companies like us. if we're not doing something about it, nothing is going to get done. and we're doing quite a lot of work. i sit on the board driving ethics and integrity across business, across the continent. women are very good question, right? so i have some of the brightest women working in my company, and i say that without hesitation.

and they're not even watching, because they're probably in bed now back in nairobi, so i'm not saying it for their benefit. [laughter] something like 36% of my expo are women. i spend more on developing the level below that than i spend on men. i have a crash in the office because women have to deal with this whole double shift stuff. but we're going beyond that. so we're going right back into the primary schools and explaining to children, bringing them into the workplace to show them what can be done. and why is that important? next door to me is a bank, a big bank, international bank. and i take jeremy to my office, and i say, jeremy, you look at my workplace and look at your workplace, and if you're hiring an accountant, who do you think can you would pay for the if you paid the same salary? for me because i have a more conducive environment. because we work children right away from the primary school through secondary and the university and we bring them in -- not because we necessarily want to hire them, but because we want to create a larger pool of women, and african women are

some of the smartest and the most fearsome women, i have to tell you, that i've had to work with. [laughter] and it makes my company a much better company to work in and to serve our customers. >> you know, i, as you mentioned in your opening remarks, i chaired the alliance for a green revolution in africa. which is an organization promoting agricultural development and food security. through small holder farmers. so here are the statistics. over 70% of the food grown in africa, eaten in africa is produced by women. so the african farmer is a woman. she doesn't own the land that she's farming. and she's poor.

and she's getting older. if we are to remace her with her daughter and her daughter is smart, she's not going to go onto that land land and do it. and her son is not on the land either. so how we address this, how women, how we give them access to credit, add ownership to land, these are the heavy lifting items that need to be addressed by this crop of african leaders. we have made strives on governance. when nelson mandela came out of prison, only five or six african countries were having regular elections. today less than five or six african countries are having regular elections, and the debate has moved on to the quality of the elections and the quality of the governance. this is important. the next generation of african leaders is alive to these

issues. and we will, we will continue to push to try and address the governance issues. so it's not something we're going to hide under the table. and, of course, you will, you'll not be able to -- you know, just like with asia a difference between myanmar and singapore. remember as we have talked around here, as those who know africa know it's 55 sovereign countries. so you're going to see a differential in the pace, and those of you who are keenly interested in africa will appreciate that we're not going to be able to clear all the issues, but one thing we can be optimistic about is that the african woman is resilient, and she's very clear that she's not going to allow us, the young

men, to occupy this space. speaking for myself, i run an organization in which the majority of my top management, other 60%, are -- over 60%, are women. thank you very much. >> i like the way he said ask the young -- >> i noticed that too. that's good, that's good. [laughter] that's good. >> perhaps i would offer one other comment which is the ability to look at best practices and take role models and learn from those is something that i think hinters whens -- hinders especially when it comes to gender inequality. because i think when we lack around the world there's probably woefully very few countries, regions, you know? asia has been very successful economically, but i think we could argue about the rights of women or the ability for women to be equal partners in those economic development cans. latin america probably suffers from the same. and perhaps even the united states still has a way to go depending on which state in the union you want to look at. and so, again, i will come back

to the strength, the resilience and the capability of african women. they'll figure it out because they know how. and i think we as perhaps multi-national organizations, yeah, sure, we apply corporate american standards. we apply gender equality, we apply diversity of rules, we alie governance and transparency rules, of course we do that, and we are very consistent in how we apply them across every single government that we deal with. so that's important because that a level of consistency must remain in place. but i think that when it comes to gender equality, i agree with you. let the women in africa, they won't let us get away with it. >> but, again, you make a good point about american -- fortune 500 companies, the number of women who are sitting on boards, who are ceos, who are chairmen, it's shockingly low. and that's not a benchmark -- >> no, it's not. >> -- for africa we should be following. >> you need to give access, as bob said, and, you know, have

programs, etc., and role model, all the things you guys have said is absolutely key. on the governance thing, you know, we operate in about 160 countries around the world, and corruption is not an african issue, or bad governance is not an african issue. it's more global. and i think it's a combination of -- and it takes two. and so everybody thinks it's always, you know, you say, no, you don't do that, you know, then people understand that. we're fortunate, we're a big company that we can do that. i think it's very hard on smaller entrepreneurs that are trying to get through the system, if you will, the bureaucracy where a lot of that might occur. but what i i have found is that fundamentally if you work the process, push but don't try to get overly aggressive from a standpoint of speed, if -- because once you try to push the process faster than it really wants to go, then you're opening yourself up. and i think that's the -- and so there's this balance.

and i think the good news from our company's standpoint is, you know, no order or sale or anything that's worth saying yes to a bad thing. it's, no -- and you've got to train people continuously. but it's, and you have to understand locus toms and all as well. but, you know, i think as more people get through -- and i think the one thing i've seen in africa, the press now is really getting focused on at least government tenders and things like that. so that's always helpful as well. but it's improving. it's got a ways to go, as bob said. but, you know, we're continuing to see an improvement on that. >> well, jay, welcome bob, fern, strive, thank you so much on behalf of the whole audience here. a round of applause to our panel. [applause] enjoy the rest of your time and, again, thank you very much for joining us. [inaudible conversations]

[inaudible conversations] >> while congress is in recess this month, c-span's prime time programming continues at 8 p.m. eastern on trade with the western conservative summit in denver.

