Dr Thomas I Lemon explores the concept of deep space medicine and healthcare.
Space medicine is not a new concept. Professor Hubertus Strughold, a leading German Luftwaffe, first coined the term when he was taken to America in 1947 as part of Operation Paperclip. It was during this time he helped design the suit astronauts use today.1 However, the potential for workforces and communities to settle in deep space is becoming ever more probable. I’ll now explore some of the qualities, challenges and methods considered in relation to the practice of medicine in space.
Life on Mars
Mars One is a not-for-profit project aiming to establish a community living exclusively on Mars by 2023.2 Applications are open to the world with over 78,000 already signed up (http://applicants.mars-one.com/). This reflects a global, rather than a national effort towards solar system and planet explorations – currently space exploration budgets are decided on a nation-by-nation basis.2
Mars One believes that by establishing life on Mars there will be acceleration in our understanding of the solar system and other origins of life. The recent rise in notoriety of companies, such as Planetary Resources, with the potential for mining on asteroids, suggests space is rapidly becoming an environment that could host human life, and therefore an accompanying need for healthcare is emerging.
"Physician recruitment from the general physician pool is inevitable"
Space exploration remains a multi-billion pound project, with the US being the largest investor in its space programme with an annual spend of $18 billion, and countries such as Iran spending as much as $500 million annually.3 There is also external funding from innovative routes such as space tourism, raising up to $25m per trip.
Could you be a space doctor?
While some doctors have trained as experts in space medicine or as astronauts, there are not enough of them to provide the services required by the Mars One project, or indeed the support needed for the proposed meteor mining. Thus physician recruitment from the general physician pool is inevitable, and as a cross range of medical specialties will be required, it’s likely to be an opportunity open to many of us in our careers.
It is possible to draw strong similarities between the five domains Mars One pinpoints as making the ideal astronaut and with those of doctors.2
Mars One describes the importance of persistence and productiveness, having a ‘can do’ attitude and an indomitable spirit. Surviving medical school is a resolute example of one’s resiliency, but throughout our working lives, medical professionals demonstrate productivity – working to tight NHS guidelines, meeting waiting list targets, teaching and most importantly looking after patients. The trainees of today are working in an everchanging workplace, with increasing amounts of competition and let downs.
"Ideal candidates are people who ask questions to understand, rather than for an answer and who disseminate knowledge for reasons other than showcasing their own skills"
There is extra resilience training available for medical professionals, for example, the US offers doctors the Professional Provider Resiliency Training.4 It’s interesting to see the US scheme describing resilience as a skill to help avoid burnout of health providers, in comparison to the Mars One ‘productive’ and ‘can do attitude’ assimilation of the term.
Astronauts should be able to adapt to any situation. A Mars One astronaut should be someone who knows their own boundaries, and draws from the uniqueness of different cultural backgrounds. For GPs and anyone carrying out a consultation, adaptability occurs every 10-15 minutes.
Medicine is culturally diverse – we are all submerged in it and we all have used our experiences in some way or another to amend our practice. Furthermore, all doctors who remain registered with the GMC are intimately aware of their boundaries and best practice.
Ideal candidates are people who ask questions to understand, rather than for an answer and who disseminate knowledge for reasons other than showcasing their own skills. In other words, Mars One desires intelligence and imagination.
As clinicians and scientists, curiosity is the driving force behind diagnosis, a defining skill of being a doctor. This diagnosis encompasses both intelligence and imagination and hence, curiosity is an integral part of the physician’s repertoire.
Ability to trust
Mars One describes the ability to trust in yourself and others, based on good judgment. This is related to flexible thinking, the ability to listen to others while working as a team and trust their judgment. In the medical world, teamwork is central, as demonstrated by an intriguing paper by Sexton and Helmreich.5 In the paper they discuss hierarchies and the reliance of consultant surgeons on teams, in comparison to aeroplane pilots.
"Mars One desire their applicants not to be constrained by initial education when looking to resolve new tasks"
Creativity and resourcefulness
Mars One desire their applicants not to be constrained by initial education when looking to resolve new tasks; this skill reflects imagination and intelligence once again. This is possibly the most difficult dynamic for the medical professional to relate to. For many years we learn by protocol, through the BNF and by using care pathways, to what extent our practice is intrinsically linked to our initial education.
However, as we grow more competent in our chosen fields, we may push these limits and become competent in a varied application of methods. This would of course be an important skill to have, being a space doctor with potentially limited medicines and equipment.
Hazards will differ greatly in space, for example, the odds of being killed by a meteor on Earth are roughly 1 in 250,000 which compare favourably to travelling in space.6 Beyond this, the obvious issues are access to fresh water, for which the space
population would remain dependent on water purification systems, access to suitable but in the short term with supplements, food and vitamins, which may be resolved to some extent with time.
Needless to say the daily commute is not going to be similar to the road rage riddled experience that is commonplace on Earth. A ruptured space suit or a faulty spacecraft are more likely to cause problems, as is being hit by space debris. All of these dangers are far more likely to result in a serious outcome than those experienced on Earth.
Weightlessness poses severe physiological variation and an interesting contrast to the obesity epidemic most of us are currently contending with. Muscle atrophy, hypotension, and loss of bone mass all pose added risk for an exploring astronaut, with the potential damage of a fall costing them their life.7
New research is finding proprioceptive ability is impaired in space, highlighting the key role robots will play in any space community. Also other problems include slower wound healing, and immune weakness. Current countermeasures include exercise and bisphosphonates, but these have not been trialled on long-term astronauts, which is what the Mars One project is proposing.
