- Email: [email protected]
Space life and biomedical sciences in support of the global exploration roadmap and societal development
Space Policy 30 (2014) 143e145
Contents lists available at ScienceDirect
Space Policy journal homepage: www.elsevier.com/locate/spacepol
Viewpoint
Space life and biomedical sciences in support of the global exploration roadmap and societal development Simon N. Evetts Wyle GmbH, Cologne, Germany
a r t i c l e i n f o
a b s t r a c t
Article history: Received 7 August 2014 Accepted 7 August 2014 Available online 26 September 2014
The human exploration of space is pushing the boundaries of what is technically feasible. The space industry is preparing for the New Space era, the momentum for which will emanate from the commercial human spaceflight sector, and will be buttressed by international solar system exploration endeavours. With many distinctive technical challenges to be overcome, human spaceflight requires that numerous biological and physical systems be examined under exceptional circumstances for progress to be made. To effectively tackle such an undertaking significant intra- and international coordination and collaboration is required. Space life and biomedical science research and development (R & D) will support the Global Exploration Roadmap (GER) by enabling humans to ‘endure’ the extreme activity that is long duration human spaceflight. In so doing the field will discover solutions to some of our most difficult human health issues, and as a consequence benefit society as a whole. This space-specific R&D will drive a significant amount of terrestrial biomedical research and as a result the international community will not only gain benefits in the form of improved healthcare in space and on Earth, but also through the growth of its science base and industry. © 2014 Elsevier Ltd. All rights reserved.
Keywords: Biomedicine Human spaceflight Exploration Healthcare
1. Introduction Research and development for human spaceflight requires us to examine questions in the physical and life sciences that cannot be investigated within the normal terrestrial environment. The constraints imposed by operating in space often lead to innovation in terms of hardware size, power and volume reductions. The environment and simulated environments (using ground-based facilities), offer opportunities for advancing fundamental and applied knowledge. Space provides exposure to microgravity, extreme radiation, vacuum and other stressors, which when encountered separately or in combination offer new insights into scientific processes, enable the development of new industrial capabilities and products and provide the opportunity for serendipitous gains inherent in activity at the boundaries of human experience [1,2]. Much of the research carried out requires the presence of people [3]. As the global space community prepares for deep space exploration, the manner, expected benefits and costs of following the Global Exploration Roadmap (GER) [4] must be scrutinised. The cost-benefit equation is complex, multifactorial and cannot be easily defined in advance; but it can and should be debated.
E-mail address: [email protected]. http://dx.doi.org/10.1016/j.spacepol.2014.08.001 0265-9646/© 2014 Elsevier Ltd. All rights reserved.
The main output of participation in the GER can be expected to be new knowledge in multiple fields (e.g. Ref. [5] and references cited therein). For example, in the biomedical area, more detailed knowledge of the mechanisms behind viral virulence [6] and insights in to vestibular disorders [7] will be possible. As the knowledge created is spread by the people who create or use it, it impacts unanticipated areas and further benefits arise as a consequence as positive externalities or ‘spillovers’ are accrued. As commercial entities making investment decisions do not necessarily benefit from these spillovers, they typically invest only up to the point at which their private returns are recognised. This will be at a lower level than that potentially available to society if positive externalities are exploited. Therefore the political decision to participate in endeavours such as the GER offers society a means to gain greater returns than might otherwise be possible, albeit for an initial, upfront cost. This of course is investment. The cost of setting up and participating in human space flight exploration is not insignificant. The technological, scientific and operational development required to expand human presence beyond low Earth orbit (LEO) will cost billions of dollars. Such costs mean that not only are a nation's pooled resources needed to participate, but that multiple countries need to collaborate through international cooperation as envisaged by the GER for this to become a reality. This collaboration not only shares the cost of the research, but also the risks.