saturday, robert gates, condoleezza rice and madeleine albright on the situation in ukraine. and sunday on "q&a," ronald reagan biographer edmund morris. >> c-span2's booktv this weekend. friday night at eight eastern with books on marriage equality, the obamas versus the clintons and the autobiography of former mayor of washington, marion barry jr. and sunday afternoon at five, anthony marks, president and ceo of the new york public library, sheds light on the library's past, present and future. booktv, television for serious readers. >> a live look here at the washington hilton where the airline pilots' association international is hosting its annual conference in washington d.c. more live coverage beginning in just a few moments at this

event. a panel constitution on pilot health -- discussion on pilot health and occupational safety getting set to start shortly. later at 3 p.m. eastern time, a look at ways to modernize the air space system. our live coverage of the airline pilots' association international annual conference continues this afternoon here on c-span2. elsewhere on the c-span networks, today at 2:00 c-span will be showing you an ebola hearing with reports of over 900 deaths in west africa countries due to the ebola virus. congressman chris smith, the chair of the house subcommittee on global health, has scheduled an emergency hearing today to examine international efforts underway to contain the virus and explore the potential health risks here in the u.s. again, that hearing is scheduled for two eastern time, it's live on our companion network, c-span. we'll also invite you to share your reaction during the hearing both on our facebook page and on

twitter. on twitter use the hashtag c-spanchat. also tonight on c-span a look at some of the senate races in play during the fall midterm elections. we'll bring you live coverage of victory and concession speeches following the results in today's tennessee senate primary. as well as highlights from recent debates in the hawaii and virginia primary contests. live coverage of that along with your phone calls getting started tonight at eight eastern also on our companion network, c-span. [inaudible conversations]

[inaudible conversations] >> welcome back, everybody. i think we're getting ready to start. i though some people are straggling in from lunch, but we'll get started, and they'll take their seats here in a minute. please remember to silence your devices. so let's begin our next panel. ♪ ♪

>> this is an area that i think is of particular interest to me and to, i think, a lot of pilots here, medical issues. alpa says the most important safety feature on a plane is a well-trained, well-rested pilot. so now we turn our attention to that key safety feature, the airline pilot. we'll talk about what's new on the medical front in both the u.s. and canada, you'll hear the experts talk about a variety of topics that truly impact every pilot in this room. moderating the panel is alpa's air medical chair, captain john taylor. john, take it away.

reduction that is a and i appreciate the efforts you've made in that area. >> thank you. certainly that is a goal of mine in my tenure as the federal air surgeon to increase the number

of conditions that we call him e are looking at the deferment that they were able to issue right in their office. and i am looking to do whatever i can to increase the number of air men that go into c. them walk out with their ticket. presently that is 90%. if i can increase that to 92% or 95%, that would be a huge pilot friendly program because it gives those of us more time to concentrate on the more complicated medical issues. >> are there other conditions you are looking at right now on the list that you would like to expand? >> there are a lot of conditions in particular some of the cancers that we are looking at

that soon hope to turn into a khaki. >> doctor salisbury how do we compare to canada with our action across the border? >> we have very different systems how we are required to handle things. so, we don't actually have a concept of the special issue ends. the regulations are set up in such a way that the minister iss allowed to give an exemption if the safety case can be made and that is a centrally how we handle all of the cases outside of the routine ones that are comprised of 90% of what we do. >> one of the things that we see his diabetes has come back and

is in the rise and you've treated differently than we do or at least in the u.s., correct? >> it's not just confined to the united states, but the entire human species seems to be in an outbreak of particularly type two diabetes. it took us to court and then to the appeal court of the federal court which is one below the supreme court. we had a good safety case letting them fly indicated and we needed to take a proactive

look at each individual case as opposed to having a blanket policy that said no diabetic using insulin could ever buy. so we have a group of specialists we could find and we tentatively moved out into the world allowing people who are using insulin to fly in very restricted circumstances and also very special diabetics. they are not the run-of-the-mill dyadic one would see in one's office necessarily. they are under extremely good control. they don't have the wide exclusions into the low blood sugar that characterize people that are referred to as brittle diabetics and those and the people we started with word that unique compliance permit that we

have called the recreational pilot permit and that allowed them to fly light airplanes with only a single passenger. they are only allowed to fly a f. r. and that experiment worked quite well so we expanded into allowing our atpl who developed diabetes to actually have insulin added to their treatment regimen seemed to fly in the circumstance where they are required to have another pilot qualified. so we have about 15 years of experience and a little less than a hundred cases.

so far it's been a very successful experiment and it's been the same in the uk and australia as well. >> where do we stand on this standpoint we can have all of. >> if you're diabetic is controlled with medication you are going to receive a special issue ends in for quite some time the pilots require a third class medical and have been allowed to fly with insulin dependent diabetes with a very strict protocol. however the second class airmen

at present we do not allow these airmen to fly with a special mission if they are insulin-dependent and that's because of the risk of hyperglycemia which can be apparent. they cannot realize they are hyperglycemic and they can be making these errors and to be a risk to the safety of the aircraft and air space. now having said that, i'm very proud of the fact that we are presently working with the american diabetes association and we recently met with half a dozen specialized in diabetes. of course we presented the safety case and said from the

beginning of the meeting that someday we are going to be willing to certificate that subset of air men that are stable and can demonstrate they are not riddled much like david was talking about and they are not likely to become hypoglycemic or gave hyperglycemic. we are not there yet. the ada is willing to work with us. there are certainly new forms of insulin that are by mobile in the sense that they have other factors added to them in addition to insulin and there's new sensors that are getting more accurate and more timely and much like what we did three years ago when we identified that subset of air men that had

been successfully treated for depression and were on an antidepressant for the special issue ends by truly belief in the not too distant future and here i'm talking a couple of years, not a couple of months we are going to be able to certificate these folks when we can identify the subset that is controlled. >> will this be a technical issue as the people actually monitoring the glucose in the cockpit in the new technology that's coming out were are we looking at new medications you are eluting to? it would be more of a technical issue in the sense that there would have to be continuous monitoring and two special issue these folks, we would want to see the log the devices provide

a show that this air man is well controlled and is not likely to have a hyperglycemic episode. so, you know, they are i indeed getting better, but it's still going to be the technical aspect of being able to monitor and first share ourselves that they are stable and of course in the continuous monitoring would be essential if indeed they did have an episode of hyperglycem hyperglycemia. >> let's move onto one of the advancements canada has done. i've read the manual on osha. how did you come about that in canada recognizing the impact's?

