Doctors Are Not Airline Pilots

By: Bharani Padmanabhan – April, 2019

When Lucian Leape abandoned the profession of medicine and set out to make it subservient to corporate monopolies he began by claiming doctors are the same as airline pilots.

Firstly, Leape claimed that doctors do not care about their patients and care only about their outsized egos. This crystalized into the fraud called Disruptive Behavior. When doctors advocated for their patients, administrators were taught to label doctors as disruptives who needed their medical licenses suspended to teach them their place.

Secondly, Leape claimed that doctors must strictly follow centralized guidelines in order to weed out “variations in healthcare delivery.” Following checklists was labelled “Evidence-Based Medicine,” as opposed to the earlier, personalized, unscientific, voodoo, mumbo jumbo.

Both efforts explicitly aimed at turning doctors into predictable incentive- and algorithm-driven “providers” just like airline pilots. Blue Cross now pays doctors to deny pain medicine to patients with multiple sclerosis or Ehlers Danlos. The more patients you deny, bigger your bonus.

Three recent crashes demonstrate the utterly illiterate and Lysenkoist nature of Leape’s assertion that the practice of medicine must become the same as Cockpit Resource Management and commercial flying.

The first was Asiana 214 in San Francisco. Years of turning Asiana pilots into cogs dependent on programmed algorithms, predictably resulted in pilots with zero interest in hand-flying the aircraft even when landing at a gorgeous airport on a beautiful sunny day. The NTSB report bloodlessly observed “Asiana’s automation policy emphasized the full use of all automation and did not encourage manual flight during line operations.” The compliant pilots were not disruptive.

Three children died.

The second and third are the crashes of the 737 MAX-8 aircraft in Indonesia (JT610) and Ethiopia (ET302) that killed 346 people.

Why, with CRM and non-disruptive cockpits, did 346 people die violent deaths? The answer is simple. Pilots have been trained away from being professionals who really know their craft, like Earnest Gann or Orvis Nelson, and turned into actors merely following direction.

In the case of the Lion Air plane, just the day before the crash with the same faulty angle-of-attack sensor, pilots flew the plane safely because they happened to have an off-duty pilot on board who talked them through hand-flying a plane with runaway trim. Everyone lived. The pilots who flew that same plane the very next day did not know anything outside of their official algorithms and killed all on board.

This reality has now come to bite Boeing itself, a company that expects pilots to hand-fly its planes and not be dependent on algorithms and automation. Boeing’s recent statement about pilots being expected to switch automation off and hand-fly the 737 MAX despite runaway trim is now being portrayed by the corporate media as tone-deaf and heartless.

I would think pilots would die of shame if they did not know how to handle runaway trim, but then I am an independent professional. What do I know?
Here is why these crashes must sound the death knell for Leape’s efforts to destroy the profession of medicine. Human beings are not planes. They are not engineered the same way and within the same tolerances as planes. They do not come with detailed manuals and there is no model that accurately predicts their responses to any exposure. Every person is a unique genetic mix with a will of her own, an INDIVIDUAL. That is why doctors suffer from moral injury when coerced into algorithms.

It is the height of biology-denying unscientific illiteracy to claim that the daily practice of medicine is a reproducible standardized process and that doctors must be controlled the same way as airline pilots. That has never been true and can never be true. This false claim however has been useful to those interested solely in taking over the business of medicine from doctors and has rained billions of dollars on them so far.

Even with engineered assembly-line-manufactured aircraft clones, CRM and automation does squat to prevent errors when you no longer have real professionals in full charge.

Bharani Padmanabhan MD PhD is a neurologist who specialized in multiple sclerosis in the Boston area till July 12, 2017, when the medical board stole his license for reporting Medicaid fraud. ◊