144
S.N. Evetts / Space Policy 30 (2014) 143e145
2. Human health in space and on Earth A healthy population is fundamental to prosperity, security and stability e cornerstones of economic growth and social development. Poor health in rapidly ageing developed societies, however, damages the economic and political interests of a nation [8]. Because the health issues of society are growing and are proving so intractable, many sectors now impact and are impacted by human health, and many organisations are required to be involved in healthcare. As a consequence, co-operative action and creative, joined-up partnerships are needed if timely and effective solutions are to be found. The space industry can and should support this cause. Living and working in space is strikingly similar in many ways to accelerated ageing: muscle and bone mass is lost quickly, cardiovascular fitness deteriorates, the immune system weakens, and blood pressure control and neuromuscular coordination are both altered [9]. Across the globe the space industry, and in particular the key space agencies, are allocating large budgets towards attempting to reduce the deleterious effects of living and working in Low Earth Orbit (LEO) and to prepare for longer duration solar system exploration in the years ahead. In so doing a great deal of fundamental science will be undertaken, significantly strengthening our knowledge of the underlying principles and aetiology of the conditions in question. Space applications of these findings are growing and proving beneficial to the industry, but more importantly the applications and benefits to terrestrial healthcare are becoming evident and in certain spheres it is clear that potential breakthroughs in human healthcare may result. Our understanding of muscle and bone loss and countermeasures to these effects are chief amongst these. Both space and space analogue conditions, such as bed-rest and isolated environments, cause the body to decondition (i.e. to lose strength and capability) that in many respects resembles rapid ageing [9e11]. The lack of movement and muscular contraction, the lack of a gravity vector along the long axis of the body and the partial or full equilibration of body fluids that occurs in these environments are fundamental causes of the muscular, skeletal, neuromuscular, humoral and cardiovascular changes observed. The significant other circumstance that causes these effects is modern day living, but over longer time periods. By employing conditions that accelerate the effects of the modern, sedentary lifestyle on healthy subjects (astronauts), space biomedicine researchers have a unique tool to rapidly get to the roots of the issues at hand. Globally thousands of research teams are seeking the solutions to space deconditioning through ground based research using analogue space environment platforms or through actual space flight experiments. Operational human space flight uses the most effective and practicable solutions [12] and thus further advances our knowledge of the application of fundamental research for the maintenance of human health. The space deconditioning countermeasures used in space at present, however, are not perfect and thus indicate that much work is still to be done if the GER is to be followed. Society needs access to the conditions of the space environment to be able to effectively pursue this field of research and development (R&D). The R&D conducted under these conditions is mostly done through ground based research, with an important minority of work carried out through microgravity platforms such as parabolic flights, drop-towers and sounding rockets. Beyond this are the tip of the iceberg studies conducted in space. Access to these platforms enables life and biomedical science organisations to gain traction in a domain that is by its nature difficult to participate in. Consequently, the nations involved have the opportunity to be at the vanguard of a new societal endeavour which can realise significant benefits for human healthcare, and
which are transferrable to the terrestrial arena [13], a sector badly in need of support and innovation.
3. Terrestrial benefits The potential exists for developed societies to save billions of dollars each year if reductions in working-age ill health are possible. This will not come about from R&D, better practices and innovation from one industry, but from many, in particular those industries that during the current global economic downturn continue to grow. One such industry is the space industry, which in the UK between 2008 and 2012, despite an economic recession, grew by 7.3% [14]. The human spaceflight community has as a goal the elimination or significant reduction of musculoskeletal and neuromuscular disorders common with ageing. The space industry cites healthcare as one of the major benefactors of its activities. For example, one commonly known effect of time in space is the leaching of calcium from bones and a general reduction in their density and strength over time. For some astronauts the density of some bones has not recovered even years after their space mission [15]. When the stimulus for bone formation is reduced, for example by taking away impact forces felt during locomotion, it weakens, adopting a structure relevant to the new environment [14]. In certain ways this condition is like that seen in ageing. Space R&D teams are investigating the aetiology and treatment of this condition. The use of drugs, such as bisphosphonates [16], and activities such as impact and vibration exercise are all under evaluation as countermeasures [17]. In-flight countermeasure programmes, in particular since the advent of NASA's Advance Resistive Exercise Devise (ARED), do reduce the degree of bone deconditioning previously noted after long duration spaceflight, but a fully effective remedy which does not require the mass, power, volume and complexity of ARED, is needed for deep space exploration to be possible with minimal risk to the participants. With the successful