>> all federal workers in canada or who are in industries regulated by the federal government, so that would include all of the major transportation modes, the banks and some other industries that fall under that code talking about the employer relationship it also talks about occupational health and safety and the airlines and the transportation sector were not exempt from that when it was brought in. we actually realized there were some issues to deal with the ones as they were published in the code so we actually published a separate group in the aviation occupational health and safety regulations and most of that regulation is

incorporating the canada labour code to standards by reference, but there are specific things where the aircraft systems and regulations have to be married up so they don't come into conflict with each other so there's a separate set of aviation occupational standards and regulations and pilots, doctors, engineers, nobody is exempt from these consideratio considerations. that's how it is that labor canada at that time determined that they didn't have the expertise to walk onto an airplane and understand what was going on so they negotiated with transport canada and the cab and safety inspectors were deputized

to inform that part of the regulation. so, that's how it is currently done. those regulations exist. all workers are covered by god and all employers have to comply with that and the inspection or follow-up or investigation of incidents is done by transport canada inspectors mainly because they know their way around the airplane without walking into a prop or something. so, you want to have that kind of level of expertise for the inspector that's going to deal with the workplace. but essentially the regulations are the same regardless of where you work. >> doctor i know we talked in april about this a little bit on the environmental impact of that we have within the aircraft.

currently -- if i understand this correctly they are in charge of that. where do we sit there in the monitoring process of the environmental impact? and. >> let me start by saying i'm probably not the subject matter expert in this area because we certainly don't have that responsibility and as i have learned more about this in the ten years i've been with the faa it's an interesting nick's of people that have different responsibilities for the aircraft and of course that is different whether you are in the flight crew or the cabin crew. it's my understanding that they have no role in the aircraft as of the latest reauthorization

they were given partial responsibility for some of the health issues in the cabin. and i believe that's reporting that pathogens and hazardous materials. but other than that, there are a lot of things be its ventilation or owes him or flame retardants or whatever that are not specifically covered by osha neither in the cabin or the flight crew. there are many regulations and flight standards that maintain in part 21 that deal with the flight crew and likewise if you are talking ventilation issues come aircraft certification in all of the engineers in part 25

have multiple responsibilities and oversight for the flight space is. if you're talking hazardous material, we are talking in the case of pesticides and u.s. department of agriculture and st is a mismatch of different folks that have responsibility for the environment in the u.s. aircraft at present. >> what do you think we can do to facilitate that and get it to the point where the daily pilot is protected and monitored and have the protection of osha that other employees have. do you see that as a gaffe or do you think the current regulations cover that? the. >> there was political pressure

if you will though was responsible for the fact that osha assumed some of the responsibility for the health issues in the cabin environment and i feel that if these folks felt that their health monitoring was in need of improvement, then certainly at the time of the next re- operation, your office spokesman and others could certainly get to the congress and put it into the re- op and they tell us what to do. you know, i like the idea of the aviation inspectors being able to do what they've done in canada, but i am not sure that they would like it as much as i would like the thought of as they have the expertise and

access to be able to do that. so, we are learning more all the time about the airline cabin environment and we are in a supporting role and research will for ten years we have cooperated with half a dozen different universities and in the u.s. and canada and have done some incredible research into the airline cabin environment. so whether you are talking about byproducts were flame retardants we have done a lot of phd work that has been notable and moved the finance of the airline cabin environment a long way but there's always room for improvement. >> that means a lot. i know the faa has worked with

us over the years and i think that there's a little bit of a gap with the individual pilot day in and day out and if that is the root we need to go go go pursue. that topic. we know there was a period of time that it's taken three to six months for people to get special issuance and it seems anecdotally things have spread up the -- sped up. what do you anticipate to do? >> we certainly employed the expertise of the ait that control all of the dollars that are needed last march of last

year, 2013 unfortunately we had a new version of our electronic medical system introduced that was a disaster and because we could no longer work the cases when you see 400,000 airmen a year when we worked with the folks and the faa has been cooperative and magnanimous we support to fix the system and even though the average wait time on his yearly average is still around but 30 to 40 day average, looking at it since we have had the siws which is document system in the latest

month, we are under 30 days in terms of the processing time if you look at just that month. and not the year-long average. so the market improvements and i'm hopeful that with time and education in the process as well as what we call aasi special initiatives where for the first time in an air man might have a medical condition that needs to be deferred to the faa we are able to grant and give the follow-up and testing that's necessary to renew that so therefore for the next year as he simply goes with the specified for what and testing and renews the special issuance.

so in conjunction with more processes will help educate the air man that knows that these pilots friendly modes of certification exist. the. >> what do you see going forward within the flight surgeon office where do you want to go next to facilitate the pilots? >> i think i kind of eluted up to that at the beginning. we've got 3,400 aviation medical examiner's out there and we work very hard to train them initial plea and keep them trained with required education every couple of years, every three years to be specific.

these are all positions that have had a whole lot of training and they are smart folks, and my goal is to leverage the expertise and be able to give them the guidance they need to give the khaki when it qualifies and just reduce the number of the deferrals. when they walk out with a ticket my goal is to increase from 90% for something more than 90% of the number of air men that have that happen. >> it seems like a lot recently with guidance the further to the original surgeon. do you go back and originate

when it wasn't necessary or freeze bombs if or how does that work? >> we have a major role of oversight and at th the polls to regional flight surgeons. it's their responsibility but certainly, we track any cases that the issue and we counsel them when that happens and what we have started doing more recently in the past couple of years is counseling the same when they deterred that this could be the aasi or even if he would have called the regional flight surgeon for certification in new york city to talk to the physician we could have certificated the air man right there and then.

