Monday, May 08, 2006

Interesting NPR Story on Truckers with Diabetes

Michael Waterstone passes along this interesting story. An excerpt:

Now, though, a change in government policy should make it easier for Mather to get his license back. Under pressure from diabetes advocates, who say the ban on insulin amounts to discrimination that isn't supported by scientific evidence, Congress recently told federal regulators to change the rules. They'll now give diabetic truckers on insulin the opportunity to show that they can drive safely, and win a waiver from the ban. So far, Mather and thousands of other truckers have contacted the agency to ask for applications.

That's a big increase over the numbers that would have been eligible under an old waiver program, which was so restrictive that only a handful of diabetics could have applied. Before the recent rule change, diabetic drivers would have to show three years of safe driving within one state while using insulin before applying for a federal waiver. But because there's very little intrastate trucking, and few states had any kind of waiver program, diabetes advocates say this was a catch-22 that made the old waiver program impossible for most people. But now, the agency has done away with the requirement for three years of in-state driving, and diabetics can apply for the federal waiver the same day they go on insulin. If Mather's application is approved, he could be driving again within a year.

Health a Challenge for Any Trucker

Highway-safety advocates say this rule change is a big mistake.

"We think that insulin-dependent diabetic drivers should not be allowed to drive large trucks. Allowing them to drive represents a safety hazard," says Anne McCartt, a researcher at the Insurance Institute for Highway Safety. She's uneasy about opening up the waiver system, because it depends on truckers being truthful about how well they're controlling their blood sugar. And she says a trucker with low blood sugar, or hypoglycemia, is just too much of a risk to other drivers on the road.

"If there is a severe episode of hypoglycemia, that person may be incapacitated and unable to drive," McCartt says. "And this is a large vehicle maybe weighing 70,000 pounds, taking much longer to stop than other passenger vehicles. It's a risk that we don't think is worth taking."

It's true that diabetics drive cars all the time. But McCartt argues that a little car is not the same as a big truck. What's more, she says the life of a long-distance trucker is harder than most people realize. In her view, it's not the kind of life that makes it easy for people to carefully control their blood sugar.

* * *

The new program has won the support of diabetes experts like Christopher Saudek, a doctor at Johns Hopkins Hospital in Baltimore.

"Everyone ought to be evaluated on their own merits individually. I think there should not be blanket discrimination," says Saudek.

Over the years, there haven't been that many studies of insulin and driving. But Saudek says the evidence so far suggests that people who take insulin are no more likely to get into car crashes than anyone else.

He says a small percentage of diabetics do have problems with severe drops in blood sugar that could affect their driving. But, he says, "we can identify the people who are at high risk for low blood sugar and we can try to screen them out; we can effectively screen them out."

Saudek says that doctors can spot potentially high-risk drivers by looking at their medical records and past readings on their glucose monitors. If their condition is stable and they've had no problems in the past, they're unlikely to have any in the future.

As far as Saudek is concerned, the new waiver program will improve safety for everyone because it will encourage openness about the disease. "I certainly know people that are in trucking that are afraid of losing their jobs if they start insulin," Saudek says. "So they have two options. One is to take insulin secretly, and the other is to not take it and be in really poor diabetic control and put themselves at quite a risk" of diabetic complications, like eye and kidney disease.

The bottom line, he says, is if an insulin-dependent driver is as safe as anyone else, it's not fair to single them out just because they have a certain disease. And Saudek says that if the new waiver program is going to have any risks at all, they are going to be very small, and should be kept in perspective.

I wrote about this issue what seems like a hundred years ago now in a piece entitled "The Americans with Disabilities Act as Risk Regulation."


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