Deep Space Medicine in Space and on Earth, Challenges and Opportunities for the International Artemis Program to the Moon, Mars and beyond

Having attended the Canada Space Agency’s National Space Health Forum from November 13 – 14, 2019 at the John H. Chapman Space Center in Saint-Hubert, Quebec, I am eager to share with you the highlights on some of the discussions and the exciting developments and potential opportunities that will soon be coming our way.

TECHNATION Health sees opportunities for further discussion as a stakeholder and involving its members in addressing some of the technology challenges underscored by CSA. TECHNATION’s CEO, Angela Mondou was able to join me for part of the two-day forum:

“Innovation typically requires experimentation, risk taking and creativity. CSA’s goals for deep space medicine are exciting and achievable – and Canada’s tech industry is excited to support and advance healthcare in a way that is innovative, utilizes the talent of small and medium-sized businesses, and sets Canada as a global leader,” said Angela Mondou, president and CEO, TECHNATION.”

FUTURE Challenges for Colonists in Space
Imagine that you are living out your life’s greatest dream of being a first-generation colonist to a real human settlement on the Moon or Mars. Just as on Earth, the safety and well-being of all colonists will depend on appropriately shared and frequently updated health data to identify and address problems. Prior to joining the Canadian Space Program as an astronaut in 2008, Saint-Jacques was a medical doctor and the Co-chief of Medicine at Inuulitsivik Health Centre in Puvirnituq, Nunavik, an Inuit community on Hudson Bay. David spent 208 days in space aboard the ISS in years 2018–2019. David identified his top priority risks for health in deep space: impact on bone strength, impact on vision, radiation and risk of cancer, psychological challenges of isolation, and prolonged exposure to CO2 in recycled air. Unless new solutions are developed to mitigate these and other still unknown medical risks, humans will NOT be able to remain in deep space except as short-term visitors.

Shared health data will benefit all deep space colonists in addressing these health risks identified by Dr. St James. Individuals’ health data will require frequent diagnostic testing  for preventative health maintenance. Colonists will be layman proficient users, relying on easy-to-use AI enabled analyzers to achieve simplified, accurate and repeatable clinical assay results. Weightless or near weightless operation will also demand small, non-messy specimen collection, including micro-specimen or subdural patches as in use today with continuous diabetes monitoring. Deep space analyzers will have a meaningful impact of leveling out cost increases of diagnostic testing and ultimately reducing current $5.9b public expenditures across Canada.

Canada Space Agency (CSA) Forum
To open the 2019 Forum, Dr. Sylvain Laporte, CSA President, outlined CSA’s Strategic Challenges for Deep Space during his introduction of the CSA Space Medicine Forum:

  • Expand science and research for deep space, with Canadian economic benefit
  • Expand industry and commercial involvement, with Canadian economic benefit
  • Design an investment that is directly beneficial here on Earth as well as in deep space. The Sustainability Principle.

The CSA has a Federal budget commitment of $150M over the next five years, 2019–2024, for Deep Space development for:

  • new lunar rover,
  • nutrition and
  • space medicine

in support of developing the Lunar Gateway Platform. CSA’s allocation for Space Medicine is $14M. The CSA forum highlighted significant challenges and opportunity targets ahead for Canada’s deep space health program in pursuit of expanded benefits for Canada. Four of these challenges are explored in more detail below:

  1. Canada must seek benefits recovery at home on Earth in parallel to developing and investing in deep space healthcare in support of exploration (Sustainability Principle)
  2. We should expand meaningful roles for our Canadian vendor community in advancing Canada’s profile in deep space healthcare and deep space exploration.
  3. We don’t know what we don’t know; there are many unknowns for humans pursuing deep space exploration and about the healthcare support needed.
  4. A challenging timeline is being considered by the 14 international agencies for deep space exploration involving humans’ return to the Moon and beyond.

Challenge #1 Benefits realization at home in Canada in parallel to Deep Space

The Sustainability Principle was adopted by each of the fourteen international space agencies that make up the International Space Exploration Coordination Group (ISECG):

“Deep Space exploration benefits meet both exploration objectives and generate public benefits. Sustainable human space exploration must respond to exploration goals and objectives and provide VALUE to the public and other stakeholder communities. Synergies between space and other domains are crucial.”

Rural and remote Canadians require innovative approaches to accessing health care services, energy, clean environment, communication, supply chain—similar to the challenges anticipated for deep space medicine in serving populations in the vicinity of the moon, mars and beyond.

In the 2017 report, “Canadian Healthcare in Deep Space”2 the Canada Space Agency, with input by an expert group, developed recommendations that enforced the sustainability principle: “Healthcare for deep-space astronauts will require the incorporation of new virtual-care capabilities.” The term virtual healthcare refers to emerging digital and communications technologies that facilitate the delivery of healthcare to remote locations.

Challenge #2: Participation by the Canadian vendor community in Canada’s advancements for deep space

The 2017 CSA summary report identified technology trends as relevant in Canada as in deep space medicine:

  • AI and machine learning
  • Virtual and augmented reality
  • Medical training and simulation
  • Wearable technology and self-monitoring
  • Advanced bioanalysis
  • 3D printing for medical tools and supplies
  • Digital health

Robotics Vendors: The most visible vendor success has been by MDA in the development of Canada Arm-1 to integrate with NASA’s Shuttle Program, and Canada Arm-2 to integrate with the International Space Station Program. Work is underway on the Canada Arm-3 to be incorporated into the International Lunar Gateway Platform. A smaller version of the Canada Arm-3 robot will be developed for use inside the Lunar Gateway Platform quarters. Not surprised to see recent announcement of repatriation of MDA ownership by Canadian investors for future development.