so we are playing an ever stronger role in making sure these stay up to date and that includes using these more airmen friendly aasi processes and certainly calling one of us, one of the faa physicians into talking with us in terms of how we can get the air man certificated as quickly as possible. >> how would we facilitate the medical -- doctor snyder over there we call them for their questions what is the biggest issue you see coming across your desk day in and day out? >> i wish that all air men had a relationship with like many of them do in the system i grew up

in in the navy whereby we had the flight surgeons that were familiar with the air man. it would be an ideal world and in my perspective if we have the air men that have that relationship that we are willing to go to a flight surgeon and say i have this condition, should i be fighting or should i not be flying or i'm taking this medication, is there anything that i need to be concerned with? this is certainly difficult to do in the civil aviation world as opposed to in the navy or the air force or the army but i would like to encourage all air men to develop that relationship and trust in the ame so that we are able to answer questions

that we have the opportunity to resolve. >> it's proactive, what you are talking about is proactive disclosure but the biggest thing that slows down the division is lack of information. when people don't get enough of what they know where they are treating doctors know and in the absence of that knowledge. if i can press on anybody the thing you need to do is get us the information. if we look back when jim and i started in this business and we won't talk about how long ago that was, there were virtually any conditions you could name it would result in you being

grounded because of the way that it's being practiced these days we are seeing increasing numbers of conditions that are being certificated and allowed to fly safely and a lot of that has to do with the increased knowledge of disease process but it also has to come with the have to know what is actually going on with that person and keeping the information -- i don't think we will ever get to the flight surgeon flying and maybe it's okay but the canadian force is better. the kind of relationships we have with our squadrons is a very different one and being of the treating physician as long as -- as well as the one talking that the certification has its challenges and how you deal with that. with the knowledge is the thing

that makes you decide whether things are safe or not. and as a regulator our problem is sometimes we are getting just a piece of the information or arthe spectrum of disease is so wide you could end up with some of those people are fine and some of them are not fine and we need to know the details. i would say that when we looked at our statistics we are probably of all of the people that cross our desk, 99.5% of them are getting a certificate and go off-line so it's not a system that is grounding a lot of people but it's sometimes detouring a lot of people and that takes time and the reason it takes time is usually because we don't know enough. >> of the biggest challenge we face in the office is getting

the appropriate information that the faa can make based on the facts and many times the pilot is confronted with a problem and the treating physician feels that every statement is adequate but from the regulatory perspective we follow the evidence of attaining that sometimes the standards are higher than general medical standards are standards of care and the testing that either insurance companies are reluctant to provide order a physician is reluctant to do. once we can communicate that with the pilot. but the pilot of that would provide the incomplete information is really deglaze the process because the faa is faced with reviewing the

information and finding it an adequate and returning it when you need additional information and then we go through the process again. they've done quite a bit recently to put the guide to the ame online so it's available on the particular disease protoco protocols. the online guide is updated on a very monthly basis. doctor fraser's office works very closely with us in the quarterly meeting where we see opportunities to improve and have been incredibly responsive to that and incorporating those quickly so that the process goes better but also for the faa certification process. >> we started talking about

diabetes and the way we let a subseelectthe subset of diabeti. all of them in our system have recorded so that the law of their entire experience, whether it be on the ground or in the air is given to us to have a look at so that we know what's happening to them from day-to-day. there's really no single test like what is the one test that will tell me whether that a diabetic is safe to fly, there is no single answer to that. and the protocol flight is stringent and it's because we have the same concerns the faa does and others about hypoglycemia so people are required under the special

circumstance in the cockpit while lighting and other regulated intervals so that we know and they know that they are not developing hypoglycemia and there's actually protocols that say at what level of blood sugar do they have to carry the sports of glucose with them and if they reach that level than they are required to take it in order to make sure they do not get hypoglycemic. we monitor them very, very carefully. >> with that we are talking about a lot of technology that is coming out, and obviously the internet, everybody goes to webmd or xyz mayo clinic further

self-diagnosis. we look at technology. is there a way for a general pilot especially as many drugs as they are prescribing daily to access for some reason i'm trying to think of a generic drug that we take every day that would be hydrocortisone and we know from doctor snyder is there a way that we can get that publicly assessable for the general pilot's? >> we have been working on that. i had the pleasure of working with the joint safety committee and one of the issues that we looked at was better access to

information for air men regarding different medications they are taking in those times when they are taking medicines that are not truly dangerous. i mean, i continue to be amazed that the number of fatal mishaps for the toxicology show significant levels of the trade name of benadryl. there's still a number of pilots in the community that continue to take these medications despite the fact that every aviation journal that i've ever looked at in my entire career starting in the navy and in the last ten years have often talked about the dangers of over-the-counter medicines and the sedating effects of antihistamine in particular. so we have expanded the guide

and we have a pharmaceutical section. we google the guidance and not a protected source of information and you can go to the pharmaceutical section and we have recently added the issue don't fly for both air men where they can look at the categories of different medicines to know that there is a risk if they take this medicine and they need to check this flight surgeon or the ame if they are taking this medicine to see if they need to ground themselves until they stop. more recently, the gagse agreed to host the website where the

members people like aop a and organizations like that are going from other physicians are going to work and host a website where we can take the pharmaceutical section and the don't issue you don't fly and put them into the air men speak. a guide by definition is technically for physicians and not air men so we are going to think of the air men as understandable as possible. we will never be able to accomplish that. there are tens of thousands of medicines out there but certainly we can look at it by category, and better educate airmen that have concerns about

the vacations great. >> the other challenge associated with that as we get 40 to 50 calls a day in the office. can we take this medication and fly the answer isn't yes or no but what are you taking that medication for? >> the medication used for the condition that would be disqualifiedisqualified anddisqu need to take a look at why is the man is usually the underlining condition and is more significant than in the other occasion. and each person can have an id using graphic effect with a particular medication. for the ground trial that had been previously exposed is also. also. >> that's been the recommendation that we have heard from years. is there a specific amount of time that somebody should be granted with the new medication.

i've heard over 72 hours. >> i would say that it's case-by-case. but pointing out what i should have pointed out from the get-go it is the underlining condition and not the medication per se. certainly there are many medications there is no recognition for the wait time but on the other hand, it could cause you to be lightheaded and it's just a very wise to be able to take this medicine for a week or two before flying. another common example of medicine where we expect a time for period would be switching to one of the anti-diabetes medicines and folks are asked to have a weeks time before they

resumed flying in an aircraft. >> to go back to the topic you brought further how is that program working on your side? we had multiple pilots come through the program and obviously their life is better. do you see any issues going forward or anything that we can improve? i'm very proud of the role that i have as many of us were able to develop this policy we had several hundred air men now that are flying with the special issue fences with the adequately treated depression. our success has been such that now we are looking at

medications, different ssri's or depressions of and those that we originally required the air men to take before they would be considered for this condition. we are also looking at other conditions like obsessive-compulsive disorder for which the air men are sometimes given ssri's. so, we are looking at expanding the good program because even though we have several hundred successful stories at present, if you look at the american population you realize that the several hundred air men are now in adequate sample of the amount of depression that exist of the general population.

