Long-term space flights: Pie in the sky?

Man was determined to explore space “because it's there,” and to satisfy human curiosity and the yearning to overcome challenges. It turned out that sending spacecraft to the moon and beyond has produced a treasure trove of spinoffs that routinely benefit the health of people around the globe. But for astronauts who actually exit the Earth's atmosphere, space travel has proven to be not so healthful. Unless solutions are found, the lack of gravity and the exposure to cosmic radiation, among many other problems, could be an almost insurmountable barrier to the very long space flights required to reach other planets or even for long-term habitation in floating space stations. The recent return to Earth of NASA astronaut and Expedition-46 Commander Scott Kelly after a historic 340-day mission aboard the International Space Station aroused interest in the effects of long stays in space on the human body. He grew in height by five centimeters because the lack of gravity allowed the spinal column to expand, but within days of his return, the vertebrae returned to their normal position. Other conditions such as reduced bone density and muscle depletion will take longer to treat. For example, body fluids and even whole organs shift; during weightlessness, fluids rise to the head and can put pressure on the optic nerve connecting the eye to the brain and harm vision, at least temporarily. Kelly, who made three spacewalks during his mission, was a unique subject in space research, because his identical twin brother Mark, a retired NASA astronaut, engineer and US Navy captain who remained on Earth, served as a perfect “control” whose physical and mental condition will be compared in detail down to the cellular level over the next year to Scott's. Dozens, if not hundreds, of studies will be published by NASA in the coming year on what was learned from Kelly's trip on the effects of long-term living in space. NASA had conducted many experiments on mammals from the same litter, but as these could not guarantee that they had the same genetic makeup, these experiments could not compare with the Kelly brothers' studies. The International Space Station, which has been occupied continuously and visited by more than 200 people since November 2000 as a place to conduct experiments and learn how to improve living conditions in space, is considered by NASA to be the springboard to its future explorations, including missions to visit an asteroid and Mars. ONE OF the Israelis who will keep a close eye on research involving the Kelly brothers' health is Dr. Yehezkel Caine, the London-born director for the last two decades of Herzog Medical Center, the growing geriatric/psychiatric hospital in Jerusalem. The son of a former chief of urology at Hadassah University Medical center, the modern-Orthodox physician came on aliya in 1959 and studied medicine including his specialty of surgery at the Hebrew University Faculty of Medicine. Caine initially studied aerospace medicine on a fellowship at the Ohio State University fellowship and subsequently completed an advanced course at Brooks Air Force Base in San Antonio, Texas. He also has a degree in industrial administration and served for a number of years as the surgeon-general (chief medical officer) of the Israel Air Force. He also has a degree in industrial administration and served for years as surgeon-general of the Israel Air Force surgeon. When the Jerusalem psycho-geriatric hospital was thinking of setting up a surgical department (which never happened in the end), Caine was brought in as a temporary director- general, his service was extended and continues to this day. Caine maintains his interest in the narrow specialty of aerospace medicine. There are only a few dozen Israelis in the field and just a handful of members around the world in the Space Medicine Association (AsMA), a group that promotes professional fellowship among colleagues in aerospace medicine and allied sciences. The Herzog director- general was for two years president of the International Academy of Aviation and Space Medicine and hosted its annual conference in Jerusalem in 2013. In an interview with The Jerusalem Post in his Herzog Medical Center office, Caine mentioned a story that involved AsMA. As chronicled by Wall Street Journal reporter Lucette Lagnado four years ago, the association had honored Dr. Hubertus Strughold, who had been recognized worldwide as the “father of space medicine.” The association had given out the Strughold Award since 1963 to a leading scientist or physician for outstanding work in aviation medicine. It turned out that the German émigré scientist – who had been enticed by the US to work in America's early space program before he might be picked up by the Cold War Russians to work in their space efforts – was an enthusiastic Nazi who had performed horrible experiments on mentally disabled and epileptic children as well as at the Dachau concentration camp where prisoners were exposed to very cold temperatures. “I met him several times at Brooks in 1978. I remember him as an old man who gave us seminars and had a library named for him. I never had a comfortable feeling around him,” Caine recalled. Strughold's portrait was on a Wall of Fame in Ohio, and AsMA's space medicine branch named a prestigious prize after him. He was supposed to be tried at Nuremburg, but he was spirited out with rocket scientist Werner von Braun as part of “Operation Paperclip.” It was an illegal operation by the US and British government that violated their laws, as it evaded the immigration authorities and gave him false documents, Caine continued. “It was clear in those days that the rockets the Americans were building could eventually go into space. They were already talking in the '50s about manned space flights.” In the late '90s, Caine was among those who raised questions about Strughold's honors. “I was approached by the German aerospace medicine association that was considering giving an award to him. We scratched the surface and discovered a lot of his story as a Nazi and even before in the 1930s. As a result, his name was removed from the Hall of Fame in Ohio, the US Air Force base dropped his name from its library and subsequently from the award.” AS FOR space-related medical spinoffs, there are many. Caine noted that at his hospital, two large oxygen generators supply the essential gas to 140 patients on ventilators. “We extract it from air using space technology,” he said. The technique comes from prespace technologies to create closed environments to see how humans adapt to a world in which it doesn't rain, there are no clouds or wind and food has to be grown for sustenance. