herbal medication and Flying
Commentary, by Donato J. Borrillo, MD
"When having an alternate is not a good thing."
In aviation, it is usually good
practice for a pilot to have an alternate, such as an alternate airfield,
routing, or aircraft. The use of so-called alternative remedies may not,
however, be similarly "a good thing."
The aviation medical examiner (AME) should remember, "it is the medical
condition, not necessarily the treatment (herbal or otherwise), that may
influence the safety of flight."
The Food and Drug Administration (FDA) has little or no authority over the
estimated 15 million Americans that take herbal medication, nor does the AME.
The AME should simply regard all purported benefits of an herbal medication
as being "true" and disqualify based on the underlying disease or side effects.
The AME should not debate the "medical legitimacy" of an herbal medication but
should consider the possible underlying disease.
Addressing the disease, not the treatment modality, fosters a more
informative relationship with the applicant airman.
First, there are herbal medications that treat a specific underlying
condition. These include ginseng, saw palmetto, ginko, St. John's Wort, and
echinacea. Asian ginseng (Panax Ginseng) is used to increase stamina. The AME
should inquire, "Why is the pilot tired?" A flier that is tired may have a
chronic illness or depression. In addition, Ginseng should be avoided by
hypertensives and can cause anxiety, irritability, nervousness, and insomnia.
Saw palmetto (Serenoa Repens) is a berry product used to treat benign
prostatic hyperplasia; its use should spark queries about urinary tract
Ginko biloba is an antioxidant, used to increase blood circulation and
oxygenation. It is commonly used to improve memory; however, it may also be used
to treat the disqualifying conditions of tinnitus, asthma, and depression.
Furthermore, ginko has a profound effect upon platelet function and should not
be used with blood thinners.
St. John's Wort (Hypericum Perforate) promotes a healthy mood and helps to
relieve mild to moderate depression. Both of these conditions require an
evaluation prior to medical certificate issuance. Similarly, echinacea
(Echinacea Purpurea) stimulates the immune system to fight colds and flu; a
pilot should not be flying with these symptoms.
Second, the AME should be aware of herbal medications that prevent illness.
These include cranberry, goldenseal, and garlic. Cranberry (Vaccinium
Macrocarpon) is marketed to prevent urinary tract infections and should not be
considered disqualifying; however, one caveat: Is the use of cranberry to
prevent kidney stones (which may be disqualifying)? Similarly, goldenseal (Hydrastis
Canadensis) is marketed as an antiseptic for the bowel. As a preventive measure,
it is not disqualifying; however, if used for acute gastroenteritis, it may be
disqualifying. Garlic cloves (Allium Sativum) have been used to lower
cholesterol and should alert the AME to possible cardiac disease.
In sum, the AME should be ever vigilant for the airman using alternative
medicinal therapies, whether folk, herbal, diet, homeopathy, faith, new age,
chiropractic, acupuncture, naturopathy, massage, or music therapy. The AME can
make up for the lack of FDA authority, and once again make an alternative "a
good thing," by simply considering the underlying disease.