Appendix J Notice Of Completion And Associated: Fill & Download for Free

The important thing is that the cylinder is grounded. So, wooden planks would be a bad idea.You might want to watch this video AND read the material below:Video courtesy of Gas Energy AustraliaHow to Decant LPGThis video is only a supplement and refresher for those who have completed the Elgas decant training course. It is not the complete training course and other training materials apply.LPG decanting must not be attempted by untrained individuals.Safety measures that should be considered when decanting LPG:♦ Operators engaged in LPG decanting must be able to demonstrate competency in decanting procedures and emergencies, and in using personal protective equipment (PPE) appropriate for the task. Untrained individuals should not be allowed to perform decanting.♦ Cylinders must be inspected and have a current inspection mark.♦ Do not refill cylinders that are damaged or corroded.♦ Decanting area must be a safe distance from fuel dispensers, flammable materials, tanks containing dangerous goods, public places, and building entries and exits.♦ Protect LPG cylinders, attachments and associated pipe work from damage. This includes protecting the main decanting cylinder from a vehicle collision.♦ Eliminate all ignition sources. Devices such as ice freezers, static electricity and smoking are not to be introduced into a hazardous area.♦ Operators must understand the nature of static electricity, and the associated precautions included in the safety procedures.♦ Ensure operators are trained to identify any worn or damaged parts in the decanting equipment.♦ Display a notice reading ‘Flammable Gas, No Smoking’ (with letters at least 50mm high) as close as possible to the decanting area.♦ Display a notice that outlines the procedure for decanting, including a warning to stop filling as soon as the maximum permitted level has been reached. As a minimum, the procedure should reflect all the safety requirements outlined in appendix J of AS/NZ1596.♦ A trained operator must be present during the filling process.♦ Do not any device to hold the dead man’s valve open. It must only be kept open by hand.♦ Wear appropriate PPE during the decanting process. This includes gloves and safety glasses and cotton or anti-static clothes.♦ Minimise the risk of static electricity by placing the cylinder to be filled on an electrically conductive and grounded stand. Do not use a plastic milk crate or any similar non-conducting type of stand.♦ Before starting, touch the body of the decanting cylinder with bare hands to discharge any static electricity.♦ Adequate fire protection must be provided. As a minimum, have a hose reel or powder-type extinguisher should be available in the decanting area.From my article: How to Decant LPG

This is the max they can do to scrutinize the physical testing.Its for Pilots. Leniency is expected in case of ground guty.GENERAL MEDICAL AND SURGICAL ASSESSMENT1.2.1. Every candidate, to be fit for the Air Force, must conform to the minimum standards laid down in the succeeding paragraphs. The general build should be well developed and proportionate.Surgical Sequelae and Abnormalities1.2.2. Sequelae of Fractures/ Old injuries. The residual effects of such fractures/ injuries are to be assessed for any functional limitation. If there is no effect on function, the candidate can be assessed fit. Cases of old fractures of spine are unfit. Any residual deformity of spine or compression of a vertebra will be cause for rejection. Injuries involving the trunks of the larger nerves, resulting in loss of function, or scarring, which cause pain or cramps, indicate unsuitability for employment in flying duties. The presence of large or multiple keloids will be cause for rejection.1.2.3. Scars and Birth Marks. Minor scars for e.g. as resulting from the removal of tuberculous glands do not, per se, indicate unsuitability for employment on flying duties. Extensive scarring of a limb or torso that may cause functional limitation or unsightly appearance should be considered unfit.1.2.4. Cervical Rib. A well fully developed unilateral cervical rib or a rudimentary large cervical rib with signs or symptoms referable to the rib is a cause for rejection. Rudimentary small cervical rib without signs or symptoms referable to it may be considered fit. However, the defect is to be recorded as a minor disability in the medical board proceedings. Bilateral cervical ribs without any neurovascular compromise will be acceptable.1.2.5. Asymmetry of the face and head, which will interfere with proper fitting of oxygen mask and helmet, will be a cause for rejection for flying duties.1.2.6. History relating to operations. A candidate who has undergone an abdominal operation, other than a simple appendicectomy, involving extensive surgical intervention or partial or total excision of any organ is, as a rule, unsuitable for flying duties. Operation involving the cranial vault (e.g.trephining), or extensive thoracic operations such as thoracoplasty make the candidate unfit for flying.Measurement and Physique1.2.7. Chest shape and circumference. The shape of the chest is as important as its actual measurement. The chest should be well proportioned and well developed with the minimum range of expansion of 5 cm. Decimal fraction lower than 0.5 cm will be ignored. 0.5 cm will be recorded as such and 0.6 cm and above will be recorded as 1 cm.1.2.8. Height, Sitting Height, Leg Length and Thigh Length. The minimum height for entry into ground duty branches will be 157.5 cm.1.2.9. Minimum height for Flying Branch Acceptable measurements of leg length, thigh length and sitting height for such aircrew will be as under: -(a) Sitting height - Minimum 81.50 cm- Maximum 96 .0 cm(b) Leg Length - Minimum 99.0 cm- Maximum 120.0 cm(c) Thigh Length - Maximum 64.0 cm1.2.10. On account of lower age group of NDA candidates a margin of up to 5.0 cm in height, 2.5 cm in leg length (minimum) and 1.0 cm in sitting height (minimum) may be given provided it is certified by the medical board that the candidate is likely to grow and come up to the required standard on completion of his training at NDA. The actual growth is to be confirmed at the time of V term medical at NDA.1.2.11. Weight(a) Male Candidates (except NDA candidates). Ideal weight relative to age and height is as depicted in Appendix A to this chapter. For male candidates (except NDA candidates), the maximum permissible variation from the ideal body weight is ± 1SD. Fraction of less than half a Kg will not be noted.(b) NDA Candidates. For NDA candidates, at entry, the weight chart prescribed by U.P.S.C. placed at Appendix B to this chapter will be applicable. placed at Appendix B to this chapter will be applicable. Fraction of less than half a Kg will not be noted. If a candidate is overweight by more than 10 % of the ideal weight, biochemical parameters will be assessed to rule out any underlying pathology. Candidates with weight between 10 to 20 % of ideal with normal biochemical profile, normal waist circumference (< 94 cm:Males and 89 cm: Females), normal BMI range (M< 25, F< 23) and normal waist to hip ratio (< 0.9: Males and <0.8: Females) may be assessed fit. It must be ensured that all the four obesity parameters mentioned before are normal. Abnormality in any one of them will be a cause for rejection. Genetic factors must also be considered in young age obesity. Skin fold thickness and measurement of body fat with body fat analyzers, where available, may be done. Such candidates, if found fit, would be advised to reduce weight to less than 10% of ideal which should be ensured by the time the candidate joins NDA and subsequently, AFA (this stipulation is also endorsed in the joining instructions of the candidate). Candidates with weight more than 20 % above the ideal, with or without biochemical abnormalities, or BMI more than 25 or waist circumference more than 94cm, or WHR > 0.9 will be declared unfit. If a candidate is underweight by more than 10% below the ideal, a detailed history and careful examination to rule out possible causes like tuberculosis, hyperthyroidism, diabetes etc will be carried out. If no cause is detected the candidate will be declared fit. If any cause is detected the fitness of the candidate will be decided accordingly.1.2.12. Physical Standards (For Females).(a) Height. The minimum height acceptable for various branches are as follows:-(i) Flying Branch - 162.5 cm.