Soon the new European requirements1 for the medical examination of pilots come into force. These apply to commercial pilots and the many private pilots. The Joint Aviation Authorities have harmonised the requirements within all fields of aviation throughout Europe and subsequent regulations enter national law. For 6 years the medical subcommittee has laboured; most of their work relates to the adverse pathology which would make a pilot unfit, but the method by which fitness is to be policed is controversial.

Medical examinations date from 1915 when there was a high failure rate during military training. Selection, mostly eye tests, eliminated those with poor prospects of success. Although people with epilepsy were excluded on the history, long term health prospects were not a consideration. During the years between the wars, medical examinations were required of pilots under the Air Navigation Acts and these followed practices established by the Air Ministry.2 After the second world war, the International Civil Aviation Organisation extended United States practice by treaty.3 Fitness was policed by a routine medical examination every 6 months and for private pilots at 2 yearly intervals. In the United States, the Federal Aviation Administration relaxed this to 3 yearly for private pilots less than 40 years old. In Europe the opposite trend applied. Driven by pressure from medical specialists, the frequency and complexity of the examination increased, with the associated expense. Recent negotiations were based on harmonisation and not a scientific review. The outcome is that it will cost a private pilot in Europe twice what it would cost one in the United Stated to demonstrate fitness.

After a notorious accident at Staines in 1972,4 the airline industry introduced the philosophy that pilots could be expected to fail. Incapacity training was introduced together with the wearing of shoulder …