“At some point, everything’s gonna go south on you and you’re going to say, this is it. This is how I end. Now you can either accept that, or you can get to work. That’s all it is. You just begin. You do the math. You solve one problem and you solve the next one, and then the next. And If you solve enough problems, you get to come home.” -Matt Damon as Mark Watney, astronaut, in the movie The Martian.
Space exploration is one of those things that fascinates nearly everyone on Earth. On February 6, 2018, SpaceX launched the Falcon Heavy into the great beyond. Nearly everyone I know watched with fascination, rendering it not only the greatest car advertisement of all time, but another step in the direction of “to infinity and beyond…” Why does everyone want to watch a cherry red Tesla get shot into space to the tune of David Bowie’s Life on Mars? Because it’s freaking cool, that’s why. And because it gets us thinking beyond ourselves to what may be out there in the universe that we don’t yet know. But mostly because it’s cool and captures the imagination.
I’m as big a space geek as anyone else, which is why I have to count among my most favorite and absolutely coolest professional experiences the fact that I get to chair the Advisory Board of the Translational Research Institute for Space Health. TRISH, as it is known, is a NASA funded institute (managed by Baylor College of Medicine, in conjunction with MIT and Caltech) dedicated to planning for the medical and health needs of astronauts who will eventually undertake a mission to Mars, or at least to deep space, something contemplated to happen sometime after 2030. There may or may not be life on Mars, Mr. Bowie, but there will certainly be life hurtling towards the Red Planet. And if you, the reader, think you live with a lot of potential healthcare risk, you have got nothing on the guys that will undertake this mission. And I say guys because there is a possibility, for instance, that the radiation exposure from what is at least a two-year voyage into deep space could prove to be permanently damaging to female reproductive organs and hormone production. If that were found to be the case, then NASA would have to decide if women could safely make the trip, which has not yet been determined. But if it were, it would be an unusually legitimate reason for a lack of diversity, were that decision to be made.
You learn some wild stuff serving on the TRISH Advisory Board, which has a mission to help reduce the risks to human health in space. The Board is stuffed so thick with intellect that I feel like the token idiot in the room (perhaps it’s their diversity program?). There are astronauts (aka Carl Walz – noted for history’s longest stay in space at 196 days, a Nobel Prize winner (aka Dr. Robert Curl – noted for the discovery of Buckminsterfullerene, aka Buckyballs) and so many Ph.D.s, M.D.s and top-flight actual scientists that a political scientist (aka me) might feel a tad insecure. I did find out, however, that my role in the group is essential. The answer to the question, “How many rocket scientists does it take to work the inexplicably complicated coffee dispenser?” turns out to be zero. I figured it out. So there. There’s something to be said for practical skills that transcend any planet.
TRISH is looking to do a few specific things: identify and fund game changing healthcare technology that can be used on the mission, bring together a vibrant community of experts, entrepreneurs, innovators and others who can advance space health, and to develop a new pipeline of talented scientists interested in space health. The organization seeks out the best and most interesting and potentially applicable innovations that are newfangled and wildly unexpected as well as those that are based on mature technologies that can be tweaked for space. They have money to invest in the advancement of science and in companies and they want to hear from those with great ideas. They have awarded a bunch of money already and have a lot more to go – specific solicitations in the works will be coming out this year and for the next 4 years at least. Stay tuned HERE and I’ll also promote them on my website as they occur.
A key theory behind the TRISH approach is that by funding healthcare innovation, TRISH’s efforts will simultaneously advance the Mars mission and create an opportunity to advance healthcare here on earth. For instance, among the areas in which NASA is most interested in finding innovation are the following: mitigation of radiation effects; improvement of behavioral health under stressful conditions like isolation and confinement; methods and products to improve nutrition/food for health and performance; solutions to the impact of space flight/gravity on eye and lymphatic health, bone health, renal health, sleep; and the challenge that most medications do not last long enough to be safe for the entire trip, particularly if it’s longer than a two-year year journey.