(ii) Medical / Dental branches – 142 cm(iii) Other Branches – 152 cmNote: For other than flying branches only – For candidates belonging to the North East region or hilly regions of Uttaranchal, a lower minimum height of 142 cm will be accepted.CARDIOVASCULAR SYSTEM1.3.1. Relevant history. History of chest pain, breathlessness, palpitation, fainting attacks, giddiness, rheumatic fever, chorea, frequent sore throats and tonsillitis should be given due consideration in assessment of the cardiovascular system.1.3.2. Pulse. The normal pulse rate varies from 60-100 bpm. Persistent sinus tachycardia (> 100 bpm), after emotional factors and fever are excluded as causes, as well as, persistent sinus bradycardia (< 60 bpm), should be referred for specialist opinion to exclude organic causes. Sinus arrhythmia and vagotonia should be also be excluded.1.3.3. Candidates are quite prone to develop White Coat Hypertension, which is a transient rise of Blood Pressure, due to the stress of medical examination. Every effort must be made to eliminate the White Coat effect by repeated recordings under basal conditions. When indicated, ambulatory BP recording must be carried out or the candidate admitted to hospital for observation before final fitness is certified. An individual with BP consistently greater than 140/90 mm Hg shall be rejected.1.3.4. Evidence of organic cardio vascular disease will be cause for rejection. Diastolic murmurs are invariably organic. Short systolic murmurs of ejection systolic nature and not associated with thrill and which diminish on standing, specially if associated with a normal ECG and Chest X-Ray, are most often functional. However an echocardiogram should always be done to exclude organic heart disease. In case of any doubt the case should be referred to cardiologist for opinion.1.3.5. Electro Cardiograms. Assessment of a properly recorded ECG (resting – 14 lead) should be carried out by a medical specialist. Note will be taken of wave patterns, the amplitude, duration and time relationship. At initial entry no abnormalities are acceptable except incomplete RBBB in the absence of structural heart disease, which must be excluded. In such cases, opinion of Senior Adviser or Cardiologist will be obtained.CHAPTER 4RESPIRATORY SYSTEM1.4.1. Pulmonary TB. Any residual scarring in pulmonary parenchyma or pleura, as evidenced by a demonstrable opacity on chest skiagram will be a ground for rejection.1.4.2. Pleurisy with Effusion. Any evidence of significant residual pleural thickening will be a cause for rejection. Old treated cases with no residual abnormality can be accepted if the diagnosis and treatment was completed more than two year earlier. In these cases, a CT scan chest and fibro optic bronchoscopy with bronchial lavage can be done alongwith USG, ESR, and Mantoux test. If all the tests are normal the candidate may be considered fit.1.4.3. Bronchitis. History of repeated attacks of cough/ wheezing/ bronchitis may be manifestations of chronic bronchitis or other chronic pathology of the respiratory tract. Such cases will be assessed unfit.1.4.4.Bronchial Asthma. History of repeated attacks of bronchial asthma/wheezing/ allergic rhinitis will be a cause for rejection.1.4.5. Radiographs of the chest. Definite radiological evidence of disease of the lungs, mediastinum and pleurae indicates unsuitability for employment in air force.CHAPTER 5GASTRO INTESTINAL SYSTEM1.5.1. Relevant History. The examiner should enquire whether the candidate has any past history of ulceration or infection of the mouth, tongue, gums or throat. Record should be made of any major dental alteration.1.5.2. When discussing a candidate’s medical history the examiner must ask direct questions about any history of heart burn, history of recurrent dyspepsia, peptic ulcer-type pain, persistent diarrhoea, jaundice or biliary colic.1.5.3. Dental Standards. The following dental standard will be followed:-(a) Candidate must have 14 dental points and the following teeth must be present in the upper jaw in good functional opposition with the corresponding teeth in the lower jaw, and these must be sound or repairable:-(i) Any four of the six anteriors, and(ii) Any six of the ten posteriors(iii) They should be balancing on both sides. Unilateral masticationis not allowed.(iv) Any removable or wired prosthesis are not permitted.(b) Candidate whose dental standard does not conform to the laid down standard will be rejected.(c) Candidate with dental arches affected by advanced stage of generalized active lesions of pyorrhoea, acute ulcerative gingivitis, and gross abnormality of the teeth or jaws or with numerous caries or septic teeth will be rejected.1.5.4 Gastro-Duodenal disabilities. Candidates who are suffering or have suffered, during the previous two years, from symptoms suggestive of chronic indigestion, including proven peptic ulceration, are not to be accepted, in view of the exceedingly high risk of recurrence of symptoms and potential for incapacitation. Any past surgical procedure involving partial or total loss of an organ (other than vestigial organs/ gall bladder) will entail rejection.1.5.5 Diseases of the Liver. If past history of jaundice is noted or any abnormality of the liver function is suspected, full investigation is required for assessment. Candidates suffering from viral hepatitis or any other form of jaundice will be rejected. Such candidates can be declared fit after a minimum period of 6 months has elapsed provided there is full clinical recovery; HBV and HCV status are both negative and liver functions are within normal limits.1.5.6 Disease of spleen. Candidates, who have undergone splenectomy, are unfit, irrespective of the cause for operation. Splenomegaly of any degree is a cause for rejection.1.5.7. Hernia. A candidate with a well-healed hernia scar, after successful surgery, will be considered fit six months after surgery, provided there is no potential for any recurrence and abdominal musculature is good.1.5.8. Abdominal Surgery.(a) A candidate with well-healed scar after conventional abdominal surgery will be considered fit after 6 months of successful surgery provided there is no potential for any recurrence of the underlying pathology and abdominal wall musculature is good.(b) A candidate after laparoscopic cholecystectomy will be considered fit three months after successful surgery.1.5.9. USG Abdomen: Disposal of cases with incidental ultrasonographic findings like fatty liver, small cysts, haemangiomas, septate gall bladder etc., will be based on clinical significance and functional capacity.CHAPTER 6UROGENITAL SYSTEM1.6.1. Relevant History. Enquiry should be made about any alteration in micturition, e.g. dysuria or frequency. Recurrent attacks of cystitis; pyelonephritis and haematuria must be excluded. Detailed enquiry must be made about any history of renal colic, attacks of acute nephritis, any operation on the renal tract including loss of a kidney, passing of stones or urethral discharges. If there is any history of enuresis, past or present, full details must be obtained.1.6.2. Urine Examination.(a) Proteinuria. Proteinuria will be a cause for rejection, unless it proves to be orthostatic.(b) Glycosuria. When glycosuria is detected, a blood sugar examination (Fasting and after 75 g glucose) and Glycosylated Hb is to be carried out, and fitness decided as per results. Renal glycosuria is not a cause for rejection.(c) Urinary Infections. When the candidate has history or evidence of urinary infection it will entail full renal investigation. Persistent evidence of urinary infection will entail rejection.(d) Haematuria. Candidates with history of haematuria will be subjected to full renal investigation.1.6.3. Glomerulonephritis.(a) Acute. In this condition there is a high rate of recovery in the acute phase, particularly in childhood. A candidate who has made a complete recovery and has no proteinuria may be assessed fit, after a minimum period of one year after full recovery.(b) Chronic. Candidate with chronic glomerulonephritis will be rejected.1.6.4. Renal Colic and Renal Calculi. Complete renal evaluation is required. Candidates with renal calculi will be rejected.1.6.5. Absence of Kidney. All candidates found to have congenital absence of one kidney or who have undergone unilateral nephrectomy will be rejected. Presence of horseshoe kidney will entail rejection. Solitary functioning kidney with diseased, non-functional contralateral kidney will entail rejection. Crossed ectopia, unascended kidney(s) will be a cause for rejection.1.6.6. Undescended Testis. Bilateral undescended testis / atrophied testis will be a cause for rejection. Unilateral undescended testis, if entirely retained in the abdomen, is acceptable. If it lies in the inguinal canal, at the external ring or in the abdominal wall, such cases may be accepted after either orchiectomy or orchipexy operation. In all doubtful cases surgical opinion must be obtained regarding fitness.1.6.7. Hydrocele or Varicocele. These should be properly treated before fitness is considered. Minor degree of varicocele should not entail rejection.CHAPTER 7ENDOCRINE SYSTEM1.7.1. Generally any history suggestive of endocrine disorders will be a cause for rejection.1.7.2. All cases of thyroid swelling having abnormal iodine uptake and abnormal thyroid hormone levels will be rejected. Cases of simple goiter with minimal thyroid swelling, who are clinically euthyroid and have normal iodine uptake and normal thyroid functions may be accepted.1.7.3. Candidates detected to have diabetes mellitus will be rejected. A candidate with a family history of