<nettime> Bombing Error in Afghanistan Puts a Spotlight on Pilots' Pills

[J Armitage <j.armitage@unn.ac.uk>]

[Bringing a whole new meaning to the "war on drugs" ... John.]
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http://www.nytimes.com/2003/01/19/national/19SPEE.html?todaysheadlines

January 19, 2003

THE NEW YORK TIMES

Bombing Error in Afghanistan Puts a Spotlight on Pilots' Pills

By THOM SHANKER with MARY DUENWALD

WASHINGTON, Jan. 18 - A military hearing into the deaths of four Canadians
in an airstrike by two American pilots in Afghanistan has focused
attention on the military's long-held but little-known practice of using
drugs to keep its weary forces awake and alert - or to help them sleep off
the stress of combat.

Amphetamines and tranquilizers - "go pills" and "no-go pills" - are
considered useful tools for a modern American military that likes to fight
at night, given its technological superiority in finding targets in the
dark, and to an Air Force that must order its pilots to fly longer
missions from fewer overseas bases. Scientists are researching ever more
potent pills, including some that may keep combat forces alert for 40
hours or more, because the military says that fatigue can be deadly.

"The `go pill' is a tool of last resort," said Maj. Gen. Dan Leaf, the Air
Force director of operational capability requirements. "It is an insurance
policy. When they're in the air, there is no place to pull over. It's a
life-or-death situation. The decision to take a pill is made by the
individual pilot in the air."

