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At the beginning of Andy Weir's novel The Martian—soon to be released as a Ridley Scott film—astronaut Mark Watney finds himself injured and stranded on Mars.
"Fortunately, all of us had been trained in basic medical procedures, and the Hab had excellent medical supplies," Watney records in the mission log. "A quick shot of local anesthetic, irrigate the wound, nine stitches, and I was done."
That's far from the last curveball Mars throws at Watney, but nonetheless, the scene raises a salient point about the modern state of space healthcare. If humans are sincere about expanding our species to the Moon, asteroids, Mars, and beyond, one of our biggest obstacles will be staying alive over periods of months or even years in space. Will it really be as simple as Watney makes it out to be?
Given the health risks associated with cosmic radiation, microgravity, extreme isolation, and interplanetary spaceflight, safety is definitely not guaranteed. While the popularity of Mars One proves that there is no lack of volunteers for long duration spaceflight missions—and the Orion program demonstrates NASA's commitment to pursuing deep space targets—without advanced healthcare facilities and techniques, all of these efforts will be moot.
Fortunately, space medicine happens to be a thriving field, packed with interdisciplinary researchers working to untangle the quagmiric obstacle of healthcare access in space. Among their ranks is Dorit Donoviel, deputy chief scientist of the National Space Biomedical Research Institute (NSBRI) and an assistant professor at the Center for Space Medicine at Baylor College of Medicine.
I spoke with her about the challenges of administering medical care in space, and what kinds of research is being conducted today to prepare for the ambitious missions planned for the coming decades. If you regard yourself as something of a nascent Beverly Crusher, read on.
Motherboard: What are some of the essential medical tools and technologies that will enable humans to travel to deep space targets beyond low-Earth orbit?
Donoviel: To start with, you want to have the capability of doing general health surveillance. You are going to have colds, injuries, muscle strains, and a variety of things that will occur just like on Earth. Though you are pre-screening for individuals that are very healthy, even very healthy people do get sick and will have injuries. Being able to deliver a standard health package—surveillance, diagnosis, and therapy—that's one thing.
This is a challenge when you are away from a hospital or a clinic, in a situation where you really don't have the infrastructure or personnel support to provide it. You can send a physician, or a team of medically trained personnel, but generally those individuals are not specialists. If you do need a specialist for certain things, you are not going to have that capability.
You also need a crew that is very adaptable, and willing to do things that they have not done before. It will include a doctor, but maybe that doctor will get sick, or you need a backup.
We need to send individuals who are very trainable, able to improvise as medical professionals, and who are comfortable doing procedures that they have not done before, with "just in time" training.
What do you mean by "just in time" training?
[Astronauts] could practice on a phantom, or a 3D simulation, using computerized tools to practice the procedure, perhaps guided by specialists on Earth.
We're in a new age of 3D printing medications and surgical tools. Rather than having to send all kinds of medical tools or equipment or supplies, you can just 3D print whatever it is you need. And it's not just plastic material—you could 3D print fibres, medications, and biological samples. You could even 3D print an organ.
Say you wanted to practice taking out a tonsil, if someone has tonsilitis. You could 3D print something that you could practice on. These are all things that sound scifi but are actually here and now.
What kinds of medications would astronauts need to access on a long duration journey?
We don't even know how medications work in the microgravity environment. What happens to your body in space affects how medications are metabolized. So when you go into space, everything in your body changes in terms of fluids, blood volume, and how your organs work. Medications are greatly affected by the changes in the body. We don't know if medications will work as well—some do, some don't. All of those things have to be tested.
We also have to send self-stable medications. A lot of medications expire after a year or two, and the byproducts of those that do break down can be toxic. We have to think about all those things. You have to think ahead of time.
What kinds of technologies should space doctors be focused on developing over the coming years, in preparation for a manned mission to Mars?
Mars is incredibly dangerous and incredibly challenging. We should do it. We should absolutely do it. But it's not the first step. I do believe that before we go to Mars, we need to do missions like visiting a Near Earth Object—perhaps an asteroid—or going back to the Moon. Places where you are much further away, and you really have to think about really becoming autonomous.
Could the International Space Station be used as a testing ground for producing an autonomous medical facility in space?
If there is a medical emergency [on the ISS], within a few hours, you are going to bring that sick crewmate back. When you have that as an option, when Mom and Pop are right there and you have that safety net, you are not driven to be truly independent. We are not really building for that eventuality because the NASA budget is limited.