diabetes mellitus will be subjected to blood sugar and Glycosylated Hb evaluation, which will be recorded.CHAPTER 8DERMATOLOGICAL SYSTEM1.8.1. Relevant history and examination. Careful interrogation followed by examination of the candidates skin is necessary to obtain a clear picture of the nature and severity of any dermatological condition claimed or found. Borderline skin conditions should be referred to a dermatologist. Candidates who give history of sexual exposure, or have evidence of healed penile sore in the form of a scar should be declared permanently unfit, even in absence of an overt STD, as these candidates are likely ‘repeaters’ with similar indulgent promiscuous behavior.1.8.2. Assessment of diseases of the Skin. Acute non-exanthematous and noncommunicable diseases, which ordinarily run a temporary course, need not be a cause of rejection. Diseases of a trivial nature, and those, which do not interfere with general health or cause incapacity, do not entail rejection.1.8.3. Certain skin conditions are apt to become active and incapacitating under tropical conditions. An individual is unsuitable for service if he has a definite history or signs of chronic or recurrent skin diseases. Some such conditions are described below:-(a) Palmoplantar Hyperhydrosis. Some amount of Palmoplantar Hyperhydrosis is physiological, considering the situation that recruits face during medical examination. However, conditions with significant Palmoplantar Hyperhydrosis should be considered unfit.(b) Acne Vulgaris. Mild (Grade 1) Acne consisting of few comedones or papules, localized only to the face may be acceptable. However moderate to severe degree of acne (nodulocystic type with or without keloidal scarring) or involving the back should be considered unfit.(c) Palmoplantar Keratoderma. Any degree of palmoplantar keratoderma manifesting with hyperkeratotic and fissured skin over the palms, soles and heels should be considered unfit.(d) Ichthyosis Vulgaris. Ichthyosis involving the upper and lower limbs, with evident dry, scaly, fissured skin should be considered unfit. Mild Xerosis (dry skin) could be considered fit.(e) Keloids. Candidates having any keloid should be considered unfit.(f) Onychomycosis. Clinically evident onychomycosis of finger and toenails should be declared unfit, especially if associated with nail dystrophy. Mild degree of distal discolouration involving single nail without any dystrophy may be acceptable.(g) Giant Congenital Melanocytic Naevus. Giant congenital melanocytic naevi, greater than 10 cm should be considered unfit, as there is a malignant potential in such large sized naevi.(h) Callosities, corns and warts. Small sized callosities, corns and warts may be considered acceptable after treatment. However candidates with multiple common warts or diffuse palmoplantar mosaic warts, large callosities on pressure areas of palms and soles and multiple corns should be rejected.(j) Psoriasis. Psoriasis is a chronic skin condition known to relapse and/or recur and hence should be considered unfit.(k) Leukoderma. Candidates suffering from minor degree of Leukoderma affecting the covered parts may be accepted. Vitiligo limited only to glans and prepuce maybe considered fit. But those having extensive degree of skin involvement and especially, when the exposed parts are affected, even to a minor degree, should not be accepted.1.8.4. A history of chronic or recurrent attacks of skin infections will be cause for rejection. A simple attack of boils or sycosis from which there has been complete recovery may be considered for acceptance.1.8.5. Individuals who have chronic or frequently recurring attacks of a skin disease of a serious or incapacitating nature e.g. eczema are to be assessed as permanently unfit and rejected.1.8.6. Any sign of Leprosy will be a cause for rejection.1.8.7. Naevi. Naevus depigmentosus, Beckers Naevus may be considered it. Intradermal Naevus, Vascular Naevi may be considered unfit.1.8.8. Ptyriasis Versicolor. Mild P Versicolor may be considered fit. Extensive Ptyriasis Versicolor may be considered unfit.1.8.9. Tinea Cruris and Tinea Corporis. Maybe considered fit on recovery.1.8.10. Scrotal Eczema. Maybe considered fit on recovery.1.8.11 Canities (premature graying stain) maybe considered fit if mild in nature and no systemic association is seen.1.8.12. Intertrigo. Maybe considered fit on recovery.1.8.13. Sexually Transmitted Diseases : Genital Ulcers. These should be considered unfit.1.8.14. Scabies. Maybe considered fit only on recovery. Genital scabies maybe made unfit.CHAPTER 9MUSCULOSKELETAL SYSTEM AND PHYSICAL CAPACITYPhysical Endurance1.9.1. The assessment of the candidate’s physique is to be based upon careful observation of such general parameters as apparent muscular development, age, height, weight and the correlation of this i.e. potential ability to acquire physical stamina with training. The candidate’s physical capacity is affected by general physical development or by any constitutional or pathological condition.Spinal Conditions1.9.2. Relevant history. Past medical history of disease or injury of the spine or sacroiliac joints, either with or without objective signs, which has prevented the candidate from successfully following a physically active life, is a cause for rejection for commissioning. History of spinal fracture/ prolapsed intervertebral disc and surgical treatment for these conditions will entail rejection.1.9.3. Examination. Mild kyphosis or lordosis where deformity is barely noticeable and not associated with pain or restriction of movement may be accepted. When scoliosis is noticeable or any pathological condition of the spine is suspected, X-ray examination of the appropriate part of the spine needs to be carried out.1.9.4. X-Ray Spine. For flying duties, X-ray (AP and lateral views) of cervical, thoracic and lumbosacral spines is to be carried out. For ground duties, X-ray examination of spine may be carried out, if deemed necessary.1.9.5. Assessment. The following conditions detected radiologically will disqualify a candidate for Air Force service: -(a) Granulomatous disease of spine.(b) Arthritis / Spondylosis.(i) Rheumatoid arthritis and allied disorders.(ii) Ankylosing Spondylitis.(iii) Osteoarthrosis, spondylosis and degenerative joint disease.(iv) Non-articular rheumatism (e.g. lesions of the rotator cuff, tennis elbow, recurrent lumbago etc.)(v) Misc disorders including SLE, ,Polymyositis, and Vasculitis.(vi) Spondylolisthesis / spondylolysis(vii) Compression fracture of Vertebra(viii) Scheuerman’s Disease (Adolescent Kyphosis)(ix) Loss of cervical lordosis when associated with clinically restricted movements of cervical spine.(x) Unilateral / Bilateral Cervical ribs with demonstrable neurological or circulatory deficit.(xi) Any other abnormality is so considered by the specialist.1.9.6. Fitness for Flying Duties. The deformities/disease contained in para 1.9.5 above will be cause of rejection for all branches in IAF. In addition for candidates for flying branches the under mentioned rules will also apply: -(a) Spinal anomalies acceptable for flying duties: -(i) Bilateral complete sacralisation of LV5 and bilateral complete lumbarisation of SV1.(ii) Spine bifida in sacrum and in LV5, if completely sacralised.(iii) Complete block (fused) vertebrae in cervical and /or dorsal spine at a single level.Note: However, an annotation will be made of these anomalies in AFMSF-2.(b) Spinal conditions not acceptable for flying duties.(i) Scoliosis more than 15 degree as measured by Cobb’s method.(ii) Degenerative disc disease.(iii) Presence of Schmorl’s nodes at more than one level.(iv) Atlanto - occipital and atlanto-axial anomalies.(v) Hemi vertebra and/or incomplete block (fused) vertebra at any level in cervical, dorsal or lumbar spine and complete block (fused) vertebra at more than one level in cervical or dorsal spine.