New era for 'space medicine' as scientists expand specialist care for astronauts

From the impact of radiation on our bodies to the effects of living in isolation and the emergence of remote medicine, the experiences of space exploration are helping shape how we deliver healthcare on Earth.

The rapidly growing commercial space flight sector is likely to lead to an exponential growth in the number of humans entering space.

That changing landscape is leading to a greater requirement for specialist medicine to cope with the demands of microgravity and radiation.

Ambitions to enter deep space and to travel to Mars in the generations ahead are also driving a change in how medicine is delivered in space, with more autonomy for astronauts who may one day be out of reach of remote healthcare from Earth.

Prevention is the keyword for astronauts on the International Space Station, with each assigned a space flight surgeon to monitor their health.

But when emergencies arise, the unique physical demands of living in space must be considered before applying treatment and care.

According to Dr Farhan Asrar, a Dubai-born associate professor at the University of Toronto, that has created an emerging market for space medicine.

“The greater distances we can travel, the greater challenges will arise and we will no longer be able to rely on Earth-based care, so developing this area of space medicine is hugely important,” said Dr Asrar, who is also chairman of the Human Performance in Space Life Sciences department at the International Space University in France.

“We are limited in the medication and medical equipment we can send to Mars so we need to find solutions before we look to travel there.

“Astronauts have not been to deep space or lived there so it will be a steep learning curve in how people respond to radiation.

“What we know on Earth gives us a baseline, but space radiation exposure and its carcinogenic effects is one of the key challenges we are looking at to see how it can be addressed.

“It also puts a strain on the heart, so we need to understand how it impacts our cardiovascular and neural systems.

“Not using our lower limbs in micro gravity in space changes the body, so counter measures need to be put in place such as regular exercise, as muscular atrophy and bone health are issues of going into space.”

New health tech

Space exploration has opened up new health technology on Earth, experts said.

With limited space on-board craft, engineering innovation is vital to provide effective new medical tools.

Small ultrasound devices plugged into an iPhone are the kind of innovations perfectly suited to extreme medicine and the space environment.

Another medical innovation used on Earth that originated in space is the ‘neural arm’, a precision robotic limb that now performs brain tumour-related surgeries.

It was developed from the Canadarm, which has the dexterity of a human arm and was created for use on ISS and the Space Shuttle.

“Space spin-offs have evolved seamlessly into our lives, particularly since Covid, and many started out in space or with space technology,” said Dr Asrar, who aims to establish a department of space medicine and centre for excellence to keep pace with demand.

“In medicine, the knowledge and expertise with isolation during the pandemic was already a common experience during astronaut training, so the physical and mental impact could be evaluated and learnt from.

“Modern telemedicine that we have seen post-pandemic also originated from treating astronauts in space. All that information has been transferable.

“In the past, only astronauts could go into space, now we have seen the private sector offer seats on space voyages.

“It is still expensive but as time passes the number of individuals going into space will increase, so we need to be ahead of the curve from a health perspective.”

Space tourism

At around $55 million a ticket, a journey to the International Space Station will be out of reach for the majority but as suborbital space tourism flights – that cost around $450,000 – continue to grow through companies like Space X, Blue Origin and Virgin Galactic, so will healthcare demands.

The Mars Dune Alpha programme in the US will monitor the effects of long-term isolation of four crew inside a 158-square metre, 3D-printed living space to simulate the health impact of a long-term mission to the Red Planet.

Crew include a biologist, structural engineer, physician and Navy microbiologist who will only be able to communicate with the outside world on a 22-minute time delay to replicate the distance to Mars from Earth.

It is hoped the cognitive and performance data gleaned will help shape health requirements for future space programmes.

Mark Hannaford, the founder of World Extreme Medicine, the global network delivering medical training and expertise, wants to expand the knowledge of space health, with upcoming medical courses for UAE health professionals.

“The idea of a voyage to Mars has shone a light on the medical requirements, how do we get people there and back again safely,” he said.

“For example, how do we protect women of child-bearing age if they want to have children, as space radiation is a massive consideration?

“Shielding costs weight and capacity so we need to ensure they do not have long-term health impacts.

“Technology and hand-held devices don’t make doctors out of non-medics, but they can help with diagnostics.

“Space travel used to be exclusive to the reasonably fit and healthy, now people can buy their way into space without that physical conditioning.”

In a recent World Extreme Medicine podcast, Mr Hannaford asked Dr JD Polk, Nasa’s Chief Health and Medical Officer, about how developments in space can improve healthcare on Earth.

“When we had the Zika outbreak we were able to work with aqua satellites to work out where the most likely breeding grounds were for mosquitoes, based on the soil and environment,” said Dr Polk.

“There are things that space brings to the table to benefit humankind on Earth that most people are unaware of."

He added that in medicine, the temperature probe they use in clinics to insert into a child's ear came from Nasa.

"That thermographic technology was used to tell how hot or warm a planet was via a satellite by Nasa," he said.

"There are many things being done on ISS that are inspiring, such as the work on Parkinson's disease, vaccination and stem cells.

"Microgravity allows different proteins to occur due to lack of gravity that could revolutionise pharmaceuticals."