When something breaks, for example, [the ISS astronauts] have to wait for the next launch to send up another replacement part. If you have a critical piece of medical equipment or anything else, you are still not autonomous. You have to develop that capability if we are ever going to actually colonize or live on the surface of another planetary body, and we are still very far away from doing that.
What kinds of healthcare issues do you expect astronauts might encounter on a long duration spaceflight mission?
The real elephant in the room is radiation. We do know that we can block certain kinds of radiation, but not all of it. Galactic cosmic rays can do some serious damage to the body and we have no way of shielding against them right now.
On a trip to Mars, for example, you are exposed to all of these radiation particles. While they are at a low dose, we know that over time, damage can accrue and eventually will put astronauts at a higher risk for cancer, cataracts, and all kinds of other things. You will probably develop some problems. It'll probably exacerbate heart disease and bone loss.
So, one thing that I'm really worried about is that we have not been investing in radiation countermeasures. Because we can't really shield against these things, what we need to do is develop medications that can allow us to overcome some of the damage, like antioxidants. There are ways to minimize the bad effects of the radiation.
What NASA has been focused on is estimating the risk. But their predictions are based on a lot of assumptions with huge error bars, so even if they figure out the risk, they may be completely off by two orders of magnitude. I really believe that we need to work on medications. We need more evidence-based study on what we can use to protect people from long-term effects of radiation.
Another major medical issue that I need to mention is intracranial pressure. We think there might be elevated intracranial pressure in astronauts that is causing some vision problems [collectively known as Vision Impairment and Intracranial Pressure (VIIP)].
Astronauts are developing some pathologies around the optic nerve which suggest that there may be increased pressure on the brain. It has to do with the fluid shift with regards to lack of gravity. The vision changes are no problem [on the ISS], because we can send different pairs of glasses. But the optic nerve itself may be degenerating because of the pressure, and that can lead to vision loss. That's a concern.
Is there any way to treat these instances of VIIP?
[The ISS One Year Crew] is participating in a study called Ocular Health that NASA is conducting. They are basically doing longitudinal measurements every month or so on the astronauts' eyes.
Right now, we cannot measure pressure on the brain in space, because it requires an invasive procedure. What we've been focused on is finding a non-invasive, simplified way to measure all of these things in the space environment. For example, a really cool device, which I think is going to even change the way we do medicine on Earth, is an ultrasound-based device that can tell the pressure of the brain based on the blood flow of the eye.
This is something that we want to fly on ISS. This is something that we can certainly be testing. On a long duration mission, you are going to want to be able to assess pressure on the brain, especially if you suspect that space travel may actually cause [VIIP].
Pressure on the brain—it's not good. It's not only going to make you lose vision but also other cognitive functions, and you can die from it if it's uncontrolled. That's something that we are definitely working hard on.
What about the training process for the astronauts? What are some of the mental and physical preparations that might be involved in the lead-up to an interplanetary voyage?
We did this Mars 500 study in Russia, where an international crew of six men were isolated for 520 days simulating a mission to Mars. We were the only organization that participated on behalf of the US and what we found is that over time, people started to move less and less because they were closed off in this small chamber.
Even though they still made sure to exercise, their overall mobility dropped. People tend to hibernate more in a closed environment. So in preparation, the crew would have to be very resilient emotionally, and motivated to exercise.
Moreover, some specialists have even talked about removing the appendix before flight, just in case—so that if they do develop appendicitis, it is not a life-threatening case.
They would have to be very well-trained on engineering systems, too. Everything that can possibly break down will break down. If you talk to most astronauts, they will tell you, everything breaks down. So, the simplest things are actually the best.
I love the story, for example, about the US space program spending a lot of money on a pen that would work in microgravity, whereas the Russians just used a pencil. That's the point. The more complicated your solutions, the more difficult they are going to be to fix.
How far away do you think we are from achieving the first manned missions to distant bodies like asteroids or other planets?
I really feel like space is where commercial aviation was 60 years ago. People thought it was a big deal to fly across the world, and now we don't even think about hopping on a plane and being in Japan the next day.
So, low Earth Orbit is like the Wright Brothers taking that first flight. Essentially that's where we are. But I truly do believe that spaceflight will become more routine.
Modern Medicine is a series on Motherboard about how health care and medical technology can move forward so rapidly while still being stuck in the past. Follow along here.