(vi) Unilateral sacralisation or lumbarisation (complete or incomplete) at all levels and bilateral incomplete sacralisation or lumbarisation.Conditions affecting the assessment of Upper Limbs1.9.7. Amputations. Candidate with an amputation of an upper limb will not be accepted for entry. Amputation of terminal phalanx of little finger on both sides is, however, acceptable1.9.8. Fingers and Hands. Deformities of the upper limbs or their parts will be cause for rejection. Syndactyly, polydactyly will be assessed as unfit except when polydactyly is excised.1.9.9. Wrist. Painless limitation movement of wrist will be graded according to the degree of stiffness. Loss of dorsiflexion is more serious than loss of palmer flexion.1.9.10. Elbow. Slight limitation of movement does not bar acceptance provided functional capacity is adequate. Ankylosis will entail rejection. Carrying angle of more than 15 degree for male and more 18 degree for female candidates will be a cause for rejection.1.9.11. Shoulder Girdle. History of recurrent dislocation of shoulder will entail rejection.1.9.12. Clavicle. Malunion / non-union of an old fracture clavicle will entail rejection.Conditions affecting the assessment of Lower Limbs1.9.13. Hallux Valgus. Mild cases (less than 20 degrees), asymptomatic, without any associated corn / callosities / bunion, are acceptable. Other cases will entail rejection. Shortening of first metatarsal is also considered unfit.1.9.14. Hallux rigidus. Hallux rigidus is not acceptable.1.9.15. Hammer Toes (single or multiple). Isolated single flexible mild hammertoe with no history of disabling symptoms may be accepted. Fixed (rigid) deformity or hammertoe associated with corns, callosities, mallet toes or hyperextension at metatarsophalangeal joint (claw toe deformity) is causes for rejection.1.9.16. Loss of Digits. Loss of any digit of the toes or fingers entails rejection.1.9.17. Extra Digits. Extra digits will entail rejection if there is bony continuity with adjacent digits. Cases of syndactly or loss of toes/fingers will be rejected.1.9.18. Flat feet. Feet may look apparent flat. If the arches of the feet reappear on standing on toes, if the candidate can skip and run well on the toes and if the feet are supple, mobile and painless, the candidate is acceptable. Restriction of the movements of the foot will also be a cause for rejection. Rigidity of the foot, whatever may be the shape of the foot, is a cause for rejection.1.9.19. Pes Cavus and Talipes (Club Foot). Mild degree of idiopathic pes cavus is acceptable. Moderate and severe pes cavus and pes cavus due to organic disease will entail rejection. All cases of Talipes (Club Foot) will be rejected.1.9.20. The Ankle Joints. Any significant limitation of movement following previous injuries will not be accepted. However, cases with no history of recurrent trouble and having plantar and dorsiflexion movement of at least 20 degree may be assessed fit for ground duties. Fitness for aircrew duties will be based on functional evaluation.1.9.21. The Knee Joint. History or clinical signs suggestive of Internal Derangement of Knee will need careful consideration. Fitness in such cases will be based on functional evaluation and possibility/progression/recurrance of the treated pathology.1.9.22. Genu Valgum (Knock Knee). If the distance between the internal malleoli is less than 5 cm, without any other deformity, the candidate is considered fit. If the distance between the two internal malleoli is more than 5 cm, he should be declared unfit.1.9.23. Genu Varum (Bow Legs). If the distance between the femoral condyles is within 10 cm the candidate should be considered fit.1.9.24. Genu Recurvatum. If the hyperextension of the knee is within 10 degrees and is unaccompanied by any other deformity, the candidate should be accepted as fit.1.9.25. Hip Joint. True lesions of the hip joint will entail rejection.CHAPTER 10CENTRAL NERVOUS SYSTEMRelevant Personal History1.10.1. Mental Illness. A candidate giving a history of mental illness/psychological afflictions requires detailed investigation and psychiatric referral. Such cases should normally be rejected. Most often the history is not volunteered. The examiner should try to elicit a history by direct questioning, which may or may not be fruitful. Every examiner should form a general impression of the candidate’s personality as a whole and may enquire into an individual’s stability and habitual reactions to difficult and stressful situations.1.10.2. Insomnia, Nightmare, Sleepwalking or bed-wetting. History of insomnia, nightmares or frequent sleepwalking, when recurrent or persistent, will be a cause for rejection.1.10.3 Severe or ‘throbbing’ Headache and Migraine. Common types of recurrent headaches are those due to former head injury or migraine. Other forms of occasional headache must be considered in relation to their probable cause. A candidate with migraine, which was severe enough to make him consult his doctor, should normally be a cause for rejection. Even a single attack of migraine with visual disturbance or ‘Migrainous epilepsy’ is a bar to acceptance.1.10.4. Fits and convulsions. History of epilepsy in a candidate is a cause for rejection. Convulsions/fits after the age of five are also a cause for rejection. Convulsions in infancy may not be of ominous nature provided it appears that the convulsions were febrile convulsions and were not associated with any overt neurological deficit. Causes of epilepsy include genetic factors, traumatic brain injury, stroke, infection, demyelinating and degenerative disorders, birth defects, substance abuse and withdrawal seizures. Enquiry should not be limited only to the occurrence of major attacks. Complex Partial seizures may masquerade as “faints” and therefore the frequency and the conditions under which “faints” took place must be elicited. Such attacks indicate unsuitability for flying, whatever their apparent nature. An isolated fainting attack calls for enquiry into all the attendant factors to distinguish between syncope and seizures. For e.g. fainting in school is of common occurrence and may have little significance. Other complex partial seizures may manifest as vegetative movements as lip smacking, chewing, staring, dazed appearance and periods of unresponsiveness. In any event, a prolonged period of freedom from recurrence must have elapsed before fitness for flying duties can be considered and if the electroencephalogram does not show any specific abnormality.1.10.5. Heat stroke. History of repeated attacks of heat stroke, hyperpyrexia or heat exhaustion bars employment for air force duties, as it is an evidence of a faulty heat regulating mechanism. A single severe attack of heat effects, provided the history of exposure was severe, and no permanent sequelae were evident is, by itself, not a reason for rejecting the candidate.1.10.6. Head Injury or Concussion. A history of severe head injury is a cause for rejection. The degree of severity may be gauged from the history of duration of Post Traumatic Amnesia (PTA). Mild brain injury is associated with 0-1 hour PTA, moderate with 1 – 24 hours PTA, severe with 1-7 days PTA and very severe with > 7 days of PTA. Other sequalae of head injury are post concussion syndrome which has subjective symptoms of headache, giddiness, insomnia, restlessness, irritability, poor concentration and attention deficits; focal neurological deficit, posttraumatic epilepsy and posttraumatic neuropsychological impairment which includes deficits in attention concentration, information processing speeds, mental flexibility and frontal lobe executive functions and psychosocial functioning. Neuropsychological testing including pyschometry can assess these aspects. It is important to realize that sequelae may persist for considerable period and may even be permanent. Fracture of the skull need not be a cause for rejection unless there is a history of associated intracranial damage or of depressed fracture or loss of bone. When there is a history of severe injury or an associated convulsive attack, an electroencephalogram should be carried out which must be normal. Presence of burr holes will be cause for rejection for flying duties, but not for ground duties. Each case is to be judged on individual merits. Opinion of neurosurgeon and psychiatrist must be obtained before acceptance.Family History1.10.7. History of Psychological Disorders. When a history of nervous break down, mental disease, of suicide of a near relative is obtained, a careful investigation of the personal past history from a psychological point of view is to be obtained. While such a history per se is not a bar to air force duties any evidence of even the slightest psychological instability, in the personal history or present condition, should entail rejection.1.10.8. Epilepsy. If a family history of epilepsy is admitted an attempt should be made to determine its type. When the condition has occurred in a near (first degree) relative, the candidate may be accepted, if he has no history of associated disturbance of consciousness, neurological deficit or higher mental functions and his electroencephalogram is completely normal.1.10.9. Emotional Stability. The assessment of emotional stability the must include family and personal history, any indication of emotional liability under stress as evidenced by the occurrence of undue emotionalism as a child or of any previous nervous illness or breakdown. The presence of stammering, tic, nail biting, excessive hyperhydrosis or restlessness during examination could be indicative of emotional instability.1.10.10. Psychosis. All candidates who are suffering from psychosis are to be rejected. Drug dependence in any form will also be a cause for rejection.1.10.11. Psychoneurosis. Mentally unstable and neurotic individuals are unfit for commissioning. Juvenile and adult delinquency, history of nervous breakdown or chronic ill health are causes for rejection. Particular attention should be paid to such factors as unhappy childhood, poor family background, truancy, juvenile and adult delinquency, poor employment and social maladjustment records, history of nervous break down or chronic ill-health, particularly