achievement of this challenge will come important terrestrial healthcare benefits directly pertinent to the problem of brittle bones in the ageing society. A second example that illustrates how biomedical sciences can support the GER and in turn aid societal development is that of remote healthcare. Exploration mission crews will not have the medical ground support that current International Space Station missions have access to. With the distances involved, lack of Earth return capability and the communications delays that result, crews will be required to become more autonomous with respect to healthcare. All crew cannot be trained up to physician standards and indeed the one or two physicians that can be expected to be in the crew will not be expert in all medical fields. Furthermore, over the course of a two to three year mission it will be difficult to retain the highest levels of proficiency in all aspects of medical care. As a consequence, highly ‘intelligent’, remote care systems with significant databases and a broad expanse of capabilities will be required to support the crew. The databases will contain information specific to the crew members on board thus enabling a degree of personalised medicine to be applied where required. These systems will need to be small, low mass, user friendly and conservative with power. All of these characteristics are applicable to the paradigm shift in healthcare that can be expected in the next few decades as healthcare, in particular for the elderly, shifts from centralised, institutional care, to more peripheral, local care. Looking beyond the needs of the developed society, it can be seen that telemedicine technology of this nature can be beneficial to patient groups in developing countries. The disparate and remote nature of the healthcare needs of sub-Saharan Africa, for example, highlight the multiple and global nature of
S.N. Evetts / Space Policy 30 (2014) 143e145
terrestrial applications of space biomedicine derived healthcare solutions [18]. 4. Communication, coordination and collaboration In the last three years the UK has established the UK Space Agency, embarked upon limited subscriptions to the European Space Agency Life and Physical Sciences and ISS programs, and has been fortunate in having one of its citizens, Major Tim Peake, selected as a European Space Agency astronaut. Furthermore research teams and organisations which use elements of the space environment for R&D have formed the UK Space Environments Association [19]. This association will provide a means for augmented communication and cooperation, facility and apparatus share, and collaboration between industry and academia within the UK space sector. Of the various domains that reside under the Space Environments Association umbrella, Space Life and Biomedical sciences is the field which encompasses the 'human' element of human spaceflight. Efficiencies within this domain are being achieved through the strategic merger of the UK Space Biomedicine Association and Consortium [20] and the planned establishment of a Space Life Science & Innovation Centre in Edinburgh, Scotland. These significant steps for the UK, and this marked degree of cooperation within the UK space industry, will not only enable the nation to more efficiently participate in human spaceflight activities, but the efficiencies engendered in such coordinated activity offer the potential for the UK to make up the lost ground it has suffered by its lack of involvement in human spaceflight in the last half century. Furthermore, the involvement of the last of the G8 nations not to participate in human spaceflight, in particular one with such a strong life science heritage [21], will strengthen the international effort and capabilities in this field of endeavour, something that will prove beneficial as the international community considers pursuit of the GER. Communication, coordination and collaboration (C3) in the field of human healthcare on a scale greater than that seen in the UK has been facilitated by NASA through the establishment of the NASA Human Health and Performance Centre (NHHPC) [22]. This organisation provides a web-based platform for the marriage of space and terrestrial healthcare needs with solutions offered by providers from around the world, often from sectors and disciplines not normally associated with healthcare. Space needs such as those inherent in the GER can be met through the more efficient pursuit of healthcare solutions made possible by C3 enterprises such as NHHPC. The commonalities between space and terrestrial healthcare are such that solving one directly benefits the other. By 2050 the number of people in the European Union aged 65þ will grow by 70% and the 80þ age group will grow by 170% [23]. On average this will amount to about a 25% increase in healthcare spending as a share of GDP [23]. Any increase in the length of active, healthy lifespans will lead to significant economic savings under these circumstances. Taking Britain, the most obese nation in Europe [24], as an example, the nation could save up to £100 billion a year by reducing working-age ill health [25], which is predominantly related to the deconditioning of the musculoskeletal system. On the eve of the new space era, as commercial space travel augments government human space flight to rapidly increase human presence in space, and as preparations occur for the implementation of the GER, the search for solutions to space-induced deconditioning becomes ever more important. The societies that embrace this new field of endeavour, and collaborate to do so, will find an increasingly powerful avenue for terrestrial growth and healthcare progress at their disposal. Millions spent now on space life and biomedical sciences can lead to savings and growth worth billions in the years ahead.
145
Acknowledgements The author would like to thank those members of the UK Space Biomedicine Consortium and Association whose past work and support have been influential in the production of this paper.
