Mental and physical health, zero gravity among considerations

[00:00:00] Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. As the space industry grows in the coming decades, average Americans will have career opportunities in outer space. So how do we protect the health and safety of average civilians who may want to work and/or live in space? Today I am talking about countermeasures against space hazards with Dr. Michael Marge. He has a faculty appointment at Upstate in physical medicine and rehabilitation, and he's associated with the International Association for the Advancement of Space Safety. Welcome to "The Informed Patient," Dr. Marge.

[00:00:44] Michael Marge, EdD: Thank you very much.

[00:00:47] Host Amber Smith: Now we should clarify first, you're a doctor of education, is that right?

[00:00:50] Michael Marge, EdD: Yes.

[00:00:51] Host Amber Smith: So, have you always been interested in space? How did you get involved in this field?

[00:00:57] Michael Marge, EdD: Well, it's interesting. My education at Harvard was really, they taught me how to think, not what to think. And as a result, I've gone through a number of professional modifications in my life, starting with a focus on child psychology. Then I went into speech pathology. Then I went into public health. And I began to focus on the health and quality of life of people with disabilities and began to work for not only the Centers for Disease Control, but the National Institutes of Health (NIH), at the Department of Health and Human Services.

And that led me eventually to my work in space. Because I was approached in 2016 while I was at NIH by a colleague of mine at NASA (National Aeronautics and Space Administration) who headed up all of the health research being done on preparing astronauts for the journey to Mars. And he needed more research background and research resources to answer the challenging questions about maintaining the health and performance of astronauts in that long journey to Mars, which would be almost a year and a half: six months up, a year on Mars, and maybe six months back. That's two years. And to make a long story short, I asked Francis Collins, the director of NIH, if I have his permission to consult with the 27 institutes at NIH to see if they're interested in collaborative research with NASA.

And I did contact all of them, and 22 out of 27 were interested in working with NASA. And so we set up a NIH-NASA Collaborative Research Interest Group. And then that group has continued to collaborate with NASA on their specific problems with regard to the health of their astronauts. And that's how I got interested in it.

I studied the problems that NASA had to, rather wanted to address, such as problems related to space radiation, which they hadn't solved, and problems that dealt with microgravity, the loss of gravity in space. And in that process, I was then hired by NASA to be a consultant and to advance this research as it related to people with chronic health problems and people with disabilities.

[00:03:29] Host Amber Smith: Well, let me ask you though, because you, it sounds like you started out looking at astronauts, but astronauts are different from civilians. Is that right?

[00:03:37] Michael Marge, EdD: Correct.

Can you please explain?

Yes. And to make a long story short with regard to that issue,while I was at NASA, I asked them to expand their health research program to include the population of civilians who have notable chronic health problems and also have disabilities. Because the space industry in America, the US space industry, the commercial space industry, SpaceX, Virgin Galactic, Blue Origin, Axiom Space and so forth, Sierra Space, they all have been asking for the involvement of average civilians into space. They want space to become accessible to everybody.

And so my challenge was: "do you folks know anything about sending a person with Parkinson's disease, or cerebral palsy, or migraine headaches or diabetes into space? I mean, you're sending healthy astronauts, who have no health problems whatsoever, and they're highly educated, they've had over 1,000 hours of jet space flight and so forth, and then you're going to send an average civilian with atrial fibrillations into space. I said, do you realize what you're talking about?" Well, NASA immediately said, this is not their cup of tea. They said we will not expand our program. We'll stay focused on astronauts because we are known as the agency in government for space exploration. We are not disinterested in average civilians because we know that in the future, in the coming decades, thousands will be traveling in space, living in space, and working in space. So we anticipate the population of average civilians to go into space almost at the same rate as we experienced with commercial airlines. There'll be thousands, maybe millions, working and living in space.

[00:05:45] Host Amber Smith: How soon?

[00:05:47] Michael Marge, EdD: Well, members of the space industry are building what they call orbital platforms. These are like malls that will be up in space, maybe 300 to 400 miles above the earth, in orbit -- like the International Space Station is in orbit at 230 miles above the earth. These will be higher. And, they'll have shopping centers, hotels, you can look at the moon over the weekend, on a tourist visit. They'll have research laboratories with the actual researchers doing research in the area of pharmaceuticals, as well as in discoveries that deal with medicine.

They found, for example, cancer cells do not live in space. They die in space. They can't cluster because of microgravity. They found that the DNA of the cells actually change. So they feel they've opened a whole new area of cancer research that will have great implications for terrestrials, people here on earth.

