Biology of Business

Boeing 737 MAX: A flawed flight-control system

Dominic Gates

Seattle Times (2019)

TL;DR

MCAS system design and single-sensor reliance failures.

By Alex Denne

Pulitzer Prize-winning investigation documenting how MCAS eliminated redundancy that existed (two sensors) by design choice (reading only one), while path dependence locked Boeing into a flawed architecture that killed 346 people.

Key Findings from Gates (2019)

  • MCAS used only one of the 737's two angle-of-attack sensors—Boeing could have compared both
  • System authority increased 4x during development (0.6° to 2.5°) while single-sensor design remained
  • Boeing removed MCAS from pilot manuals on the same day the system was expanded
  • 346 deaths in Lion Air 610 (Oct 2018) and Ethiopian 302 (Mar 2019) crashes
  • 20-month grounding—longest for any U.S. airliner in history
  • Boeing costs exceeded $20B direct, $60B+ indirect from 1,200 cancelled orders
  • 2024: Boeing agreed to plead guilty to felony fraud, pay $487.2M fine (plea later rejected)

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