References [1] Bond P. Benefits of human spaceflight. Report BR-230. ISSN0250-1589. European Space Agency Publications Division; 2005, ISBN 92-9092-569-8. [2] International Space Exploration Coordination Group (ISECG) White Paper “Benefits Stemming from Space Exploration”; 2013. http://www. globalspaceexploration.org/wordpress/wp-content/uploads/2013/10/BenefitsStemming-from-Space-Exploration-2013.pdf. [3] Crawford IA, Cockell C. The scientific case for human space exploration, vol. 46. A&G; 2005. http://www.star.ucl.ac.uk/~iac/RAS_space_summary.pdf. [4] International Space Exploration Coordination Group (ISECG) “The Global Exploration Roadmap”; 2013. http://www.globalspaceexploration.org/ wordpress/wp-content/uploads/2013/10/GER_2013.pdf. [5] Crawford IA, Anand M, Cockell CS, Falcke H, Green DA, Jaumann R, et al. Back to the Moon: the scientific rationale for resuming lunar surface exploration. Planet Space Sci 2012;74(2012):3e14. € ner zu Bentrup K, Ramamurthy R, Quick L, Porwollik S, [6] Wilson JW, Ott CM, Ho et al. Spaceflight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq. Proc Natl Acad Sci U S A 2007;104(41):16299e304. [7] Clement G, Reschke MS, Wood S. Neurovestibular and sensorimotor studies in space and Earth benefits. Curr Pharm Biotechnol 2005;6(4):267e83. [8] Health is Global; UK Government Strategy 2011e2015. https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/67578/health-isglobal.pdf [9] Buckey JC. Space physiology. Oxford, UK: Oxford University Press; 2006. [10] Bergouignan A, Rudwill F, Simon C, Blanc S. Physical inactivity as the culprit of metabolic inflexibility: evidence from bed-rest studies. J Appl Physiol August 11, 2011;111:1201e10. http://dx.doi.org/10.1152/japplphysiol.00698.2011. First published. [11] Matsumoto A, Storch K, Stolfi A, Mohler S, Frey M, Stein T. Weight loss in humans in space. Aviat Space Environ Med 2011;82:615e21. [12] Smith SM, Heer MA, Shackelford LC, Sibonga JD, Ploutz-Snyder L, Zwart SR. Benefits for bone from resistance exercise and nutrition in long-duration spaceflight: evidence from biochemistry and densitometry. J Bone Miner Res 2012;27(9):1896e906. http://dx.doi.org/10.1002/jbmr.1647. [13] Green DA. How the UK can lead the terrestrial translation of biomedical advances arising from lunar exploration activities. Earth Moon Planets 2010;107:127e46. [14] The Size and Health of the UK Spacer Sector. UK department for business, innovation and skills; 2012. https://www.gov.uk/government/publications/ uk-space-industry-size-and-health-report-2012. [15] Sibonga JD, Evans HJ, Sung HG, Spector ER, Lang TF, Oganov VS, et al. Recovery of spaceflight-induced bone loss: bone Mineral density after long-duration missions as fitted with an exponential function. Bone 2007;41(6):973e8. [16] Swift JM, Swift Sibyl N, Nilsson Mats I, Hogan Harry A, Bouse Scott D, Bloomfield Susan A. Cancellous bone formation response to simulated resistance training during disuse is blunted by concurrent alendronate treatment. J Bone Miner Res 2011;26(9):2140e50. Rosenberger, Edwin Mulder, [17] Tobias Weber, Asa Beijer, Andre Yang Pengfei, Eckhard Schoenau, et al. Vascular adaptations induced by 6 weeks WBV resistance exercise training. Clin Physiol Funct Imaging 2013;33:92e100. [18] The Economist Intelligence Unit. The future of healthcare in Africa; a Janssen e Economist Intelligence Unit report; 2011. http://www.janssen-emea.com/ sites/default/files/The%20Future%20of%20Healthcare%20in%20Africa.pdf. [19] UK Space Environments Conference Report. http://www.uksbaconference.co. uk/2013-downloads/; 2013. [20] UK Space Life and Biomedical Sciences Association (UK Space LABS). www. ukspacelabs.co.uk [21] The Academy of Medical Sciences. Biomedical research e a platform for increasing health and wealth in the UK; 2010. http://www.acmedsci.ac.uk/ policy/policy-projects/biomedical-research-a-platform-for-increasing-healthand-wealth-in-the-uk/. [22] The NASA Human Health and Performance Center (NHHPC) http://www.nasa. gov/offices/NHHPC/index.html [23] EPC and EC. The impact of ageing on public expenditure; projections for the EU25 Member States (2004e2050). Economic Policy Committee and European Commission; 2006. 2006. Special Report 1/2006, http://europa.eu/epc/ pdf/ageingreport_en.pdf. [24] Government HM. Healthy lives, healthy people: our strategy for public health in England. TSO; 2011. https://www.gov.uk/government/publications/ healthy-lives-healthy-people-our-strategy-for-public-health-in-england. [25] Black C. Review of the health of Britain's working age population. Working for a healthier tomorrow; 2008. www.dwp.gov.uk/docs/hwwb-working-for-ahealthier-tomorrow.pdf.