we will have a major disorder and 10% on this or having depressive symptoms and 10% in america at least are on an antidepressant on the ssri's so if you look at the number of air men that we assigned we are nowhere near 10%. and they are a microcosm of the general population, so as we continue to operate the program. they work with the specified follow-up that we require your index back to the percentage of air men that have these to work closely to approximate what we see in the general population. >> it is an excellent example of the cooperation and the response to the emerging technology. we had concerns about the

initial implementation of the ssri's policy pushed for that for a long time because we recognized that the old policy had selected the least to remain in the cockpit, those that were depressed but were not taking medications and we left the pilots who were in pair to fly in and of those that were doing better in motion will be interesting better work around it or we had a third population that was taking medicine repetitious lay without monitoring and they were the least safe if there were still some bear ears. the amount of testing that is required and the duration of the monitoring so there's a huge disincentive for the pilots to take advantage of the particle. with additional studies they have reduced the amount of testing that is required to make

it substantially less expensive. much more convenient to schedule the observation period has been shortened from 12 months to six months and again removing the barriers and it is just another example of coming as david talked about earlier, to get enough information to track this and you can make the changes in the policy that not only improve the safety of the national airspace system with the help of the pilot both physical health and in many cases the financial health of the pilots, to back. we have a long history of this disease that used to be disqualifying and now it is just common. it was disqualified in 1997 and that was changed and it came incrementally and it is so routine. we are moving forward now and i think the faa has yet to announce but what i understand a very good policy that makes sense and is still pilot friendly.

>> that was my new topic. do you want to address that? >> it's certainly an elephant in the room and i expected the question as many of you may be aware last november my predecessor, great guy wrote an article in the federal bulletin talking about the fact that we were making proactive steps to those that had a bmi of 40 or greater because of the sick they can't risk they have the obstructivhad of theobstructived unstructured sleep apnea is one of the causes of fatigue but in our obese society we are seeing the obstructive sleep apnea more commonly into the statistics that i see are at least two to 4% of females and some medical

sources say much more than that. so in a proactive fashion or what we thought was a proactive fashion, we proposed further screening of the air men that had a bmi of 40 or greater and there was an outcry that went to congressional levels and we certainly backed off and pled guilty to not working perhaps with the industry stakeholders as closely as we should have. but we had a meeting with many of the other in this race take older is early last year, january i believe involving that. we agreed to a significant compromise whereby we would want to see further evaluation by just ahead of the bmi of 40 or greater but those that have a history of the symptoms &-and-sign.

so now we have our draft policy that others were able to look at and provide comments and we have basically addressed the concern as well as all of the other industry stakeholders that had concerns about our policy, and it's ready to go. it's been vetted by my boss and in different colors very methodically we put which ended a stakeholder has these concerns and how we've addressed this in the new policy but the delay now is the fact that one of the compromises is that when we ask for further evaluation they have got that a group of history syms and signs. while we have it accomplished

and we are working with our folks to be able to turn our electronic medical record to be able to track these airmen where we expect to see further evaluation and possibly further testing because our system is set up to track the air men that gets the third. so, when we agreed to allow the air men to maintain a regular certificate at the same time they get a letter for me saying that we expect further evaluation and possibly treatment we had to get an electronic fix so that all will manage the air men in the same passiofashion and will be standd and consistent in making these changes to the software changes we hope to be ready to go by the end of the calendar year.

the policy is a return and we are ready to put that into the guide and i think that we will make a national airspace safer when we have an appropriate screening procedure for the obstructive sleep apnea. >> so in a year it will be with the new program and not grounded as long as the pilot is seeking treatment. >> and of course one of the other compromises that we made is that the men need only see a physician not a sleep medicine specialist that need only see a physician as primary care provider or perhaps a sleep medicine specialist that any physician can evaluate the airmen looking to his constellation of the past history symptoms and signs and tell us if he is at risk of the obstructive sleep apnea. is it, we are allowing any physician, not just a and e. to

tell us if he feels that the air man is at risk of the constructive sleep apnea and if so, we would want to see further testing and of course this could be as simple as a home test accepted by medicare so it is a standard of care in the costs of couple hundred bucks and of course there were lots of folks that pointed out if you get the full poly sonogram that could be a couple thousand dollars but we would only want to go to that level of testing when it was true we indicated by that constellation of history symptoms &-and-sign as. >> you are eluting to the bmi. >> it is certainly one sign.

if you have a receding jaw that's another sign you could be at risk of the obstructive sleep apnea but all of those signs aside based upon the input from the industry stakeholders, we are still going to expect a history of people that say they wake up tired and are unable to concentrate or have symptoms but they are gasping for air and we are putting it all together. there is no yes or no in terms of putting you at risk for obstructive sleep apnea. >> despite the cry that came out of the newsletter of the outcome has been positive but the health

of the pilot is improved because we removed a disincentive to get the evaluation that existed before as it was mentioned in the newsletter so now we are seeing the pilots that were hyper intensive or had cardiac disease or different conditions that now don't have that anymore. they are coming off their medications and their lives are better. the most common comment we get is i never knew i felt so bad until now i feel so good and it's almost a universal comment when they come back from treatment rated their health is improved and the safety of the air system and they are career longevity is enhanced. >> if there is a good thing about being corrected in terms of our readiness to be proactive it is indeed the recognition of

obstructive sleep apnea is a real issue not only for safety but in terms of the folks that have hypertension and heart attacks and sudden cardiac death due to this obstructive sleep apnea so we feel good about the fact that we have raised the awareness of the risk of obstructive sleep apnea and there is also a brochure that is available to its been updated and is very good. >> does anybody have a question that they would ask? >> we have a couple of questions from the floor. let me read one to you. i would like to hear the psychological issues. pilots self diagnose their fitness to fly versus the dock or is diagnosis whether the pilot is fixed to fly into the reporting requirements when the