if these have interfered with employment in the past.1.10.12. Organic Nervous Conditions. Any evident neurological deficit should call for rejection.1.10.13. Tremors. Tremors are rhythmic oscillatory movements of reciprocally innervated muscle groups. Two categories are recognized: normal or physiologic and abnormal or pathologic. Fine tremor is present in all contracting muscle groups, it persists throughout the waking state, the movement is fine between 8 to 13 Hz. Pathologic tremor is coarse, between 4 to 7 Hz and usually affects the distal part of limbs. Gross tremors are generally due to enhanced physiological causes where, at the same frequency, the amplitude of the tremor is grossly enhanced and is elicited by outstretching the arms and fingers which are spread apart. This occurs in cases of excessive fright, anger, anxiety, intense physical exertion, metabolic disturbances including hyperthyroidism, alcohol withdrawal and toxic effects of lithium, smoking (nicotine) and excessive tea, coffee. Other causes of coarse tremor are parkinsonism, cerebellar (intention) tremor, essential (familial) tremor, tremors of neuropathy and postural or action tremors.1.10.14. Stammering. Candidates with stammering will not be accepted for air force duties. Careful assessment by ENT Specialist, Speech therapist, psychologist/ psychiatrist may be required.1.10.15. Basal E.E.G. Only those candidates for aircrew duties will be subjected to EEG examination as specified in para 2.9.13. Those with following EEG abnormalities in resting EEG or EEG under provocative techniques will be rejected for aircrew duties: -(a) Background Activity. Focal, excessive and high amplitude beta activity /hemispherical asymmetry of more than 2.3 Hz/generalized and focal runs of slow waves approaching background activity in amplitude.(b) Hyperventilation. Paroxysmal spikes and slow waves/spikes/focal spike pattern(c) Photo Stimulation. Bilaterally synchronous or focal paroxysmal spikes and slow waves persisting in post-photic stimulation period/suppression or driving response over one hemisphere.1.10.16. Non specific EEG abnormality will be acceptable provided opinion of Neuropsychiatrist / Neurophysician is obtained. The findings of EEG will be entered in AFMSF-2.CHAPTER 11EAR, NOSE AND THROAT1.11.1. Nose and paranasal sinuses.(a) Obstruction to free breathing as a result of a marked septal deviation is a cause for rejection. Post correction surgery with residual mild deviation with adequate airway will be acceptable.(b) Any septal perforation will entail rejection.(c) Atrophic rhinitis entails rejection.(d) Cases of allergic rhinitis will entail rejection for flying duties.(e) Any infection of para-nasal sinuses will be a cause for temporary rejection. Such cases may be accepted following successful treatment.(f) Multiple polyposis is a cause for rejection.1.11.2. Oral Cavity and Throat.(a) Candidates where tonsillectomy is indicated will be temporarily rejected. Such candidates may be accepted after successful surgery.(b) The presence of a cleft palate is a cause for rejection.(c) Any disabling condition of the pharynx or larynx including persistent hoarseness of voice will entail rejection.1.11.3. Eustachian Tube Dysfunction. Obstruction or insufficiency of eustachian tube function will be a cause for rejection. Altitude chamber ear clearance test will be carried out before acceptance for aircrew duties.1.11.4. Tinnitus. The presence of tinnitus necessitates investigation of its duration, localization, severity and possible causation. Persistent tinnitus is a cause for rejection, as it is liable to become worse through exposure to noise and may be a precursor to Otosclerosis and Meniere’s disease.1.11.5. Susceptibility to Motion Sickness. Specific enquiry should be made for any susceptibility to motion sickness. An endorsement to this effect should be made in AFMSF-2. Such cases will be fully evaluated and, if found susceptible to motion sickness, they will be rejected for flying duties.1.11.6. A candidate with a history of dizziness is unsuitable for employment on flying duties.1.11.7. Hearing loss.(a) Free field hearing loss is a cause for rejection.(b) Audiometric loss should not be greater than 20 db, in frequencies between 250 and 4000 Hz. In evaluating the audiogram, the baseline zero of the audiometer and the environmental noise conditions under which the audiogram has been obtained should be taken into consideration. On the recommendation of an ENT Specialist, an isolated unilateral hearing loss up to 30 db may be condoned provided ENT examination is otherwise normal.1.11.8. Ears. A radical / modified radical mastoidectomy, or a fenestration operation entails rejection even if completely epithelialised and good hearing is preserved. Cases of cortical mastoidectomy in the past with the tympanic membrane intact and presenting no evidence of disease may be accepted.1.11.9. External Ear. Cases of chronic otitis externa accompanied by exostoses or unduly narrow meatii should be rejected. Exaggerated tortuosity of the canal, obliterating the anterior view of the Tympanic Membrane will be a cause for rejection.1.11.10. Middle Ear. Tympanoplasty type I is acceptable twelve weeks after surgery, provided ear clearance test in altitude chamber is normal. The following middle ear conditions will entail rejection:-(a) Attic, central or marginal perforation.(b) Tympanic membrane scar with marked retraction.(c) Tympanoplasty type II onward but not type I(d) Calcareous plaques (tympanosclerosis) if occupying more than 1/3 of pars tensa.(e) Middle ear infections.(f) Granulation or polyp.(g) Stapedectomy/ Stapedolysis operation.1.11.11. Miscellaneous Ear conditions. The following ear conditions will entails rejection:-(a) Otosclerosis even if successfully operated.(b) Meniere’s disease.(c) Vestibular Dysfunction including nystagmus of vestibular origin.(d) Bell’s palsy.CHAPTER 12OPHTHALMIC SYSTEM1.12.1. Visual defects and medical ophthalmic conditions are amongst the major causes of rejection for flying duties. Therefore, a thorough and accurate eye examination is of great importance in selecting flying personnel.1.12.2. Personal and Family History and External Examination.(a) Squint and the need for spectacles for other reasons are frequently hereditary and a family history may give valuable information on the degree of deterioration to be anticipated. Candidates, who are wearing spectacles or found to have defective vision, should be properly assessed.(b) Ptosis interfering with vision or visual field is a cause for rejection till surgical correction remains successful for a period of six months. Candidates with uncontrollable blepharitis, particularly with loss of eyelashes, are generally unsuitable and should be rejected. Severe cases of blepharitis and chronic conjunctivitis should be assessed as temporarily unfit until the response to treatment can be assessed.(c) Naso-lachrymal occlusion producing epiphora or a mucocele entails rejection, unless surgery produces relief lasting for a minimum of six months.(d) Uveitis (iritis, cyclitis, and choroiditis) is frequently recurrent, and candidates giving a history of or exhibiting this condition should be carefully assessed. When there is evidence of permanent lesions such candidates should be rejected.(e) Cornea - corneal scars, opacities will be cause for rejection unless it does not interfere with vision. Such cases should be carefully assessed before acceptance, as many conditions are recurrent.(f) Cases with Lenticular opacities should be assessed carefully. As a guideline any opacity causing visual deterioration, or is in the visual axis or is present in an area of 7 mm around the pupil, which may cause glare phenomena, should not be considered fit. The propensity of the opacities not to increase in number or size should also be a consideration when deciding fitness.(g) Visual disturbances associated with headaches of a migrainous type are not a strictly ocular problem, and should be assessed in accordance with para 3.10.3 and 3.10.4. Presence of diplopia or detection of nystagmus requires proper examination, as they can be due to physiological reasons.(h) Night blindness are largely congenital but certain diseases of the eye exhibit night blindness as an early symptom and hence, proper investigations are necessary before final assessment. As tests for night blindness are not routinely performed, a certificate to the effect that the individual does not suffer from night blindness will be obtained in every case. Certificate should be as per Appendix “A” to this chapter.