Contents lists available at ScienceDirect
Space Policy journal homepage: www.elsevier.com/locate/spacepol
Viewpoint
Space life and biomedical sciences in support of the global exploration roadmap and societal development Simon N. Evetts Wyle GmbH, Cologne, Germany
a r t i c l e i n f o
a b s t r a c t
Article history: Received 7 August 2014 Accepted 7 August 2014 Available online 26 September 2014
The human exploration of space is pushing the boundaries of what is technically feasible. The space industry is preparing for the New Space era, the momentum for which will emanate from the commercial human spaceflight sector, and will be buttressed by international solar system exploration endeavours. With many distinctive technical challenges to be overcome, human spaceflight requires that numerous biological and physical systems be examined under exceptional circumstances for progress to be made. To effectively tackle such an undertaking significant intra- and international coordination and collaboration is required. Space life and biomedical science research and development (R & D) will support the Global Exploration Roadmap (GER) by enabling humans to ‘endure’ the extreme activity that is long duration human spaceflight. In so doing the field will discover solutions to some of our most difficult human health issues, and as a consequence benefit society as a whole. This space-specific R&D will drive a significant amount of terrestrial biomedical research and as a result the international community will not only gain benefits in the form of improved healthcare in space and on Earth, but also through the growth of its science base and industry. © 2014 Elsevier Ltd. All rights reserved.
Keywords: Biomedicine Human spaceflight Exploration Healthcare
1. Introduction Research and development for human spaceflight requires us to examine questions in the physical and life sciences that cannot be investigated within the normal terrestrial environment. The constraints imposed by operating in space often lead to innovation in terms of hardware size, power and volume reductions. The environment and simulated environments (using ground-based facilities), offer opportunities for advancing fundamental and applied knowledge. Space provides exposure to microgravity, extreme radiation, vacuum and other stressors, which when encountered separately or in combination offer new insights into scientific processes, enable the development of new industrial capabilities and products and provide the opportunity for serendipitous gains inherent in activity at the boundaries of human experience [1,2]. Much of the research carried out requires the presence of people [3]. As the global space community prepares for deep space exploration, the manner, expected benefits and costs of following the Global Exploration Roadmap (GER) [4] must be scrutinised. The cost-benefit equation is complex, multifactorial and cannot be easily defined in advance; but it can and should be debated.
E-mail address: [email protected]. http://dx.doi.org/10.1016/j.spacepol.2014.08.001 0265-9646/© 2014 Elsevier Ltd. All rights reserved.
The main output of participation in the GER can be expected to be new knowledge in multiple fields (e.g. Ref. [5] and references cited therein). For example, in the biomedical area, more detailed knowledge of the mechanisms behind viral virulence [6] and insights in to vestibular disorders [7] will be possible. As the knowledge created is spread by the people who create or use it, it impacts unanticipated areas and further benefits arise as a consequence as positive externalities or ‘spillovers’ are accrued. As commercial entities making investment decisions do not necessarily benefit from these spillovers, they typically invest only up to the point at which their private returns are recognised. This will be at a lower level than that potentially available to society if positive externalities are exploited. Therefore the political decision to participate in endeavours such as the GER offers society a means to gain greater returns than might otherwise be possible, albeit for an initial, upfront cost. This of course is investment. The cost of setting up and participating in human space flight exploration is not insignificant. The technological, scientific and operational development required to expand human presence beyond low Earth orbit (LEO) will cost billions of dollars. Such costs mean that not only are a nation's pooled resources needed to participate, but that multiple countries need to collaborate through international cooperation as envisaged by the GER for this to become a reality. This collaboration not only shares the cost of the research, but also the risks.