If you take a good hard look at that list, the challenges faced by astronauts on an extended mission are not entirely unlike those of people as they age. Loss of bone mass, compromised hearing/sight, cancer prevention (and notably the impact of radiation treatment for cancer is relevant), loneliness/isolation, neurological impairment; I could go on and on, but if we are able to leverage NASA’s money to address the problems of the fastest growing population here on earth, seniors, we will have taken one hell of a large step for mankind. Pun intended.
One of the most interesting parts of the TRISH meeting, held within spitting distance of the Johnson Space Center in Houston – so cool – were the stories from the astronauts themselves. Both Carl Walz and Don Pettit (NASA’s oldest active astronaut and veteran of two long International Space Station expeditions) waxed rhapsodic about the actual user needs/patient requirements when in space. One of the things I found most interesting about their thoughts was that the priorities the astronauts focused upon first are primarily those related to functions of daily living while the top priorities discussed at the meeting by NASA leadership are more weighted to preventing long term health risk damage after the mission. Certainly they each had significant overlap in their priorities, but the prioritizations were of a notably different ilk.
One very stark example of this: astronauts are eager to ensure that Orion, NASA’s deep spacecraft currently in development, is being designed in a way that would not raise the risk of explosion (complex story about dual fault tolerant fuel propulsion system and how it might or might now be integrated). At the same time, Pettit explained, NASA is currently considering adding radiation shielding to Orion which would add 800 lbs of weight to Orion but also protect crew members from radiation exposure (thus reducing their risk of getting cancer years after the mission). It is possible that the weight of the radiation shielding could mean other items could not be adopted due to weight restrictions. Obviously not exploding and not dooming the astronauts’ later lives are both critical priorities for both NASA leadership and the astronauts, but it is interesting that such trade-offs even have to be considered. Pettit pointed out that the Russian equivalent of NASA designs for a much higher risk of cancer – nearly 3x that for which the American version allows. Such an interesting fact for so many reasons.
Pettit was asked specifically about what methods are best to ensure that the astronaut’s mental health remains stable during long periods of isolation in a small space, where you may not like all your roommates and have no tangible method of escaping them. Pettit pointed out that the best solution was first to choose people who are happy sitting in boxes, a pretty hilarious comment that made me think that my cats, Ruby and Luna, may be particularly well-suited to long term space flight. But Pettit was serious about the importance of this issue and it was high on both his and Walz’ list of priorities. They both spoke about the importance of windows in the capsule so one could look out and get perspective and marvel at the sights; they noted that the scene in the Right Stuff, where the astronauts nearly have to mutiny to get a window in the capsule was real and that the potential of this may re-occur since some drawings they had seen for future space compartments were windowless.
Walz pointed out that improving the food was a key priority for him and many of the astronauts, both to enhance taste and also to ensure optimal performance. Space apparently also raises body temperature – Pettit said his increased by over 1 degree and it made him eat ravenously, highlighting the need for decent and high-quality, highly functional food. I could not help think of that scene in The Martian movie where Matt Damon says, “It has been seven days since I ran out of ketchup.”
Walz also talked about the importance of miniaturizing medical equipment given the small size of the space and all of the crap they have to lug up there with them. Imagine this: 4 people on a two-to-five-year mission; only one is a physician, and someone has to have emergency surgery or deal with a kidney stone or get treated for cancer (and it could be the physician). There is no quick trip back to earth for this on the Star Trek transporter – you live or die in the capsule. Kind of an intense thought so I can imagine why Walz wants to ensure you can cram enough stuff onto the space ship to maximize the chances of survival.