pilot self-diagnosis so he's looking for some general attitudes on that. >> there's an old saying that the doctor that treats himself as a fool for a patient into the pilots that diagnose themselves for the patient. i -- guess yes i am all in favf checkout how you feel. am i safe is a good acronym and those are good things to do but diagnosing your self as to whether you have a treatable condition or not i have to say isn't necessarily the best thing in the world for anyone to do including physicians. >> it's also a good reason to have a relationship with him ame

where you can talk with someone and understand that what you are perceiving or read on the internet may not be correct. there may be other options you should consider some dangers you haven't considered and to take a look at those. if they will work with you thand there is no disincentive to discuss the question. many treating physicians are not really aware of the medical standards either the lookout for these of the medication so they may well give advice that is incorrect. having those opportunities to discuss this with someone who has expertise in aerospace medicine is the best person to do it without the fear that there will be a reporting requirement. contact in the united states and

context with healthcare providers are reportable to them that we see appropriate documentation or the appropriate relationship that is a no risk issue for the pilot and we would encourage them to talk it over if there's an there is any doubr mind. he armed safe check works well and the self-assessment also it's good and it's required, it's not always complete. >> i would echo the comments of my colleagues. the answer lies in the eye and safe checklist and self-assessment. there've been incidents as i'm sure that you are all aware of where there have been events in the cockpit or a pilot or first officer has been walked out of and there are always inevitable questions from the press. i don't know why if you let this

happen why didn't you prevent this and there will be people that will actually recommend that we do a thorough evaluation in each and every examination and of course we say that is not going to help. that is not a solution and it never will be certainly because these are impossible to predict sometimes, and even though we depend on them to be honest and forthright and ask questions about the hospitalizations and things of that nature there are those subset of folks that have not had that guy could have psychiatric issues and we will work with those as the issues arrive, plus the solution lies on the self-assessment not in any kind of regular assessment. >> i'm with delta airlines, and

i'm really pleased. i have a great relationship with my ame only i stumped him. last year recovered from a pinched nerve and physical therapy. i was able to get back and actually have my range of motion measured. found out that unfortunately as you get older your range of motion decreases. and i'm finding out now that we are about ready to put these devices on the windows that are exceeding what the normal range of motion would be for a 62 to 65-year-old would be. how would i get -- i don't know if the medical folks or aviation related people have different studies to find out how far we can go on these windows but where we are going to get problems with overextending and have been mac and pain related issues. if there's somebody in the air medical i can find out from my would love to hear it.

>> i will be honest and say this is the first time that i've heard of that as an issue, that certainly we at the faa have consultants that we regularly use including orthopedic surgeons and others that would be the subject matter experts in the range of motion issues of this nature. and we have actually both been airmen in need of the medical certificate and many second and third that are able to use what we call the medical flight test where an airman goes up essentially on a check ride and has to demonstrate that he can do all of the operations required in the cockpit safely. so, certainly if any air man can demonstrate that, we would readily certificates them. >> and adulthood has a great relationship and during the flight test i msn leaders there and he said if i can check we are not getting people cut or

anything like that it is people observing you doing routine pilot activities and emergency activities and d-delta routinely cooperates in the system in atlanta to use the summit leaders and we don't have any problem getting the pilots evaluated for the conditions that may be some doubt about whether they can do all of the routine emergency duties. >> over to this site. >> first of all thanks for your efforts. i appreciate it. i was curious, my name is john mcfadden, on the issues what extent do you belief if any far 117 may have increased the level of fatigue and are your conclusions borne out by any of the reports that are coming in and do you know are there any other currently ongoing any type

of research that's being done to validate the 117 is decreasing the level of fatigue. >> that's a good question and let me say from the get-go the people that put 117 out are the flight standard folks. we at aerospace medicine plays a supporting role and we have a big ethical institute in oklahoma city and they have some very smart phd's, some of which sub specializing fatigue so they were involved in some of the studies that involved the development of the flight risk management tools that all the air carriers use now. i would be interested to talk with you why you believe these rules have increased the amount of the fatigue because i know we

are continually dealing with the cargo pilots to feel very left out and that they were not included in all of the flight duty as well as many of the flight attendants that come to us through the politicians thatt feel that there should be requirements for them that allow them to work with the same flight duty the air men work with. so, i will certainly be willing to pass that on to the folks at the faa headquarters who work the flight duty that i am not aware of any allegations that its actually increaseit's actuae amount of fatigue. >> ..

so am going to leave that for the political arena, and just tell you that it's not, those of us were in the trenches at faa headquarters that are against it. it's omb and a political issue

in terms of the cost of making those changes for cargo pilots. >> but at the end of the day, it's your number one goal, right? >> that is the faa's number one goal. >> question over here. >> let me just start by saying a very distinguished panel this afternoon. i'm a canadian pilot assistance chair, and so i guess my crush would be directed to dr. salisbury. and it's kind of a multilevel question. regarding dsm five. if an individual is diagnosed under the new dsm five, what are the expectations from transport about how trade options will be considered? for example, education versus outpatient treatment versus full inpatient treatment programs. what level of reporting and feedback will be needed for each of these category of diagnoses?