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans, which are routinely used to diagnose diseases and to follow their development, could not exist without NASA-developed technology developed to get better images of the moon, said Caine. Radiation therapy for the treatment of malignancies resulted from work on the cyclotron at NASA's John Glenn Research Center in Cleveland. As muscles atrophy because of weightlessness in space, NASA developed electric muscle stimulators now used by those suffering from paralysis. Caine noted that a NASA center in Ohio created diabetic foot mapping to follow the effects of diabetes on the soles of the feet. Emergency beepers used by the elderly and sick who live alone that send a signal to a center like that of Yad Sarah were designed with NASA telemetry technology. Even kidney dialysis machines for those whose kidneys have failed resulted fro NASA technology built to remove liquids from the body. Implantable pacemakers to put heartbeats in order were based on NASA technology for using with satellites. Special foam used to make it more comfortable for astronauts to survive the vibrations and acceleration of liftoff is utilized in old age homes and hospitals to prevent pressure sores and improve the quality of sleeping in the immobile elderly. The space administration has registered a total of 1,700 medical and other spinoffs that it developed in the last 40 years, thanks to its space program, and the effort continues. NASA is now working on carbon nanotubes to diagnose and treat brain tumors, developing software to identify and treat depression and creating fiber-optic probes to find cataracts in the eyes. AVIATION MEDICINE, which morphed into aerospace medicine, has long been concerned with the effects of cosmic radiation on airline pilots and stewards/stewardesses who are regularly exposed to it. “Most commercial flights are well within the safety zone of radiation exposure. We recommend that women crew members don't fly during the first and last trimester of pregnancy” because of the risk of exposure to the radiation, which potentially can be teratogenic (cause organ malformations). Risks to passengers, with the exception of very-frequent fliers, are much less relevant than to air crews, said Caine. An Israeli company has developed personalized protection – a radiation shield that protects the pelvis from radiation. Yet thick, all-body shields are impractical because of their weight. The most dangerous flight routes the polar ones such as from Japan to Europe, he explained, as radiation there is most powerful. “Latitude and altitude are the most important factors. But you can shorten flight time. Pilots and other air crew are switched around so they are not constantly exposed to the highest levels of radiation.” Solutions will probably be found to cope with the effects of weightlessness on the body, but with the current technology, radiation problems have not been solved, said Caine. . Without a solution, manned flights to Mars will be harmful to health. “Theoretically, antioxidants in foods or food supplements could sop up free radicals caused by radiation if you have an overdose, but it's very unlikely that it would work with the amount one is exposed to in space, and it would not solve the major problem of other cellular damage,” he suggested. Without a solution, manned flights to Mars will be harmful to health. “Theoretically, antioxidants in foods could sop up radiation if you have an overdose, but it's very unlikely that it would work with the amount one is exposed to in space, and it would not solve the major problem of other cellular damage,” he suggested. As shuttle crews are cooped up in a small, isolated space for long periods, coping even with colds could be a challenge. In the 1960s, when Apollo 7 took off, the commander got a cold and “gave it” to two other astronauts, who spent all 11 days in the Earth's orbit coughing, sneezing and complaining. How could one fight viruses during a 30-month mission to Mars? As all the available medications in a pharmacy could not be taken with them to space, various pharmaceutical raw materials would have to be provided and drugs would have to be produced with some kind of 3-D printer to manufacture them in space. Space missions to Mars would take years to return to Earth, so medical teams would have to be on board to treat staff members and even perform operations. “Sophisticated surgery such as organ transplants wouldn't be performed on Mars or in space stations, but some surgery might be assisted by telemedicine and robots. A major problem is that it would take minutes for communications signals to travel from Earth to Mars, and such a delay can be critical in surgery.” The Herzog director-general – pointing to the only space image in his office (a photo of a Gemini space capsule with the reflection of sunlight on it, a NASA gift) – said with much seriousness that he would “jump at the chance” to fly to Mars if invited.

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