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."