(j) Restriction of movements of the eyeball in any direction and undue depression/ prominence of the eyeball requires proper assessment.1.12.3. Visual Acuity/Colour Vision. The visual acuity and colour vision requirements are detailed in Appendix B to this chapter. Those who do not meet these requirements are to be rejected.1.12.4. Myopia. If there is a strong family history of Myopia, particularly if it is established that the visual defect is recent, if physical growth is still expected, or if the fundus appearance is suggestive of progressive myopia, even if the visual acuity is within the limit prescribed, the candidate should be declared unfit.1.12.5. Ophthalmic Surgeries. Radial Keratotomy, Photo Refractive Keratotomy / Laser in Situ Keratomileusis (PRK/LASIK) surgeries for correction of refractive errors are not permitted for any air force duties. Corneal Topography may be done in suspected cases. Candidates having undergone cataract surgery with or without IOL implants will also be declared unfit.Ocular Muscle Balance1.12.6. Individuals with manifest squint are not acceptable for commissioning.1.12.7. The assessment of latent squint or heterophoria in the case of aircrew will be mainly based on the assessment of the fusion capacity. A strong fusion sense ensures the maintenance of binocular vision in the face of stress and fatigue. Hence, it is the main criterion for acceptability.(a) Convergence(i) Objective Convergence. Average is from 6.5 to 8 cm. It is poor at 10 cm and above.(ii) Subjective Convergence (SC). This indicates the end point of binocular vision under the stress of convergence. If the subjective convergence is more than 10 cm beyond the limit of objective convergence, the fusion capacity is poor. This is specially so when the objective convergence is 10 cm and above.(b) Accommodation. In the case of myopes accommodation should be assessed with correcting glasses in position. The acceptable values for accommodation in various age groups are given in Table 1.Table 1. Accommodation Values - Age wise.Age in years 17-20 21-25 26-30 31-35 36-40 41-45Accommodation 10-11 11-12 12.5-13.5 14-16 16-18.5 18.5-27in cm.1.12.8. Ocular muscle balance is dynamic and varies with concentration, anxiety, fatigue, hypoxia, drugs and alcohol. The above tests should be considered together for the final assessment. For example, cases just beyond the maximum limits of the Maddox Rod test, but who show a good binocular response, a good objective convergence with little difference from subjective convergence, and full and rapid recovery on the cover tests may be accepted. On the other hand, cases well within Maddox Rod test limits, but who show little or no fusion capacity, incomplete or no recovery on the cover tests, and poor subjective convergence should be rejected. Standards for assessment of Ocular Muscle Balance are detailed in Appendix C to this chapter.1.12.9. Any clinical findings in the media (Cornea, Lens, Vitreous) or fundus, which is of pathological nature and likely to progress will be a cause for rejection. This examination will be done by slit lamp and ophthalmoscopy under mydriasis.HAEMOPOIETIC SYSTEM1.13.1. All candidates will be examined for clinical evidence of pallor (anaemia), malnutrition, icterus, peripheral lymphadenopathy, purpura, petechae/ecchymoses and hepatosplenomegaly.1.13.2. In the event of laboratory confirmation of anaemia (<13g/dl in males and <11.5g/dl in females), further evaluation to ascertain type of anaemia and aetiology has to be carried out. This should include a complete haemogram (to include the PCV MCV, MCH, MCHC, TRBC, TWBC, DLC, Platelet count, reticulocyte count & ESR) and a peripheral blood smear. All the other tests to establish the aetiology will be carried out, as required. Ultrasonography of abdomen for gallstones, upper GI Endoscopy/ proctoscopy and hemoglobin electrophoresis etc may be done, as indicated, and the fitness of the candidate, decided on the merit of each case.1.13.3. Candidates with mild microcytic hypochromic (Iron deficiency anaemia) or dimorphic anaemia (Hb < 10.5 g/dl in females and < 11.5g/dl in males), in the first instance, may be made temporarily unfit for a period of 04 to 06 weeks followed by review thereafter. These candidates can be accepted, if the complete haemogram and PCV, peripheral smear results are within the normal range. Candidates with macrocytic / megaloblastic anaemia will be assessed unfit.1.13.4. All candidates with evidence of hereditary haemolytic anaemias (due to red cell membrane defect or due to red cell enzyme deficiencies) and haemoglobinopathies (Sickle cell disease, Beta Thalassaemia: Major, Intermedia, Minor, Trait and Alpha Thalassaemia etc) are to be considered unfit for service.1.13.5. In the presence of history of haemorrhage into the skin like ecchymosis / petechiae, epistaxis, bleeding from gums and alimentary tract, persistent bleeding after minor trauma or lacerations / tooth extraction or menorrhagia in females and any family history of haemophilia or other bleeding disorders a full evaluation will be carried out. These cases will not be acceptable for entry to service. All candidates with clinical evidence of purpura or evidence of thrombocytopenia are to be considered unfit for service. Cases of Purpura Simplex (simple easy bruising), a benign disorder seen in otherwise healthy women, may be accepted.1.13.6. Candidates with history of haemophilia, von Willebrand’s disease, on evaluation, are to be declared unfit for service at entry level.1.13.7. Human Immuno Deficiency Virus (HIV). Seropositive HIV status will entail rejection.CHAPTER 14ASSESSMENT OF WOMEN CANDIDATES1.14.1 History. Detailed menstrual and obstetric history, in addition to general medical history, must be taken and recorded as outlined in para 2.13.2. If a history of menstrual, obstetric or pelvic abnormality is given; an opinion of gynaecologist is to be obtainedExamination1.14.2. General Medical and Surgical Standards(a) Any lump in the breast will be a cause for rejection. Cases of Fibroadenoma breast after successful surgical removal may be considered fit with the opinion of a surgical specialist.(b) Galactorrhoea will be cause for temporary unfitness. Fitness after investigation/treatment may be considered based on merits of the case and opinion of the concerned specialist.1.14.3. Gynaecological Disorders(a) Any abnormality of external genitalia will be considered on merits of each case. Significant Hirsutism especially with male pattern of hair growth will be a cause for rejection. Doubtful cases if any will be decided based on the opinion of the specialists.(b) A detailed pelvic sonography will be conducted. If any abnormality is detected, the candidate will be examined by the concerned specialist. Following conditions will not be a cause for rejection:-(i) Small fibroid uterus (3 cm or less in diameter) without symptoms.(ii) Small ovarian cyst (3 cm or less in diameter) as such cysts are invariably functional.(iii) Congenital elongation of cervix (which comes up to introitus).(iv) Congenital uterine anomalies such as bicornuate uterus, uterus didelphys and arcuate uterus.(c) Acute or chronic pelvic infection and Endometriosis will be causes for rejection.(d) Severe menorrhagia will entail rejection, since it is likely to interfere with work ability. Amenorrhoea without pregnancy will be investigated and fitness will be considered on merits after examination and investigation by gynaecologist.(e) Complete prolapse of uterus will be a cause for rejection. Minor degree, after surgical correction, may be considered for fitness on merits.(f) Any other gynaecological condition not covered above will be considered on merits of each case by gynecologist.(g) Pregnancy will be a cause for rejection during commissioning for all branches other than medical and dental, where temporary unfitness will be given till 24 weeks after delivery.THIS IS THE MAX I COULD DO TO BAFFLE UP ANY CANDIDATE OVER THE MEDICAL REQUIREMENTS. ^_^ XDCourtesy : http://dgcamedicals.in/IAFMedstd.htm

Usually I’ve just referred folks to an off-Quora site for this area of question, but it was suggested to me that I should try putting it here directly — so I’ll give it a try. This is Appendix C of my 2003 Dissecting Antismokers’ Brains. Things have changed a LOT since then as taxes on cigarettes have skyrocketed and as geriatric medical costs have gone up as well. The general brief answer to this question is that to be fair on a purely economic basis, IF the Antismokers are telling us anything NEAR the truth about how much smoking shortens one’s life, then taxes on cigarettes should pretty much disappear: I.E. instead of $14/pack in NYC, they’d be about $3 per pack.See more about the reasoning in the full Appendix below. Please forgive any pasting-transcription errors I miss (particularly with hyphenated end-of-line words from the printed version.Specific, substantive criticisms are, as always, welcome. Enjoy!Taxes, Social Cost, And the MSAGesundheit ist Pflicht! {Health is Duty!