So we anticipate new drugs, new manufacturing, new research being done in space, a lot of advantages. However, the human who goes into space is still heavily challenged by all of the hazards that they face as they go into space. Space is very dangerous.

[00:07:12] Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Michael Marge about the safety and hazards of space travel for regular people.

NASA has had a human research program since 2004, looking at the space hazards in biomedical risks. Can you give some examples of what they've found so far?

[00:07:35] Michael Marge, EdD: Yes. In preparation for a workshop we held, with the assistance of the National Space Council of the White House back in 2020, and also with the help of the space industry --we had all of the key space industries working with us through their association called the Commercial Space Flight Federation. They wanted to look at how can we prepare average civilians for space. So I did a complete, as much as one can do, a review of all the (medical and scientific) literature that dealt with the findings from NASA over its years of investigating the health and the impact of space on their astronauts. And what we found was that there are many, frankly, unreported adverse health outcomes.

And we discovered the reason that NASA did not report it was because their population is so small that individuals will begin to identify, against the HIPAA (Health Insurance Portability and Accountability Act privacy) regulations, who got that problem. We found that some of the individuals developed blood clots, edema, brain edema, blindness in one eye. I mean, microgravity is quite a dangerous place to work and live in, and without countermeasures, it's going to be very difficult to survive.

One of the major problems that NASA addressed was that immediate bone loss occurs after you're in microgravity for a short period of time. In some cases it was weeks. In some cases it was months. And the bone loss could lead to dangerous situations where the bone is so weak that it fractures, and it also affects muscle loss. So NASA has been working feverishly to combat that with exercise in medications, while their astronauts are in space.

Now for a healthy individual,bone loss can be combated fairly well, not completely, but fairly well if you live in microgravity for more than, say, 30 days or up to, say, three months. But for a person who may already have a chronic bone loss, such as in Paget's disease or someone with cerebral palsy, or someone with spinal cord injury, multiple sclerosis, you're going to send them into space with advanced bone loss and then have that exacerbated by further bone loss in space? We know nothing about the impact of space on that population, yet the industry wants to send everyone into space, which to me becomes a serious, a very serious problem.

[00:10:25] Host Amber Smith: How big of a threat is space radiation?

[00:10:29] Michael Marge, EdD: It's a very big threat. We've pretty well took care of the hazards of solar radiation from our sun. They have water bags inside the spaceship. They're able to put in zinc lining, and the spacesuits now, uh, can pretty well handle solar radiation. But the biggest danger is galactic cosmic radiation, the radiation from the stars. Once you leave the earth's atmosphere and you get into space, say 100 miles or 200 miles above the earth, you'll face galactic cosmic radiation. Very dangerous. Ionizing penetrates everything. And NASA does not have an adequate countermeasure for that yet.

They're still planning to send people to the moon next year. And I've asked them to please hold off until they've found a countermeasure for a galactic cosmic radiation. And their current approach is to say, "well, we will handle that by the amount of exposure when they leave the spaceship, once they land on the moon." I say, but that's not an adequate, how much time can they spend outside the spaceship? And they say, "well, we're working on that now. We don't know if it's two hours or three hours." But if the astronaut who's going to the lunar projects called at the Artemis project -- and they're going to the South Pole where they feel there's water. Now that's the first stop -- if they intend to get out to explore how much exposure can they have? This is radiation from the stars surrounding, within our universe, surrounding our solar system.

[00:12:15] Host Amber Smith: So the spacesuits protect from the sun...?

[00:12:19] Michael Marge, EdD: Yeah.

[00:12:19] Host Amber Smith: But not from other, from the galactic or cosmic....?

[00:12:22] Michael Marge, EdD: No. No. And the spacesuit does not protect, also, from flying debris, which is going at thousands of miles per hour, like a bullet. And if it penetrates any of the space suits, a person can live in space for 11 seconds. Their lungs explode if they're not protected. So if they leave the space ship, the space suit is essential in terms of their survival.

Do we know of astronauts that have suffered radiation damage? Well, when you say, "do we know of," I don't know who they are. But, we have found NASA reports that it affects the cardiac muscle. It affects other organs of the body. One of the Kelly twins (retired astronaut Scott Kelly) who was up there for more than one year, he said he's going to die of cancer, because he was exposed to space radiation, all types, both types, galactic as well as solar, for over one year. He said he expects to die from cancer due to radiation.

[00:13:27] Host Amber Smith: Hmm.