Pettit talked about what he perceived to be one of the largest challenges faced on a prior spaceflight – toilets. Apparently when the canister is, ahem, full, a red light goes on and tells you it’s time to change it out. User-centered design flaw: it only tells you this when you sit down to do your business, not that you have been the person to fill it at the end of your visit to the latrine. Thus, when you take a very difficult-to-schedule break in your daily astronaut tasks to answer nature’s longer call, you may sit down to find the red light goes on; astronauts call this “winning the red light lottery.” The particularly bad news about this experience is that you can’t go until the canister is replaced and it takes about 10 minutes to assemble a new one, which may extend the entire bio break into a far longer experience than for which the highly structured NASA daily schedule allows. The astronauts themselves figured out it was prudent to keep an extra canister handy for those moments when you might be visited by Moon Man’s revenge, but it’s an interesting and important, if mundane, problem to consider if hardly as lofty as cancer prevention in a high radiation environment.
Pettit also told a story about how the astronauts were finding themselves with very itchy eyes for several months and kept asking NASA for ways to help, which did not arrive until it was determined that certain electric shavers send whisker fragments out into the capsule and into the eyes of the astronauts, causing the problem. Turns out that the astronauts used to bring their own shaving equipment of choice – some use safety razors, some electric of different brands. In the end it was determined that the certain types of electric razors sucked the whiskers into the shaver better, and now those are standard issue. Interesting how unintended consequences of everyday life can cause unexpected health impacts and how much these are amplified when you are hanging out in an enclosed box for long periods of time. Ruby the cat is paying rapt attention.
Since I could listen forever to these astronaut real-life stories, I’m going to keep going. Pettit also said that something about space flight makes all the callouses on your feet peel off in tiny and giant flakes, which float around the cabin making it both disgusting and a biohazard. This skin-shedding causes nasal congestion and dangerously clogs up the air filters. There is a pretty gross video about this that Pettit conveniently downloaded to YouTube so you can share the experience of a bunch of sweaty astronauts simultaneously experiencing catastrophic foot exfoliation. Ew.
If you have survived the video, how about this: astronauts are required to spend 2.5 hours every day exercising, split between cardio and weights (and including some dressing/showering time). How many of us spend 2.5 hours exercising any day, much less every day. Granted there are few movie theaters or golf courses in space, but wow, that’s a lot of time. I asked what the scientific basis for 2.5 hours is and it turns out…there really isn’t one except what they have observed using this methodology. Astronauts following this regimen tend to come home with no muscle loss or bone atrophy. But it is considered unethical to run an A/B experiment to figure out if a shorter period would be just as good. The pursuit of science is not always scientific, as we know well here on Earth.
I will close by saying say that it’s pretty cool to think about how audacious innovation for space may lead to dramatic innovation here on Earth…how an actual moonshot may result in a terrestrial medical moonshot being achieved, where those are so rarely generated for Earth first. At the TRISH meeting, Dr. Bill Paloski, Director of NASA’s Human Research Program said, “If we aren’t doing things that are risky enough we are not trying hard enough.” That is as an excellent observation for Earth-bound healthcare entrepreneurs, not just for aspiring space medicine innovators. I see so much incrementalism in the business plans I see as an investor. But it’s when you see something wildly audacious and seemingly impossible that you start to dream. And yet, finding the right balance between risk and reward is never easy when large amounts of money and real lives are at stake, no matter what your relevant profession.
And by the way, yes even NASA is focused on Artificial Intelligence for predictive analytics. It turns out that you can’t even escape the AI discussion in orbit – it’s everywhere. Notably, blockchain did not come up for a change.
So, watch this space (or the TRISH website) and I’ll keep you up to date when TRISH activates solicitations for specifically targeted areas of medical innovation. They are looking for things that can be ready to go by about 2026, when they hope to lock down the design for the deep space vehicle. In the meantime, NASA can test things on the International Space Station. 2016 seems like forever but in medical innovation it is actually not a lot of time, depending on what you are trying to create. Its 2018 and the clock is ticking. Entrepreneurs, time for liftoff. As Buzz Aldrin once said, “Mars is there, waiting to be reached.”
And by the way, the fabulously talented Dorit Donoviel is Director of TRISH. You can listen to her talk about space and cool stuff on the Tech Tonics podcast by clicking HERE and selecting episode 33 (you can also get to the podcast HERE).