(Gingernut, who I think knows how to sharpen a scalpel, and is a helpful in these matters, might have some pithy comments to make on mine?)
- I try my best to keep my patients away from sharp scalpels
I guess, what we're trying to get to the bottom of, is whether or not the use of stress ECG's, in fit healthy individuals, predicts those pilots that are likely to die at the wheel.
I'm no expert, the patients I send for exercise testing (walking on a treadmill whilst wired up to an ecg) are sent because they have symptoms. (Usually chest pain.) It's used to see if they have ischemic heart disease.
I've not heard of any evidence for it's use in healthy individuals in predicting death at the wheel or yolk. Perhaps someone more informed could enlighten us.
The questions I'd ask before advocating it's use for healthy pilots would include:
- How often should we perform it-(would Fabrice Muamba have passed the day before.)
- How would we deal with "positive" cases
- Is there an easily recognised latent or early symptomatic stage that can be recognised by the test?
- Is a mortlity rate of 1:10,000 acceptable?
- How do we deal with the false positives. (In effect we'd ground 5% of pilots who undertook the test-immediately.)
There are alternative tests, which claim to predict risk of cardiac events, by measuring plaque deposits in the coronary arteries, but quite frankly, they are a waste of time. (Doesn't every Westerner my age have some degree of furred arteries?) - the key is translating these findings, to risk of event, which unfortunately is no better than having your risk factors (bp/smoking/age/choleserol etc) measured and analysed.
Safe flying