[00:13:27] Michael Marge, EdD: But we don't have any exact measure now of effects, except the studies that have been done in analog situations. NASA has said, "why do you want to do the research on civilians? Why don't you simply extrapolate the data that we have acquired all these years to the US population?" I said, "well, first of all, there're two problems. One is your 'n's' (numbers) are very small. When you report on, say, radiation affecting a cardiac muscle, you're speaking about an 'n' of one or two. If you're going to apply it to the US population, you've got to have much larger numbers in order to handle this appropriately. And the other thing is, the populations are quite different. The two populations are quite different. NASA's, their selection criteria is very exacting. They've got to have a master's degree. They've got to have, their astronauts have to have no underlying health problems that they can perceive at first. They can't be blind or deaf. They can't wear glasses. They can't have any heart conditions. They have to be completely healthy. Their performance is, they're physically fit.

Many Americans are not physically fit. They're smoking, and they're drinking, and they don't exercise. They're that in good shape. And also, NASA spends four to five years training their astronauts, at a cost of $5 million per astronaut. And the other thing that's very different is, they're medically supervised and monitored every single week. They get regular physicals and they found, for example, one of the astronauts -- they finally reported this, which was really surprising because NASA, as I said, does not report on their astronaut's health because of people being able to violate the HIPAA (privacy) Act -- one of their astronauts had completed three trips to the International Space Station, and he's ready to go on his fourth trip and develop atrial fibrillation. So NASA said, what are we going to do about this? We invested $5 million in this individual.So they sought the best cardiac surgeon in America to do an ablation surgery on this astronaut and eliminated the, at least at that point in time, his atrial fibrillation. And he went on his fourth trip to ISS.

Now, how many Americans face that kind of medical care? Very few. Well, they have $5 million invested in each astronaut, and they're a small number. You're talking about a handful. And the other thing that I have pointed out, which people in my writings and so forth, is that another major difference is that astronauts know that when they go into space, they face serious injury or death. Most Americans, most average civilians, if they were told, "your lungs will explode if the spacesuit is torn in any way and you lose all of the oxygen and so forth, and the pressure, your lungs will explode, and you'll die in 11 seconds." They will not want to go into space. So the risk issue, in my judgment, is another major issue.

A colleague of mine who was the medical director for SpaceX, for Elon Musk. Dr. (Anil) Menon is a emergency physician who was working for SpaceX for seven years as the medical director. He left SpaceX about three years ago to become a NASA astronaut, to go on the first trip to the moon. They're going to have a physician for the first time with them on the moon in case someone gets appendicitis or what have you. And so I asked him, I said, "are you willing to take the risk? You're a doctor." He said, "yes. I'm a risk taker. I've always been a risk taker. I like to climb mountains and things of that nature. It's part of my character. We all are risk takers. We know the dangers involved."

Now, if a person goes into space who is not a risk taker, they have to be pretty well informed about what the trip may entail, or we must make sure that space travel becomes as safe as possible and as comfortable as possible, where the person goes up there and comes back with the same status in health. If a person has cerebral palsy, and they go and work up in space for say, three weeks or 10 weeks, what have you, for a company, they should come back without having any exacerbation of their neurological problem. That's what I'm working toward.

[00:18:32] Host Amber Smith: So whether if they're working or as space tourists, let's talk about some of the potential health problems that civilians could face and the countermeasures that are being considered. You already mentioned microgravity and radiation. What about just isolation and confinement?

[00:18:52] Michael Marge, EdD: Yes. That, If a person has had depression, it will exacerbate the depression. The person will become depressed, even in short space travel because immediately when you leave the earth, there's a syndrome called Distance From Earth Syndrome. The farther you leave the earth, and you look back and see this, see our sphere become smaller and smaller, we've learned from even healthy astronauts, there's an anxiety that develops that they'll never be able to return. They've lost contact with this beautiful green verdant, lovely planet that we love, that we live in with trees and so forth. They're going to a sphere, which has nothing on it, but dust and rocks and things of that sort. It's a scary kind of a thing. How can they overcome it? We have not solved that problem yet. Even with other astronauts as a team, we're worried about anxiety and how it may lead to disruption in the travel. The greatest concern astronauts have is that someone goes berserk during a long trip.

[00:20:09] Host Amber Smith: I imagine.

What about sleep? Is it easier, or harder to get a good night's sleep in space?

[00:20:17] Michael Marge, EdD: It's very difficult. Your sleep deprivation is quite noticeable because you lose your concept of time, and your body clock changes rapidly. So deprivation is a problem. It does lead to not only depression, but loss of performance, acuity and skill. And they're very much worried about that.

