So You Want to Go to Space: You’ll Need Medical Clearance First

Space tourism isn't on the list of family vacation destinations yet, but that doesn't mean doctors shouldn't be thinking about pre-flight medical checkups.

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BRUCE WEAVER / AFP / Getty Images

SpaceX's Falcon 9 rocket blasts off as it heads for space carrying the company's Dragon CRX-1 spacecraft at Cape Canaveral, Fla., Oct. 7, 2012.

Space tourism isn’t on the list of family vacation destinations yet, but that doesn’t mean doctors shouldn’t be thinking about pre-flight medical checkups.

With Richard Branson selling $200,000 tickets for spots on his SpaceShipTwo, which he hopes will launch in 2014, space travel may not be so far-fetched. Or at least that’s what Branson and other commercial space travel companies are betting on. The Federal Aviation Administration (FAA) recently awarded grant money to Boeing, Space Exploration Technologies and the Sierra Nevada Corporation to develop safe vehicles for space travel. As the next frontier in exotic destinations, there may be big bucks in traveling to the unknown; some experts estimate [PDF] revenues in the first ten years of commercial space travel operations might reach between $600 million to $1.6 billion. If that’s the case, then it’s really only a matter of time before space-bound passengers line up at the doctor’s office to get medical clearance for extraterrestrial travel.

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“It’s a very real thing,” says Dr. Millie Hughes-Fulford, a professor at the University of California, San Francisco (UCSF) department of biochemistry and biophysics and part of a group of UCSF researchers who published a helpful paper outlining some of the unique issues that physicians conducting pre-flight physicals might consider, such as extraterrestrial effects on the body including motion sickness, muscle deterioration and exposure to radiation that could increase the risk of cancer. The paper includes a list of medical conditions associated with space flight, culled from health records of astronauts, as well as a tally of medical conditions that might be worsened in space, and potential treatments. “We are at the beginning and it is time to say, ‘heads up, this is coming at you,'” she says.

Granted, Fulford may be more passionate about the impending possibilities of space travel than most scientists, since she’s been there. She traveled on the Space Shuttle in 1991, as a NASA payload specialist aboard STS-40, a Spacelab mission dedicated to biomedical studies. She currently studies the effects of microgravity on immune function and infection, an interest triggered by the high number of otherwise healthy astronauts who became ill during the Apollo space missions. If astronauts are felled by infections in space, says Fulford, then it’s important to understand how extraterrestrial travel affects the immune system in order to find ways to make such journeys safer for ordinary citizens who may not be as physically fit.

With a casual space traveler, for example, a doctor may be faced with medical challenges like “Can my patient with a pacemaker participate in a suborbital Virgin Galactic flight?” and “What is the maximum allowable time my patient with osteoporosis can spend on vacation in a space hotel” before the effects of gravity erode his already brittle bones to a point where it becomes debilitating?

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The idea is to find ways to allow the most diverse group of medically able people to make the journey to space. “We have to think about civilians flying as opposed to what is currently pretty much only governmental astronauts. If we start to see that only completely healthy people will be able to fly, then we are going to see a drop in the number of people going,” says another of the paper’s authors, Marlene Grenon, an assistant professor of vascular and endovascular surgery at UCSF. “We need to address the people with medical conditions who would like to fly. If anyone can fly, there will be a lot of conditions that will be different in space, and we need to better understand these disease conditions in microgravity.”

Even less severe symptoms, such as motion sickness and loss of appetite, are common among veteran astronauts, so doctors should be prepared to assess less experienced vacationers for any health problems that could be aggravated or put the passenger at undue risk by space travel. If a patient has cancer, for instance, it’s possible space travel could expose them to radiation that would cause tumors to flourish, so a pre-flight evaluation would include warning the patient about the risk and possibly asking him to postpone the journey. Kidney stones are also more common among astronauts, due to dehydration, so establishing guidelines for passengers to drink enough fluids in space might also be a consideration.

As far-fetched as such preparation seems, more groups like the FAA and Aerospace Medical Association Commercial Spaceflight Working Group are proposing medical recommendations for space flight and starting  to draft proposals for regulating commercial travel. However, the authors note the the FAA’s Office of Commercial Space Transportation has not made specific medical requirements or disqualifications for space tourists, probably because overregulation deters interest and could hinder development. That’s more reason for physicians to take a stronger role in anticipating how they would evaluate potential space travelers, Fulford and her colleagues say, since doctors who clear patients for space will share the responsibility of issuing that clearance (and any potential health problems that result) with the commercial travel company selling the ticket.

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“There is definitely a trend toward more work being done in [space medicine] as the medical field catches up with what’s going on in commercial space transportation,” says Grenon, who is researching the effect of microgravity on the heart and on cells that line blood vessels. “This [effect] is important to understand with regards to long-duration space flight and exploratory missions. We feel that we are pushing the limits of our knowledge and really contributing to making journeys in space as safe as possible.”

It might seem they are getting ahead of themselves, but Fulford, for one, believes it’s never too early to start preparing, and estimates space tourism could be active in six to seven years. “As a country we are in the dull drones of thinking: ‘oh, we’re in the fiscal cliff.’ No one is looking to the future and saying, ‘we are in a great age. [But] we are in a great age, and I think it’s time to enjoy that. We have to recognize where we are [part of] the progress of mankind.” Which will eventually take us, she hopes, to infinity and beyond.