and what level of follow-up monitoring will be needed or expected by transport? and last but not least, when will we be able to expect some guidelines on the transport canada website regarding alcohol abuse disorders? >> well, that's your question. >> okay. >> so first of all for those of you who don't know what some of the question was about is that recently the psychiatric world was kind of turned on its head a little bit by the introduction of a new diagnostic manual, and it's dsm five. one of the major changes in that was the way substance abuse disorders are both diagnosed and categorized. and it doesn't quite line up with the way we have traditionally talked about that. our read on that is, is that

there is no substantive difference in the way you make the diagnosis. and if you look at the dsm five categories, you can make parallels to what was a dsm 4. so there really isn't going to change in policy from our point of view. our approach to substance abuse has always been and i think will continue to be that to begin with is disqualifying. and then okay, you get together with your treating physician, you're a unique and usually your employer to come up with a mitigation strategy that you more or less sal to transport canada. we are not going to, with the policy telling people how to practice medicine. we're not going to come out with a policy that will tell you

exactly x, y and z -- i just proved on canadian. [laughter] what you have to do. i think that's counterproducti counterproductive. and by the way, as you all know, using it takes a long time to change regulations in the united states. i can tell you it takes just as long to do it in canada. i don't see a car to change on the. i don't see -- card change your idols is making major difference. we have always taken the stance that people with significant substance abuse disorder issues can be treated, so that the back and the cockpit, but it's a tripartite agreement that basically says this person has got their act together and they're under control, that they are safe to return to the pit. and that's how we're going to stay. and again, i'll say that that's

a change in policy. as to updating my website, well, if you have any political pull, you can write your member of parliament and ask them whether i can have some more money. updating my website is sort of the last of my priorities at the moment. i was interested to jim talk about is i am, i.t. problems are i can through the 49th parallel doesn't change those. i mean, it's a constant battle to keep the electrons going where you want them to go. and website changes in the government of canada on our right at the moment she which. and, i mean, it's almost daily, by almost logging everyday define that where did my website move to today. and hopefully that will settle

down later this year. and we are thinking about in terms of putting together some kind of a working group on larger issues to do substance abuse, because we are now faced with the new reality about medical marijuana and a bunch of other things where people are saying well, these things are legal so why can't people fly with them? well, yeah, treating you as morphine is also legal i don't want you to fly on the. drinking alcohol is also legal but don't let you fly while you were drunk. taking medical marijuana and fun is probably not a real good idea. but we need to get some guidance on that, both on the science side but also on the legal side. because we're going to have to look at that. and the big issue with a lot of these other drugs is more or

less we can predict when alcohol goes into your body and when it leaves your body, would you cannot have a residual effect. that's not true of these other medications, or substances. and so that's a long rambling and to say, i don't see us having change with dsm five. the names put on the diagnoses are essentially changed a little bit, but our policy with respect to will be allowed to go back into the cockpit is staying the same. >> okay, thank you. >> i also like to comment that the faa renew the contract for him so we can continue the education process that the medical professional pilots and airline management about the hazards of substance abuse and a pathway to get back. we have a new contract and when you're contracting, possibly for

three extension, any of you or all are interested in it, the next seminar is the eighth through the 10th of september in denver. i think will be a very, very good similar. it continues to improve every year. >> and i just have to say i am very proud to be an easy baby, teeny-weeny part of this program. but since he faa started working with alpha in the various characters many, many years ago wwe've not been able to put literally thousands of pilots through successful treatment rehab and aftercare and have safely returned them to the cockpit. and we are frequently asked to travel throughout the world to talk to other air carriers in foreign countries to tell them how we been able to achieve this. and it's not just pilots. its physicians and others that are concerned about substance, dependence of this abuse

problems and their population, and to have just a teeny-weeny part of that makes me very proud. >> we are over 5000 pilots now that have been returned to fly safely with diagnosis of alcohol dependence or substance abuse. and just yesterday, the national chairman for although and i were asked to go to speak at the american psychiatric association here in d.c. for the police and firefighters grew. group but they don't have a program at all. they have a problem but they don't have way of dealing with it. the questions were very perceptive and the comments about the comprehensiveness and the success of the program were very, very gratifying. i think you'll see other industries adapting this model much like the physician communicate about 20 years ago. >> we basel ii follow the hims model. we just don't have an acronym

for it. >> the acronym was designed to confuse. >> do we have another text question? >> yes, we did. this one is from the floor. it says for any member of the panel you say the most difficult part of making an adequate assessment of an airman so that getting the information. with more and more of our health records being stored electronically, could you foresee a move in the future to require all aaron and to give access to their medical records to their a&e's? >> i'll start with my parochial opinion and based on my experience, the answer is no. the patient privacy act are pretty doggone strict. and we have to be very careful and squeaky clean when we handle medical records, and that

includes medical records of their men. so the requirement for their men to provide their record to their a&e, i don't think you'll see in my lifetime. >> nor in mind. and we have similar issues in canada with respect to privacy and health information disclosure. i don't see that kind of a compulsory law as being actually necessary for us to do our job either. i don't need to be flooded with information on everything that's ever happened to you as a pilot. but when you have a particular condition, i do need to know what's going on with that one in order to make a certification decision. but i don't need your complete medical record in order to do that. and i think having any kind of a law like that is not within the

foreseeable future. and they don't think the various privacy information people who think about these kinds of things are even thinking that way in any way, shape, or form. >> i'll comment not on the radio to aspect. i agree with jim and david on the regulatory part. but the problem we see is when pilots are asked to provide medical records. some of them electronic -- generate the entire file. the mayo clinic is famous for the very, very detailed records and very comprehensive. you need two pages that you get 400 pages. and the other problem is that there may be errors in the medical record that are not corrected, and they tend to propagate over time and become legendary within a person's record. and when we review those records we realize that's not an appropriate diagnosis but we

have to go back, go through a correction process to however you can't delete entries from the medical records. so the correction involves another visit to the physician to document this was an inappropriate diagnosis to have that available. side you see that as a problem with the medical records, although i agree, i can't imagine in my lifetime it will become mandatory. at least under the current governments we have. >> it brings up a good complaint. when we fill out our faa physical now online, it doesn't self propagate. it doesn't have a memory. for example, i saw my doctor last year for the flu. and i have to remember that. is there anyway we can work on that? >> we are indeed working on that. and we are very hopeful that we will be allowed to propagate

that information that does not change. as you might expect there's a legal side to this. there have been, in the past, talked about the fact that the form was such that they didn't understand and they have put no to all the answers before and they put no to all the edges again, despite the fact that they may have had a heart attack or a psychiatric admission, or something of that nature. so the lawyers tell us that it's a good idea to have the airman actually go through that list and read the questions that we ask rather than self propagate with all memos, which has been successfully -- with all know. >> but the same time the who's on the same medication for life so to speak speed is absolutely. >> that's a catch there.