But lawyers for the pilots, Majors Harry Schmidt and William Umbach of the
Illinois Air National Guard, said that the men had felt compelled to take
the amphetamine Dexedrine or be scrubbed from their mission, and that the
drug may have clouded their judgment on that clear night last April. Even
though the case has brought new scrutiny of amphetamine use in the
military, the defense's central argument is that the pilots should not be
held responsible because they were not informed that ground fire they
spotted near Kandahar was a Canadian military exercise. The government
argues that Major Schmidt ignored an order to hold his fire, and that
Major Umbach, the lead pilot, failed to exercise good leadership.
Amphetamines as a combat tool are not new. Military historians say they
were dispensed to German and British forces in World War II. The American
military gave amphetamines to pilots on trans-ocean missions in the 1950's
and 1960's, to air and ground combatants in Vietnam, and to Air Force
pilots in the Persian Gulf war. Asked to comment on the current case,
scientists outside the military who research the use of amphetamines say
it is impossible to know whether Dexedrine muddled the pilots' thinking
without knowing how tired they were at the time, whether they had been
taking the drug for many days in a row, and how strongly their bodies
responded to it. The most important factor in whether their judgment was
impaired, these specialists said, is not the use of amphetamines, but
whether the pilots were sleep-deprived before the mission. "Some people
are more sensitive to amphetamines than others," said Dr. Eric J. Nestler,
a psychiatrist at the University of Texas Southwestern Medical Center at
Dallas. "Even the same individual can differ in sensitivity from day to
day, depending on their level of fatigue or stress. So it's impossible to
say what was going on in that plane with those pilots on that night."  
Studies conducted over the last 40 years suggest that low doses of
amphetamines do not affect alertness, reaction time or decision-making
ability in well-rested people. The drugs do improve the mental performance
of people who are fatigued. Researchers at Columbia University's medical
school, for example, have recently tested amphetamines on people
undergoing abrupt changes in their sleep patterns. The subjects were kept
awake at night for one week, and switched back to a daytime schedule the
next. Immediately after making such a shift, the subjects performed poorly
on tests of cognitive ability and reaction time, said Dr. Carl L. Hart, an
assistant professor of neuroscience. But when given 5- to 10-milligram
doses of amphetamines - the size prescribed by Air Force flight surgeons -
the subjects performed as well as when they are rested. "In well-rested
people, you don't see the amphetamines cause much improvement," Dr. Hart
said. "But in people who are changing shifts, the drugs bring their
performance back up to baseline." Air Force officials say that
amphetamines have never caused a flight accident. "The pill has never been
found to cause or contribute to a mishap before," General Leaf said. But
exhaustion is a constant concern on lengthy missions, officials said. The
Air Force conducted one study, "Air Crew Fatigue as a Human Factor in
U.S.A.F. Class A Mishaps - a Twenty-Year Review," that found that fatigue
was a factor in 101 accidents from 1977 to 1997. Current policy allows a
flight surgeon to dispense "go pills" on sorties over 8 hours in a
single-pilot fighter or 12 hours in a two-pilot bomber, said Betty Anne
Mauger, spokeswoman for the Air Force surgeon general. Any unused pills
must be returned by the pilots, and none are prescribed for helicopter
pilots, who traditionally fly shorter missions, or for maintenance crews.
Ms. Mauger said that sedatives - nicknamed "no-go pills" - are also
prescribed, most often to help pilots adjust to a change in time zones or
to sleep during the day in preparation for a night mission. The sleeping
pills Sonata, Ambien and Restoril, are used by the Air Force. Air Force
officials deny that pilots are forced to ingest the "go pills," although
an agreement to carry them into the cockpit in case they are needed is one
of many criteria that may be used by a commander and flight surgeon in
approving a pilot for a mission. The use of "go pills" has been opposed at
even the highest levels of the Air Force. When he was Air Force chief of
staff in 1992, Gen. Merrill A. McPeak told his service's medical corps to
stop dispensing amphetamines to pilots. "I was a fighter pilot for 37
years, and I had been issued `go pills' on occasion for long, over-water
flights and so on," General McPeak, now retired, said in a telephone
interview. "I always just threw them away. Most of the guys I knew just
threw them away." General McPeak said his decision to ban the pills was
prompted by personal experience, and not based on any formal research. "I
have absolutely no science in back of that," he said. "It was entirely
subjective. It just didn't match my style. Jedi Knights don't need them."
The Air Force reinstated the use of Dexedrine in 1996. In three studies
conducted in the 1990's, helicopter pilots were kept awake for 40 hours
and asked to perform certain maneuvers - making left or right turns while
maintaining a certain altitude, or ascending or descending while
maintaining the same speed. Two of the studies were done in flight
simulators and in the third, in real flights. In each case, when the
pilots were given 10 milligrams of Dexedrine one hour before being tested,
they performed better than when they were given a placebo. On Dexedrine,
the pilots also reported feeling more alert and vigorous.  "If anything, a
5- to 10-milligram dose of amphetamines is going to improve their
performance," said Dr. Charles R. Schuster, a psychopharmacologist at
Wayne State University School of Medicine, who formerly led the National
Institute on Drug Abuse. "The culprit here, in my opinion, is sleep
deprivation." But other scientists question whether the controlled studies
of amphetamines are enough to show how the drugs affect judgment in real
life. "These pilots were in an incredibly stressful situation," said Dr.
Jon Morgenstern, director of treatment research at the National Center on
Addiction and Substance Abuse, at Columbia University. "You had fatigue
and the need to make a split-second decision. I don't think you could rule
out that the amphetamines would be a factor. They might have altered the
pilots' perception enough to make them feel more threatened than they
normally would have felt." Amphetamines increase alertness by increasing
the supply of certain neurotransmitters in the brain.  But people easily
grow tolerant to them, and they can be addictive. Large doses, over time,
can lead to such side effects as anxiety, paranoia and heart problems,
medical experts say. Civilian pilots are prohibited from using them.  But
scientists in and out of the military say the use of amphetamines makes
sense in combat. Military pilots, they say, are less likely than the
average person to become dependent on the drugs, especially if they take
them under medical supervision and only in a deployment. "If I were a
general in charge of a combat force, and I needed people to stay awake for
their own safety," Dr. Nestler said, "I think that's a reasonable use of
the drug." ************************ Dr John Armitage Head of
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Multidisciplinary Studies School of Arts & Social Sciences Northumbria
University Newcastle upon Tyne NE1 8ST, UK. Tel: 0191 227 4971 Fax: 0191
227 4558 E-mail: (w) j.armitage@unn.ac.uk (h)
j.armitage@technologica.demon.co.uk (h) johnarmitage@blueyonder.co.uk
*******************************


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