Pubdate: Sun, 19 Jan 2003
Source: New York Times (NY)
Copyright: 2003 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Authors: Thom Shanker, With Mary Duenwald

BOMBING ERROR IN AFGHANISTAN PUTS A SPOTLIGHT ON PILOTS' PILLS

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."
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