>> mark, do we have another text? >> we sure do. this question is directed to dr. schneider. what happens when a pilot calls the aeromedical office? would you describe the process that your office uses to handle an individual case? >> certainly. when the pilot calls we determine if he or she is eligible for services and valid alpa member. we validate the information to make sure we can reach back to them. one of our telephone technicians takes a one or two sentence synopsis of what the medical issue is, and then electronically sends it to one of our physicians for a call back. we track called within an hour. sometimes on monday or tuesday's after holiday it's a little more challenge. other times we can get back right away. the physician will then discuss with the pilot what the problem he or she has.

there may be an interim step. it's about has received a letter from the faa, we will have them facts it or e-mail it to us in the interim so we can look at the letter and give them the best advice. if they have a condition that is a civil question, can i take this medication and fly, as we've gone through the appropriate historical review and discussed the faa policy with them, that's the end of that call. however, a lot of pilots will have conditions that have reporting requirements. we the capability of generating electronic letters to them usually within two or three minutes to e-mail to them with a checklist of all the information that will be required from the physician, a copy of the faa's protocol, all of our contact information, and release information so we can interact within the faa on the path or anyone else they designate, frequently their primary

physician. when they received records back from the pilot to reach back and cotton -- contact them about our assessment of what those records contain, whether their current condition would allow them to fly, and other medical reinstated, if it was indicated either condition, or whether it's simply a condition we can report to them prior to the next physical, make it easier on the ame, and occasionally we need to tell pilots that this is a condition that may not be waived. have a psychosis or some condition like that. but it's important for them to know that information early in the process so they can make the appropriate planning. we can also direct the pilot to alpa resources, perhaps retirement interest people is that the condition that they will be getting long-term disability for. for pilots have gotten themselves into some sort of trouble with the law, we can

also recommend that contract administrators are sometimes alpa headquarters with the attorneys on staff. that over all what we try to do is get back to the pilot within an hour with a complete answer, not only with respect to the health but also with respect to the requirements with the faa and the certification, and to assure them we will be an advocate for them, as a liaison between them and their physician, and the faa. we have a great working relationship with the folks at the aeromedical aviation and faa headquarters, at our staff will send a list everyday, a cases that are pending down there and take them to the end of the month when pilots might be grounded, the faa's extreme good at getting back to us and taking action to make sure that pilots don't lose the opportunity to fly. because of some administrative issue. and we'll provide the pilot with

a copy of the letter and it is a requirement, follow-up and year, nine months later, we will send them a reminder that hey, it's time to look at getting your appointments rescheduled so that your special issuance doesn't collapse. >> another crushing? >> thank you very much for a very candid and open discussion. i'm with the staff in ottawa canada. you seem to be all in agreement that it has relationship to sleep apnea. now, some people do snore more than others. that doesn't seem to have any relationship to your weight. other than telling your spouse, put me on drugs and live with it, is there anything medically that works, you know? there's a whole bunch of charlatans out there who say try this, put something in your nose, sleep on your site, please sleep on your back. can you give us a bit of your

expert opinion on what would work for somebody who snores? it doesn't affect your sleep ant it certainly affects your spouse is. [laughter] spent there's a recent article in "the new england journal of medicine" that says, it's called the elbow signed. supposedly very, very predictive of people who have abstracted sleep apnea. -- abstract in sleep apnea. snoring isn't always a obstructive sleep apnea. it's one of the signs, and there are effective treatments for sleep apnea. cpap is i think the gold standard at the moment. from what i've heard and what i read about many of the proposed surgical approaches to it, i wouldn't recommend you go there. and let's just leave it at that.

to our effective treatments but you need a full workup and need find out whether those treatments will work for you. you can't make just a blanket statement because not everybody come sleep apnea is caused by the same mechanism. and you need to know what it is and why it exists, and then the appropriate treatment should be prescribed as a follow-on. and certainly if it is followed there's no reason why that isn't compatible with certification for flying, at least in canada. >> i would recommend go to board-certified specialist in sleep medicine or innocent throat to do it so you make sure you have a quality evaluation from expert in the area. >> thank you very much, ma dr. fraser, dr. salisbury, dr. snyder. i think those are in for the. i've learned a little bit.

hopefully i can take a blow more here. i really do appreciate your time. [applause] >> thank you, john. thank you, panelists. we have now come to the air safety forms version of what we call the seventh inning stretch. but before i let you go we have another drawing. captain sean cassidy will join it, we will reward another member of the audience. >> not particularly my punchline, so sean will come back -- >> we are covering the air line pilots association international hosting their annual conference here in washington, d.c. the we are going to break away but live coverage will continue at 3 p.m. eastern with a panel on ways to modernize the airspace system. we'll take you back to washington hilton for the air line pilots association international conference live here on c-span2.

tonight on c-span it's a look at some of the senate races in play during the fall midterm elections. we'll bring you live coverage of victory and concession speeches fallen to result in today's tennessee senate primary. also highlights from recent debates in the hawaii and virginia primary contests. again the live coverage along with your phone calls eating underway tonight at eight eastern on our companion network c-span. me on c-span2 tonight we continue to bring you booktv highlights in prime time beginning at eight eastern. the remains of major general

harold green who was killed in an attack in afghanistan earlier this week arrived at dover air force base in delaware this morning where his body will be prepared for burial at arlington national cemetery. according to the ap, general greene, a 34 year army veteran is the highest ranked u.s. officer to be killed in combat since 1970 during the vietnam war. soldiers carried his casket as army secretary john mchugh and army chief of staff general ray odierno paid their respects. >> president obama today will be signing into law or today's signing into law a $17 billion bill to revamp the veterans health care system. he did that earlier. the measure aims to expand veterans health care options come reduce delays at va facilities and hire more doctors and nurses. signing ceremony took place at

fort belvoir in virginia. it lasts about 15 minutes. [applause] >> hello, fort belvoir. [cheers and applause] everybody have a seat. i think i'm going to take sergeant major mcgruder on the road. [laughter] i'm just going to have them introduce me where ever i go. he got me excited, and i'm being -- i get introduce all the time. so thank you, james, for your incredible served our country. give james a big round of applause.