You know, the trip to Mars is going to be six months. Well, if they launch from the moon, which they hope to, it'll cut the trip down by maybe a month. So it'll be five months in a little container going into space. And they intend to establish an installation on Mars. And it'll be six months back, or, maybe they'll land back on the moon. I'm not sure. They haven't worked all those details out yet.

That's a very hazardous journey. But, you know, after the moon and after Mars, they intend to go to Europa, which is the moon of Jupiter. That's four years, a four-year journey, given our current rockets and the speed of our rockets. They're working desperately to improve the speed from 37,000 miles an hour to double that or triple that so they can cut back the trip to Europa maybe in half. Make it two years.

In some of the discussions I've had at NASA, they talked about having some of the astronauts, of course, in sleep, long periods of sleep, and have the ship operated or monitored by one person. They alternate., They saw the movie "2001: A Space Odyssey" with HAL, and they do not want a computer to run the ship without a human actually in charge.That triggered a great fear among

the NASA folks.

[00:22:16] Host Amber Smith: I imagine.

You are listening to Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Michael Marge about how regular people can safely live or work in outer space.

Getting back to the anxiety. Do medicines for anxiety work in space, or what would they do if someone started freaking out?

[00:22:39] Michael Marge, EdD: Well, they're trying to reduce the number of drugs that they take in space. But from what I understand, the astronauts who have reported experiencing anxietywere able to overcome that. I don't know of any reports of humans, I mean civilians, rather, who have had that experience. I looked at the literature, and I couldn't find any reports.

But confinement is an issue. It's identified by NASA as one of the five space hazards.

[00:23:11] Host Amber Smith: Has anyone investigated pregnancy in space?

[00:23:15] Michael Marge, EdD: No. But they have investigated, well, they report that a woman who was pregnant should not go into space, because of the radiation exposure. And we don't know what microgravity will have.

The females who are selected to go into space now know about the impact of microgravity, and males also, impact the microgravity and space radiation on the reproductive organs. So one astronaut has decided that she willsave her ova (eggs), in the event she loses that capability when she goes to the moon. There'll be a woman going to the moon, and several, maybe, going to Mars. And in that case, knowing what radiation will do to the reproductive organs, they want to be able to save what they can, and that is an issue. Yes. They do not recommend women with who are pregnant to go into space.

The space medicine group, when we first looked at this issue of people going into space, had a list of people who should not go into space. People who have had strokes, for example, should not go into space. People who have had other neurological diseases, cardiac problems, and they got battered by groups saying, "you are depriving us of the right to determine our lives." And they were hit left and right. So no one wants to say you should exclude anyone from space. Except they did say recently, women who are pregnant should not go into space.

[00:24:58] Host Amber Smith: You mentioned that you got started in this looking at for people with disabilities and whether they could travel in space. What have you found on that?

[00:25:10] Michael Marge, EdD: Well, again, if you are familiar with the disability movement in America, people with disabilities do not want to be deprived of making choices. And although I would recommend that they wait until we have countermeasures, there are those who say, "look, if I want to commit suicide, it's my choice." You know, as I said. But from an ethical point of view, if I'm involved in the situation, I'm going to tell you I'll do everything I can to do no harm. I'm committed to do no harm to you as a professional in allied health. If you want to commit suicide, I can't control that, but I'm not going to be involved in the situation. I wash my hands clear of that.

Some of my colleagues in the disability movement feel that you should not deprive them, even though they don't know the potential outcome of sending a person with amyotrophic lateral uh, sclerosis (ALS, or Lou Gehrig's disease) into space.

There's an organization called AstroAccess. That organization is taking parabolic flights and sending people with disabilities in those flights. Parabolic flights, the plane goes up about, what, 35, 40,000 feet and dips down, and then makes about 12 different dips. And in the dips you experience microgravity for seconds, like 30 seconds, 40 seconds. You start floating. That experience is relatively, I would say, benign. I don't think it'll harm anyone. And a whole group of people with disabilities -- blind, deaf, individuals with cerebral palsy -- have had that experience. But now if you're talking about going into this microgravity for, say, three months or four weeks, I have no knowledge what's going to happen to the individual. I would not go into space. I would advise them not to do that. But I guess the issue is personal freedom and personal choice. So we're facing a conundrum here.

[00:27:21] Host Amber Smith: Well, you've given us a lot to think about. I really appreciate your time, Dr. Marge.

[00:27:27] Michael Marge, EdD: You're welcome.

[00:27:28] Host Amber Smith: My guest has been Dr. Michael Marge. He holds a faculty appointment in Upstate's department of physical medicine and rehabilitation, and he's associated with the International Association for the Advancement of Space Safety. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at donvoyages.com/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, Apple Podcast, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.