Aviation and Medicine

Over the last decade, comparisons have been drawn between the healthcare and aviation industries in an attempt to improve patient safety. Beginning with the often-quoted Institute of Medicine's groundbreaking report "To Err is Human" in November 1999 stating that 44,000-98,000 people die in any given year from medical errors, researchers, hospital administrators, and policy makers have been trying to address medical errors on a systems wide level. Learning from the aviation industry, hospitals are moving towards checklists, multiple back-up mechanisms, standardized protocols, and simulation training. For example, each surgery must begin with a "time-out" to verify the patient, procedure, location of procedure, and other simple questions to prevent easily identifiable errors. We're finally starting to learn from other industries to improve health care delivery to patients. That's not new news, and later I'll review a book about medical errors in health care.

Today, I wanted to raise a parallel idea; can what we've learned in medicine help the aviation industry? Recently, the news has been focused on an attempted terrorist plot by a man flying to Detroit, Michigan on Christmas day. There has been a lot of flurry over airport security, both in why the explosive device was not detected and in how to ratchet up security measures in the future.

For me, this draws some parallels with preventive medicine. One aspect of preventive medicine is preventing cancer and identifying it when it can be cured. Like a terrorist plot, we cannot predict when, where, and who will get cancer, but the outcome is so terrifying and unacceptable that we want our cancer and terrorism incidents to be zero. We have rudimentary methods of detecting the two; X-ray machines, metal detectors, mammograms, and PSA blood tests are standard but imperfect. There's always talk that newer tests or procedures may catch cancer earlier, but cost and patient discomfort are always considerations. In the same way, Homeland Security and the Transportation Security Administration are now trying to figure out how to increase detection without breaking the bank or halting transportation.

So what have we learned from cancer screening that can cross-over to airport security? Well, you can't catch everything. The American public wants and expects the administration to eliminate all terrorist threats, but I don't think that's a reasonable expectation. We simply cannot anticipate and protect against every possible terrorist plot. And despite these scares, plane travel is actually quite safe. The balance is between increasing sensitivity (the likelihood that if there is a threat, it will be detected) and cost or inconvenience. We can increase sensitivity by doing strip searches of everyone, but the cost and inconvenience of that makes it impractical. Consider the idea that we must remove our shoes before passing through the X-ray scanner. This is a minor inconvenience that we've become accustomed to. But has it increased the sensitivity of detection? That is, have shoe bombs been averted because of this procedure? I don't know the answer to that, but if they haven't, then there's no point in forcing us to take off our shoes; we should spend our time and money in looking at other methods of detection. (I realize a weakness of this argument is that in forcing people to remove their shoes, you're preventing development of terrorist plots that involve shoes).

In any case, aviation and healthcare have a lot of parallels. Research and policy in one area should be considered in corresponding fields. I think that medicine is no longer a closed silo, and that we can learn from advances in a myriad of unrelated fields.