Following this initial item on what could and could not have been foreseen about the Germanwings murder/suicide, and this follow-up in which professional pilots talked about shortcuts in modern training systems, more response from aviators and others:

1) "If you had a mental issue, there's only one drug the FAA would allow you to take. That drug is alcohol." From a professional pilot:

Add me to the extensive list of pilots you’ve heard from, regarding the Germanwings tragedy. I agree with the people saying we only can blame ourselves, wanting cheap airfare and safe airlines, all while paying pilots nothing. I personally have avoided working for the airlines, having figured out that the charter and medical flying seems to have a better quality of life, better pay over the life of the career, and more job security. ...

When it comes to prevention of accidents like this, I honestly don’t know what can be done. I don’t believe having two people in the cockpit at all times would have prevented this specific instance; the guy was willing to take a lot of lives with him, what would the flight attendant standing in the doorway have been able to do to prevent that?

Many of your writers have mentioned the new ATP rules ... [JF: higher flight-time requirements before pilots can be considered for first-officer/ "co-pilot" jobs] but I don’t see a solution in arbitrary flight times and educational achievement. The European model, where pilots are hired and trained by the airline from the very beginning, does seem more sustainable in my opinion, compared to the U.S. model where pilots end up in excess of $100,000 in debt before they can even think of getting a job.

The person who pointed out the adversarial process of the FAA medical hit the issue right in the nose. Until recently, depression alone was enough to keep you out of the cockpit, stabilized treatment regimes and doctors' letters be damned.

To put it bluntly, if you had a mental issue that could be helped with medication, the FAA would allow you to take one drug that didn’t require reporting and documentation. That drug is alcohol.

2) On the tensions built into the medical-examination system. Another reader:

One pilot quoted in your piece wrote:

“The system gives pilots an incentive to cheat themselves out of the best quality of care. Any arrangement that promotes an adversarial relationship between doctor and patient compromises medicine.”

I fail to see how the relationship between doctors and pilots can be inherently anything other than adversarial. There is no upside for the pilot when a pilot currently holding a health certificate sees a doctor. The best result for the pilot is the continuation of the status quo. The worst result is the suspension or ending of his career.

I hope most pilots would face this periodic career peril with a moral sense of duty to passengers and therefore will be honest and forthright in any medical exam and would promptly disclose to their employers any relevant medical condition. However, human nature shows us that a meaningful percentage of pilots will conceal medical conditions or at least be very strategic in how they are examined (choosing a physician known to be lenient, seeking private diagnosis and treatment, etc.)

Thus it seems to me that the solution to this unique situation is not a more treatment-oriented system, which doesn’t address the conflict inherent in the situation. Rather, the solution is to recognize that pilots are unique in that they must be highly skilled and physically and mentally healthy, while being entrusted daily with hundreds of lives. Thus pilots should be required to give up their medical privacy to the degree necessary to ensure that all relevant medical facts are available to regulators and to their employers.

3) On the alcohol issue. From a doctor:

This event occurred many years ago,  and, hopefully, the culture of aviation safety has caught up. Here’s what happened.

I finished my residency at UC San Francisco and, not wanting to be tied down by the responsibilities of a family practice, began to practice emergency medicine. The group that I worked for assigned me to Alameda Hospital. Recall that Alameda is right next to Oakland, and is the closest facility to Oakland Airport. Therefore, it wasn’t unusual for our ER to see patients who were sent by the Oakland Airport.  

At the time, [a charter airline] was running flights out of Oakland to the Far East. One night a pilot for [that airline] was brought into our ER by the police, as he was so drunk that he couldn’t stand without assistance. On speaking with him, I learned that he was due to fly as a pilot the following morning. I told him that this was absolutely impossible, that he was in no condition to do so, etc. He was insistent that he would do so. Not knowing what to do (yes, there should have been a written policy in the ER, but there wasn’t), but knowing that I had to do something, I did the only thing that I could think of: I called the FAA and reported him.

To summarize the situation from that point on is simple: I became the villain in the eyes of everyone. The FAA was furious at me for creating paperwork for them. The airline was furious at me because I had ratted them to the FAA when they (the airline) “had the internal capability” to handle this matter “in house.” Not one person thanked me for keeping this incredibly drunk man from potentially endangering the lives of a plane full of passengers. It seemed to me that everyone was more concerned about how the bureaucracy would impact them than with true safety.

I never forgot that episode, and never regretted what I had done. I hope that the situation is different all these years later.

For what it's worth, in my own general-aviation experience over the past 20 years, I have not ever seen pilots who appeared to be drunk or impaired getting into airplanes. You can compare that with the world of driving, in which everyone knows of such cases. My observation doesn't prove anything larger, but it is my anecdotal experience.

4) On other pressures affecting the medical-examination system. A reader with an elite record as a military aviator writes:

As the TV talking heads make comments about FAA medical screening requirements, the public is getting the wrong idea about the quality of these annual and semi-annual exams.

My experience may be unique, but the FAA doctors I have seen at various locations around the country for FAA medical check-ups (Class I mostly) [JF note: Class I is the most demanding physical, which airline pilots must pass] have been "long in the tooth" and often eccentric and quirky. The physical exam was more about "checking the block" and paying the fee than a bonafide assessment.

Based on my experience, if the public thinks FAA medical exams have any sort of rigor they are mistaken.

I wrote back to this person saying that my anecdotal experience differed. Of the five or six different doctors from whom I've received Class III FAA physicals over the years, only one matched this description. The others seemed interested in giving a "real" exam—including one last year, who noticed something he thought my normal doctor should check out. (It was nothing, but worth checking.) The difference between this reader's experience and mine, then, would support his point that there can be a lot of variation within the system.

5) On the underlying financial pressures. A message I quoted yesterday argued that the "blame" for some aviation accidents ultimately rested with a public that insisted on ever-cheaper fares. A reader spells this out:

It is implicit in your argument about airline cost-cutting (although it wasn’t explicitly stated) that flight-crew pay must also be an indirect factor. The Colgan Air flight 3407 crash in Buffalo in 2009 [source of the photo at top of this item] is a case in point. The co-pilot had an annual salary of $16,200.

Tim Cook got a pay package worth $378 million to run Apple; if your iPhone doesn’t work, you send it back. But in some cases with commuter airlines, your life is literally in the hands of an overworked and undertrained flight crew member who makes McDonald's wages.

A great illustration, à la Milton Friedman, of how the free-market infallibly puts the right monetary value on services (snark).

6) Similarly on a "market equilibrium" price.  Another reader:

I never cease to be amazed by the ease at which the rhetoric about manpower shortages (pilot shortages, programmer shortages. etc.) finds acceptance. No, in free-market society, there are no shortages, only a shortage of people willing to pay the appropriate price.

Every day almost I get some email from some recruiter telling me what a great fit I would be and how I would love the company. When I tell them my price, that fit suddenly becomes not so great :)