} - - Nazi Party slogan from the 1930sThe pure hard numbers of dollars and cents should be about as far away from the value judgments, psychological theories, and slipperiness of mutating word definitions as one could hope to travel. Even here though the arguments in the conflict between smokers and Antismokers are more open to varying interpretation than would be ideal.In the 1970s and 1980s Antismoking groups claimed that cigarette taxes should be raised because nonsmokers were being unfairly forced to pay extra taxes to care for old and sickly smokers. The argument of fairness is a powerful one and many smokers resigned themselves to a future of doubled or even tripled taxes. The spectre of cigarette taxes rising from the 20 cents or so that was common then to levels of 40, 50 or even 75 cents was daunting, but seemed in fairness to be unavoidable.As the 1980s drew to a close however, new information began to emerge. An article in The Journal of the American Medical Association looked at the social costs and taxes related to drinking and smoking and arrived at an unexpected conclusion. The analysis showed that to reflect true fairness smokers should actually get paid between 22 cents and $1.28 by nonsmokers for every pack smoked in order to equalize the societal costs and savings from their habit (Manning et al. “The taxes of sin; do smokers and drinkers pay their way?” JAMA: 261:1604 1989).The factor that had previously been ignored by Crusaders in their push to raise taxes that would pay their own salaries was the fact that, while statistics pointed toward smokers getting cancer and heart disease at younger ages and then requiring expensive care, those same statistics stated that smokers were dying earlier and thus were not running up long-term nursing home and geriatric care bills, or even collecting their fair share of pension and social security payments!Manning’s paper is not alone in its conclusions. The U.S. Office of Technology Assessment noted in 1993:Reduction or elimination of smoking would improve health and extend longevity, but may not lead to savings in health care costs. In fact, significant reductions in smoking prevalence and the attendant increase in life expectancy could lead to future increases in total medical spending, in Medicare program outlays, and in the budgets of Social Security and other government programs.And again in 1997 the economist W. Kip Viscusi found that “on balance there is a net cost savings to society even excluding consideration of the current cigarette taxes paid by smokers.” When those taxes were included, at the much lower tax rates of the time, Viscusi’s figures concluded that smokers were paying $0.85 cents more per pack than their ultimate social and medical costs. Based on these calculations, he noted, one could argue that "cigarette smoking should be subsidized rather than taxed" (W. Kip Viscusi. “From Cash Crop To Cash Cow.” Regulation Vol. 20, No.3 1997).These conclusions were similar to those reached in 1995 by a Congressional Research Service inquiry into the issue, and most significantly were strongly endorsed in 1997 in an editorially headlined study in the prestigious New England Journal of Medicine that concluded health care expenditures would actually rise if everyone quit smoking:Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs,--The Health Care Costs of Smoking, Barendregt JJ et al, N Engl J Med, 337(15):1052-7 10/09/97The only well-designed study prior to 2002 that ever attempted to dispute these conclusions was one conducted by Dutch researchers and reported in the Journal of Epidemiology and Community Health. The way they arrived at a contrary finding was by assuming that smokers, instead of dying three to eight years earlier than nonsmokers as is usually claimed by Crusading organizations, actually live to virtually the same age as their nonsmoking counterparts (W. Nusselder. JECH 07/ 08/00 - as reported by Andre Picard, Public Health Reporter).Dr. Nusselder claimed that while nonsmokers would live to an average of about 81.6 years, smokers would live to be 80.8 years themselves! That’s a difference of less than ten months… far less than any figures used anywhere else by Antismoking organizations or researchers when speaking of the effects of smoking. This study stood alone in its conclusions and seems to have been tailor-made to use before public bodies voting on tax increases. It certainly does not serve in any way to negate the other studies cited above, but for completeness, it should be noted.This brings us up to the latest study to hit the news: In May of 2002, just after New York City proposed a 1700% city tax increase that would raise the price of a pack of cigarettes to over $7, the Centers for Disease Control, with great fanfare, released a study claiming that smokers cost society $150 billion a year… or, not surprisingly, just about $7 a pack (CDC Works 24/7 tobacco).They arrived at that figure by using several tricks. About half the “cost” is from what they calculate as lost production for the state: something that used to be calculated only by communist and fascist governments. In order to arrive at $75 billion as a figure for that though, they had to make an assumption in the opposite direction to that made by Nusselder in the preceding study cited: they assumed that smokers die an incredible fourteen years earlier than nonsmokers!! (And of course, the main or even the only cause of all these premature deaths is assumed to be purely the habit of smoking.) The other $75 billion is made up largely of fantastical projections of health care costs while simultaneously ignoring any decrease in costs due to those projected early deaths. As a coup-de-grace, the $50 - $75 billion that smokers ultimately pay in cigarette taxes and fees is completely ignored.It would seem obvious that the entire argument of simple fairness would dictate not just a reduction of the onerous tax burden now being borne nationally by smokers, but its total elimination. Clearly such a conclusion obviously does not sit well with the Antismoking organizers whose paychecks are flowing from those taxes. But how could they argue against the cold actuarial reality of economic fairness? Always resourceful, never hamstrung by facts, the Crusaders have found a way – actually, several different ways.The first, and boldest, was simply to ignore reality and continue to claim that smokers were still costing society money. When the facts presented above would be raised against them, they simply claimed that such reasoning was based upon “immoral economics,” since it included the savings to health and social care systems that accrued when smokers died prematurely. “Immorality” and “Big Tobacco” go hand-in-hand in the public eye so this approach to what had started out as a purely economic question has been widely accepted and touted by the media.Even the courts, normally expected to confine themselves to facts and law, have been drawn to the moral argument. One of the very first cases that Big Tobacco lost against the states was heard before Judge Fitzpatrick in Minnesota. According to an article in the Minneapolis - St. Paul Star Tribune on Feb. 24th 1998:Ramsey County District Judge Kenneth Fitzpatrick reiterated Monday he will not let the defense claim, or hint, that the plaintiffs benefit financially from the fact that smokers tend to die prematurely.Judge Fitzpatrick also refused to allow the tobacco companies to bring up the fact that smokers were already paying into the state’s coffers through their taxes. In effect, the only thing he allowed to be brought before the jury was the calculation of the increased medical costs of sick smokers, without any consideration of the extra taxes they paid or the money saved by the state in geriatric and nursing home care. Legal economic considerations in court had been replaced by a judge’s sense of morality and his prejudice against Big Tobacco.Faced with fighting a case based upon a “Let’s Pretend” Alice-in-Wonderland type world such as this, the tobacco companies realized they had no chance of winning. They chose instead to let smokers pick up the tab for them and agreed to pay almost seven billion dollars to Minnesota while also renouncing all rights to privacy and attorney-client privilege with regard to their corporate documents and memos.Eventually, Big Tobacco cut a deal with the Attorney Generals from all the states that it had not already settled within courts and agreed to pay a fee, passed directly on to smokers, for every pack of cigarettes sold in the United States. This fee, currently equal in practical terms to roughly 60 cents per pack, acts as a direct federal tax upon smokers without ever having had to go through the legislative process of a tax increase. Indeed, virtually every newspaper article and network news mention of the money paid in the Master Settlement Agreement speaks of it as money coming “from the tobacco industry.” It’s never noted that the industry itself is in actually paying nothing: every penny comes directly from the pockets of smokers without their input, choice or legislative consent.Amazingly, despite the seemingly clear figures indicating otherwise, the tobacco industry gave in to demands that it should be held responsible for government health care costs without recognition of how those costs are balanced and more than balanced by pre-existing taxes and long-term savings. Why did they do this? Simply because, as noted above, it cost them nothing: they were allowed, even