144
S.N. Evetts / Space Policy 30 (2014) 143e145
2. Human health in space and on Earth A healthy population is fundamental to prosperity, security and stability e cornerstones of economic growth and social development. Poor health in rapidly ageing developed societies, however, damages the economic and political interests of a nation [8]. Because the health issues of society are growing and are proving so intractable, many sectors now impact and are impacted by human health, and many organisations are required to be involved in healthcare. As a consequence, co-operative action and creative, joined-up partnerships are needed if timely and effective solutions are to be found. The space industry can and should support this cause. Living and working in space is strikingly similar in many ways to accelerated ageing: muscle and bone mass is lost quickly, cardiovascular fitness deteriorates, the immune system weakens, and blood pressure control and neuromuscular coordination are both altered [9]. Across the globe the space industry, and in particular the key space agencies, are allocating large budgets towards attempting to reduce the deleterious effects of living and working in Low Earth Orbit (LEO) and to prepare for longer duration solar system exploration in the years ahead. In so doing a great deal of fundamental science will be undertaken, significantly strengthening our knowledge of the underlying principles and aetiology of the conditions in question. Space applications of these findings are growing and proving beneficial to the industry, but more importantly the applications and benefits to terrestrial healthcare are becoming evident and in certain spheres it is clear that potential breakthroughs in human healthcare may result. Our understanding of muscle and bone loss and countermeasures to these effects are chief amongst these. Both space and space analogue conditions, such as bed-rest and isolated environments, cause the body to decondition (i.e. to lose strength and capability) that in many respects resembles rapid ageing [9e11]. The lack of movement and muscular contraction, the lack of a gravity vector along the long axis of the body and the partial or full equilibration of body fluids that occurs in these environments are fundamental causes of the muscular, skeletal, neuromuscular, humoral and cardiovascular changes observed. The significant other circumstance that causes these effects is modern day living, but over longer time periods. By employing conditions that accelerate the effects of the modern, sedentary lifestyle on healthy subjects (astronauts), space biomedicine researchers have a unique tool to rapidly get to the roots of the issues at hand. Globally thousands of research teams are seeking the solutions to space deconditioning through ground based research using analogue space environment platforms or through actual space flight experiments. Operational human space flight uses the most effective and practicable solutions [12] and thus further advances our knowledge of the application of fundamental research for the maintenance of human health. The space deconditioning countermeasures used in space at present, however, are not perfect and thus indicate that much work is still to be done if the GER is to be followed. Society needs access to the conditions of the space environment to be able to effectively pursue this field of research and development (R&D). The R&D conducted under these conditions is mostly done through ground based research, with an important minority of work carried out through microgravity platforms such as parabolic flights, drop-towers and sounding rockets. Beyond this are the tip of the iceberg studies conducted in space. Access to these platforms enables life and biomedical science organisations to gain traction in a domain that is by its nature difficult to participate in. Consequently, the nations involved have the opportunity to be at the vanguard of a new societal endeavour which can realise significant benefits for human healthcare, and
which are transferrable to the terrestrial arena [13], a sector badly in need of support and innovation.
3. Terrestrial benefits The potential exists for developed societies to save billions of dollars each year if reductions in working-age ill health are possible. This will not come about from R&D, better practices and innovation from one industry, but from many, in particular those industries that during the current global economic downturn continue to grow. One such industry is the space industry, which in the UK between 2008 and 2012, despite an economic recession, grew by 7.3% [14]. The human spaceflight community has as a goal the elimination or significant reduction of musculoskeletal and neuromuscular disorders common with ageing. The space industry cites healthcare as one of the major benefactors of its activities. For example, one commonly known effect of time in space is the leaching of calcium from bones and a general reduction in their density and strength over time. For some astronauts the density of some bones has not recovered even years after their space mission [15]. When the stimulus for bone formation is reduced, for example by taking away impact forces felt during locomotion, it weakens, adopting a structure relevant to the new environment [14]. In certain ways this condition is like that seen in ageing. Space R&D teams are investigating the aetiology and treatment of this condition. The use of drugs, such as bisphosphonates [16], and activities such as impact and vibration exercise are all under evaluation as countermeasures [17]. In-flight countermeasure programmes, in particular since the advent of NASA's Advance Resistive Exercise Devise (ARED), do reduce the degree of bone deconditioning previously noted after long duration spaceflight, but a fully effective remedy which does not require the mass, power, volume and complexity of ARED, is needed for deep space exploration to be possible with minimal risk to the participants. With the successful achievement of this challenge