"As a space doctor, one must consider the potential for coming across new species, perhaps fully grown aliens or perhaps microscopic nano-viruses that our faithful Acyclovir has no chance against"
NASA explain how producing gravity is not complex, it simply requires a fast rotation around an axis, but carrying this out on an object the size of a space craft is costly and time consuming. However, NASA have developed a human-powered centrifuge, in which astronauts cycle on an exercise bike in 360 degree circles.8
Radiation is currently only dealt with by limiting an astronaut’s exposure.9 The radiation is low in Earth’s orbit, and is far less damaging than that found in deep space, and the longevity of stay that is proposed would be troublesome, with special shields having to be designed.10 The best material to block this high energy radiation is hydrogen. This brings polyethylene with its one carbon and two hydrogens into the mix, due to its high carbon density, and preferable to the heavy oxygen atom carrying water.
As a space doctor, one must consider the potential for coming across new species, perhaps fully grown aliens or perhaps microscopic nano-viruses that our faithful Acyclovir has no chance against. We have not been able to isolate any bacteria from outer space yet, but when we do, it seems micro bacterias and viruses are the most likely organism that we will encounter.11
Doctors practising in space will need to access portable advanced medical technology that may indeed lack functionality in space.
"Doctors practising in space will need to access portable advanced medical technology that may indeed lack functionality in space"
Robotic surgery provides steadiness in technique and minimally invasive incisions, helping to reduce potentially damaging blood loss .This will involve recruiting highly-skilled surgeons, who perhaps have been too busy with their surgical training to consider astronaut training as well. It also opens the door to potentially long-distance remote controlled robotic surgery – an exciting concept that could also revolutionise surgical delivery on Earth.
Telemedicine is not just the future of healthcare on Earth, but it will enable medical practitioners to contact with colleagues and experts back on Earth and use photographic discussion and video to discuss consultations and patients.12
Some believe this is the first stepping stone, with only surgeons being sent to space in the first instance to operate the ‘RoboDocs’, and the rest of health care being provided through a telemedicine interface. This will also provide an interface for ongoing medical education and experience transfer. Who knows, we may see a Mars Medical School in our lifetime, and the provision of this service would likely be dependent on telemedicine. With the potential for future research, this reinforces the need for additional teaching to medical undergraduates.13
Pharmaceutical production proves to be an ongoing difficulty, with long-term inhabitants outliving the life of pharmaceuticals. As such pharmaceutical production, or a regular and reliable transport service from Earth, will be essential.
It’ll be difficult to achieve everything we’ve achieved on Earth in space. The Space Centre astronauts spend their free time exercising and watching films or reading on the internet – quite different to the freedom provided by our atmosphere.
Here’s one to ponder – with Mars One being a ‘for life’ experience, participants won’t be returning to Earth, so what will happen with salary and wages? Imagine not needing to think or worry about money ever again, or indeed the opposite could be the case, with excessive insurance costs to cover health costs, increased litigation for bad health outcomes post treatment – only time will tell.
Space is an active research environment, where data and research findings are often used to instruct everyday therapy. Computerised Tomography (CT) and Magnetic Resonance Imaging scans were developed from technology used by NASA to take pictures of Earth.14 For example, NASA devised talking wheelchairs to create synthesised speech for aircraft and implantable heart defibrillators and weightlessness therapy, such as experienced by Stephen Hawking in 2007. Scientists are creating vessels that can be injected to fix problems at a cellular level, one cell at a time, a bespoke and intricate treatment that has amazing potential for all illnesses.
Space is exciting and at the cutting edge of medical research, with paradigm shifting findings and discoveries being reported. It offers a unique opportunity for the devoted academic.
Boldly going where no doctor has gone before
"Space, the final frontier, is fast becoming a current frontier"
Space, the final frontier, is fast becoming a current frontier. As the American frontiersman had to adapt and learn from the indigenous Indians, one may ponder if there is a form of life that may help tackle the space frontier.
With the movement of populations to planets there is going to be a demand for health care. This demand will become apparent as soon as 2023 if Mars One is successful. The qualities that Mars One desires is not that dissimilar to those of experienced clinicians, although new medicolegal issues and ethical issues will arise as a result.
Dr Lemon will be working as an academic foundation doctor from August 2014. He aspires to be an academic surgeon. Dr Lemon can be contacted at firstname.lastname@example.org.
Walker, A. Project Paperclip: Dark Side of the Moon. BBC News. November 21, 2005
Mars One. What are the qualifications to apply? Date Unknown
Berger, B. U.S. Budget Compromise Includes $18.5 Billion for NASA. Space.com (2011)
Adams S, Camarillo C, Lewis S, McNish N. Resiliency training for medical professionals. US Army Med Dep J. (2010) 48-55
Sexton J and Helmreich R. Error, Stress, and Teamwork in Medicine and Aviation: Cross Sectional Surveys BMJ (2000)
Wired. Asteroid Odds
Mann, A. Blindness, Bone Loss, and Space Farts: Astronaut Medical Oddities
NASA. Spinoffs (2009)
Kerr, R. Radiation Will Make Astronauts’ Trip to Mars Even Riskier. Science 340 (6136): 1031. doi:10.1126/science.340.6136.1031
Anon. Living in Space
Gray R. Alien Life Found Living in Atmosphere Claims Scientists
Yarrow-Jenkins A* and Lemon TI*.Telemonitoring Should Have a Central Role inFuture Healthcare. Int. Journal of General Medicine (2013) 6:357–359 DOI 10.2147/IJGM.S46100 PMID: 23690698
Lemon TI, Stone B A, Lampard R. Research Skills for Undergraduates – a Must! Perspectives on Medical Education (2013) 2:175 DOI 10.1007/s40037-013-0054-3
Ferrell K. Space the New Medical Frontier. Accessed 11/01/2014
« Hot topic: End of life care
Day in the life of an F1 in gastroenterology »