in a sense required, to pass all costs directly on to the consumers of their products.In return, they were guaranteed immunity from any future lawsuits and were also afforded guarantees that new and smaller tobacco companies would not be allowed to undercut their prices simply by being honest in their business practices. Finally, as a little-noted side bonus, the massive overhead of the taxes passed on to smokers have allowed the tobacco companies to hike their profit margins to levels never dreamed of before the settlement: who will notice or care much about an extra 10 or 15 cents added on to a product that already carries a $5 price tag?The second weapon deployed by the Antismoking Crusade in pushing for higher taxes has been to make use of the “Save the Children” argument examined earlier. Antismokers have claimed that every ten percent rise in cigarette taxes would result in a seven percent decline in teen smoking. This argument was heavily used in the 1989 California referendum that brought a 50 cents per pack increase to smokers and a 100 million dollar windfall to Californian Antismoking Lobbyists. It was also being used in 2002 as state-by-state polls paid for by Crusading groups purported to show widespread support for raising cigarette taxes.The polls were cleverly slanted by starting out with questions that have obviously emotive answers (“Are you concerned about smoking by young people?”), and then moving on to budget choices dealing with such things as cutting valued programs for children and the elderly, and finally including the specific image of children in the final question: “Do you favor or oppose a one-dollar per pack increase in the tobacco tax as part of an effort to reduce tobacco use, particularly among kids…?”In Pennsylvania 75% of the voters favored the increase mentioned in that final question, in a classic “three wolves and a sheep voting on the dinner menu” split (http://www.taxtobacco.com/Docs/Poll_Results.pdf).One has to wonder if social justice might have made a better showing if the poll was not so cleverly designed to play the “protect the kids” card. What if the wording had more honestly been “Do you favor or oppose a one-dollar per pack increase in the tobacco tax as part of an effort to reduce tobacco use particularly among lower-income adults…?” A poll worded in that way might well have yielded a result in which 75% of the voters voted against the tax increase rather than in favor of it despite the wolves and sheep motivation.In any event, despite the enormous tax rises of the last 15 years we've seen youth smoking rates increase by as much as 50% although there's been some downturn in the last three years or so among teen boys. If the statistics of the Antismokers were true teen smoking would be virtually non-existent at this point. Of course they're not true and teen smoking is still higher than it was back in the 1970s and 1980s when taxes were enormously lower, Antismoking ads on TV were almost non-existent, schools had smoking areas for student breaks, and the Antismoking budget was more like $9 million a year rather than $900 million.This general experience of rising youth smoking rates was duplicated in state after state throughout most of the 1990s, despite the fact that the massive tax increases were also accompanied by a truly fantastic increase in government-sponsored Antismoking media propaganda, widespread smoking bans, and hitherto unparalleled enforcement of underage sale penalties.The extra billions that smokers have been forced to pay to Antismoking efforts to vilify and ridicule themselves on billboards and in TV ads has generally done little other than enrich the Antismokers and impoverish the smokers. To add insult to injury, Antismoking organizations are now using that same money to crusade for even higher taxes in order to save even more of the children. As for the adult smokers who buy 95% or more of the cigarettes sold, they’re expected to simply grin and bear it… or even welcome the higher taxes as a blessing from Antismokers who are helping them give up their nasty habit!The third argument for further increasing the tax burden on smokers is not widely publicized outside of circles where a sympathetic ear is expected. That argument is simply that massive increases in the tax rates will force poorer smokers to give up the habit or sacrifice basic life necessities in order to pay for it. Once again the technique of doublethink is employed by Antismokers as they argue that an extra dollar or two a pack will make smokers quit while at the same time they continue to argue that smoking is an addiction worse than a two hundred dollars a day heroin habit. If their perception of the addictiveness of smoking were even slightly true, all that the extra dollar a pack would accomplish would be to make poor people who smoke even poorer while affecting wealthier people not at all, and leaving the smoking rate absolutely untouched.There is one further argument that has become increasingly common since the late 1990s. This argument is based upon the obvious fact that when you have 50 different states with many different tax rates, about half those states will be below the average and about half will be above. This basic statistical reality has opened the doors for Antismoking organizations to pummel legislatures with demands that state taxes be raised to at least that “average” amount, while ignoring the fact that as soon as they are, the “average” will have then increased to a new and higher level.On the high end of the scale, Antismokers will point to states like Alaska, California, and New York, and point out how well they are doing with all the money they are raising from their incredible tax rates, while ignoring the fact that in most cases those states with the highest tax rates are also losing an incredible amount of money to black marketeering and the crime that cigarette smuggling generates. At well over $5 an ounce, cigarettes in many states are now more valuable by weight than pure silver ingots! This is clearly reflected in the increased crime spiraling out of control as convenience stores are robbed, not of money, but of cigarettes. It is reflected as well in the social fracture that accompanies such crime and its acceptance by otherwise law-abiding citizens.Greedy tax grabs in the name of public health have resulted in similar disparities across borders overseas. Cigarette smuggling, and the human and economic costs involved in its control have now become a significant factor on the international crime scene. Individual “busts” have now reached the level of almost twenty million dollars apiece (“Irish Customs Makes Largest Cigarette Seizure” Reuters 12/11/01), and in China cigarette smugglers have even been executed (“China Executes Seven…” Reuters 02/23/01). Meanwhile, as national authorities were focusing on the multiple “Beltway Sniper” shooting investigation in October 2002, the FBI was being chastised for not devoting enough of its energy to stopping smokers from buying tax-free cigarettes on the Internet (Mike Godfrey. http://TaxNews.com 10/14/02).Overall, the push to increase cigarette taxes comes down to two basic motivations: Greed and Control. The greed of governments for increasing income without the negative repercussions of generalized tax increases, and the increased control over the poor by making smoking too expensive for them to regularly indulge in, have combined to create a tax monster that is out of control and growing stronger every day. Current efforts by international Crusaders are aimed at getting worldwide laws setting extortionate tax rates levels on cigarettes in every country that depends in any way on United Nations aid or benefits from the World Health Organization’s other activities. Anyone resisting these efforts is instantly branded as a tool of Big Tobacco.In August of 2000 a 500 page WHO report argued for a worldwide tax increase on tobacco products, using basically the same argument that American Crusaders used: tying the increase to a theoretical reduction in smoking rates “particularly among children.”One item of note with regard to this report: in terms reminiscent of a slur that’s been made against American tobacco companies (“We target the black, the poor, the young, and the stupid” – often cited by Crusading groups as being a quote from a tobacco executive) the UN report noted, in more politically correct language, that these Third World tax increases were important because “youth, poor people, and the less well-educated (Third World people) are more likely to respond to an increase in price.” Unlike the apocryphal tobacco executive quote, the UN focus is well documented (N. Koppel. Associated Press 08/08/00).A rose is a rose is a rose.Those specific, substantive criticisms are indeed welcome, and also any feedback on the good or bad aspects of quoting my entire Appendix for this rather than just linking to it somewhere.MJM, who wrote the above over FIFTEEN YEARS AGO! Sheeesh! And things have gotten SOOO much worse since then!