will come important terrestrial healthcare benefits directly pertinent to the problem of brittle bones in the ageing society. A second example that illustrates how biomedical sciences can support the GER and in turn aid societal development is that of remote healthcare. Exploration mission crews will not have the medical ground support that current International Space Station missions have access to. With the distances involved, lack of Earth return capability and the communications delays that result, crews will be required to become more autonomous with respect to healthcare. All crew cannot be trained up to physician standards and indeed the one or two physicians that can be expected to be in the crew will not be expert in all medical fields. Furthermore, over the course of a two to three year mission it will be difficult to retain the highest levels of proficiency in all aspects of medical care. As a consequence, highly ‘intelligent’, remote care systems with significant databases and a broad expanse of capabilities will be required to support the crew. The databases will contain information specific to the crew members on board thus enabling a degree of personalised medicine to be applied where required. These systems will need to be small, low mass, user friendly and conservative with power. All of these characteristics are applicable to the paradigm shift in healthcare that can be expected in the next few decades as healthcare, in particular for the elderly, shifts from centralised, institutional care, to more peripheral, local care. Looking beyond the needs of the developed society, it can be seen that telemedicine technology of this nature can be beneficial to patient groups in developing countries. The disparate and remote nature of the healthcare needs of sub-Saharan Africa, for example, highlight the multiple and global nature of
S.N. Evetts / Space Policy 30 (2014) 143e145
terrestrial applications of space biomedicine derived healthcare solutions [18]. 4. Communication, coordination and collaboration In the last three years the UK has established the UK Space Agency, embarked upon limited subscriptions to the European Space Agency Life and Physical Sciences and ISS programs, and has been fortunate in having one of its citizens, Major Tim Peake, selected as a European Space Agency astronaut. Furthermore research teams and organisations which use elements of the space environment for R&D have formed the UK Space Environments Association [19]. This association will provide a means for augmented communication and cooperation, facility and apparatus share, and collaboration between industry and academia within the UK space sector. Of the various domains that reside under the Space Environments Association umbrella, Space Life and Biomedical sciences is the field which encompasses the 'human' element of human spaceflight. Efficiencies within this domain are being achieved through the strategic merger of the UK Space Biomedicine Association and Consortium [20] and the planned establishment of a Space Life Science & Innovation Centre in Edinburgh, Scotland. These significant steps for the UK, and this marked degree of cooperation within the UK space industry, will not only enable the nation to more efficiently participate in human spaceflight activities, but the efficiencies engendered in such coordinated activity offer the potential for the UK to make up the lost ground it has suffered by its lack of involvement in human spaceflight in the last half century. Furthermore, the involvement of the last of the G8 nations not to participate in human spaceflight, in particular one with such a strong life science heritage [21], will strengthen the international effort and capabilities in this field of endeavour, something that will prove beneficial as the international community considers pursuit of the GER. Communication, coordination and collaboration (C3) in the field of human healthcare on a scale greater than that seen in the UK has been facilitated by NASA through the establishment of the NASA Human Health and Performance Centre (NHHPC) [22]. This organisation provides a web-based platform for the marriage of space and terrestrial healthcare needs with solutions offered by providers from around the world, often from sectors and disciplines not normally associated with healthcare. Space needs such as those inherent in the GER can be met through the more efficient pursuit of healthcare solutions made possible by C3 enterprises such as NHHPC. The commonalities between space and terrestrial healthcare are such that solving one directly benefits the other. By 2050 the number of people in the European Union aged 65þ will grow by 70% and the 80þ age group will grow by 170% [23]. On average this will amount to about a 25% increase in healthcare spending as a share of GDP [23]. Any increase in the length of active, healthy lifespans will lead to significant economic savings under these circumstances. Taking Britain, the most obese nation in Europe [24], as an example, the nation could save up to £100 billion a year by reducing working-age ill health [25], which is predominantly related to the deconditioning of the musculoskeletal system. On the eve of the new space era, as commercial space travel augments government human space flight to rapidly increase human presence in space, and as preparations occur for the implementation of the GER, the search for solutions to space-induced deconditioning becomes ever more important. The societies that embrace this new field of endeavour, and collaborate to do so, will find an increasingly powerful avenue for terrestrial growth and healthcare progress at their disposal. Millions spent now on space life and biomedical sciences can lead to savings and growth worth billions in the years ahead.
145
Acknowledgements The author would like to thank those members of the UK Space Biomedicine Consortium and Association whose past work and support have been influential in the production of this paper.
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