Medical Analyzers Vendors involved in Space Research: Canadian vendor MDS-Sciex is one of the Canadian biomedical and clinical equipment vendors that has provided mass spectrometry analyzer instrumentation used for medical research on the ISS Platform. Dr. Fernanda Mora, NASA Jet Propulsion Laboratory, USA, has led research using MDS-SCIEX analyzers in Capillary Electrophoresis Electrospray Ionization Mass Spectrometry methods and equipment. She has developed the first portable, fully-automated, reprogrammable, and battery-powered microchip electrophoresis instrument for use in space operations environment.

Artificial Intelligence for Clinical Laboratory Medicine, Past and Future
Before humans will be able to safely survive in deep space, diagnostic testing services must make a significant capability leap forward enabled by NEW AI methods. Canada has historically been a leader in the field of diagnostic clinical testing. Beginning in 1993, Canadian innovator collaborators included Dr. Stephen Middelton, MDS Corp, Ms. Eileen Page, People and Process Solutions, Labotix Inc. These organizations partnered in a major revolution in clinical laboratory medicine. MDS Corp funded this transformative project in high-volume clinical lab medicine at their 100 International Rd laboratory in Toronto. The MDS project embraced emerging technologies uniquely applied to high-volume clinical lab medicine for the first time in the world.

The innovative project was the foundation for MDS-Autolab Inc, and the successful evolution of the Labotix team, today known as Cerner-Labotix. The MDS-Autolab solution included advanced control system and robotics automation to manage automated conveyance throughout a provincial core lab. Innovation included automated analytics work cells, an automated storage and retrieval of clinical specimens, and integration of an expert system with graphical, pathologist-friendly interface to configure AI algorithms for diagnostic testing rules.

NASA has made a priority to accelerate genomic molecular diagnostic testing in space. In his recent article by Season Wong, co-founder of AI BioSciences Inc.,3 noted that “Currently, molecular diagnostics in space can be feasible with an onboard, real-time PCR thermal cycler and MinION sequencing machine. However, to become a government-approved diagnostic tool, the workflow has to be streamlined, and the reliability, sensitivity, and specificity of the tests have to be validated. We envision that automated extraction and molecular detection can be carried out using minimal crew time with just a few pipetting steps to add the sample and remove the eluate. Whether landing on Mars or the Moon, it is in NASA’s best interest to design, prototype, and test crew procedures for highly automated molecular diagnostic protocols. It is anticipated that fully integrated, automated molecular tests with high sensitivity and specificity are within reach.”

Virtual Care capabilities: Vendors will opportunities to implement virtual health in Canada and in deep space including capabilities for:

  • Virtual consultations and patient visits
  • Remote ICUs
  • AI-based diagnostic decision-support technologies
  • Transitional (post-discharge) care and home/mobile health monitoring
  • e-Health (internet-enabled remote medical care)
  • Remote monitoring of home-based chronic care patients
  • Secure electronic messaging and
  • Personal Health Records (PHRs) linked to Electronic Health Record (EHR) systems’

ACCESS GATEWAY: Attila Farkas, Director Tech Standards from Canada Health, highlighted key components of the Access Gateway 20224 (Figure 1) at the CSA Forum. Infoway has identified opportunities in collaboration by industry vendors, health care providers, provinces, territories and Canadians in Improving Access to Care for Canadians:

  • Canadians will gain a greater ability to manage their care,
    more convenience and increased control over their personal health information.
  • Clinicians will be able to share information and communicate with each other and their patients in a modern, efficient manner.
  • Governments will be able to provide citizens with safe and secure access to their personal health information and increase access to virtual care.
  • Industry Vendors will gain the ability to integrate with ACCESS Gateway, a national technology service being developed by Infoway. Gateway will become a trusted service that digital health solutions can connect to in order to access common utilities, such as identity, access and consent management, and modern APIs that will enable integration to data repositories.

Challenge #3: We don’t know what we don’t know

One of the great unknowns for human habitation in deep space is the risk and exposure to radiation sickness outside of Earth’s protective magnetosphere. This was a hot topic for discussion  at the two-day forum and summary essay on “Death on MARS” by Caleb Scharf, the director of astrobiology for Columbia University.

The ISS experience is “near earth” and is not the same environment as deep space; simulations on earth are approximations only. Multiple simulation studies are in progress on Earth, including a 2020 simulated MARS mission involving Dr. Sylvia Pandya from Alberta. Dr. Pandya participated in the two-day CSA forum. To date, there has been very limited data gathered for space medical research by a handful (8–10) of ISS astronauts and cosmonaut occupants, such as Scott Kelly (ISS for one year) and his brother astronaut Mark Kelly (on Earth).

Challenge #4: Timeline for Humans in Deep Space Exploration

As illustrated by Figure 2, there is an ambitious timeline under discussion for milestones to return humans to the Moon and to, for the first time ever, introduce humans into the MARS environments. The deep space platform timelines are optimistic and elastic. Human habitation in deep space will have to develop mitigating solutions for both known and unknown health risks in deep space exploration. Current budget allocations may need to be significant expanded in order to design appropriate solutions. In addition, there is current back and forth debate in the US Congress with the House recommending 2028 for the return to landing people on the Moon while the Senate continues focus on 2024, i.e., which Executive Administration will be in the White House to reap PR benefits of this significant milestone.

Summary and conclusions
It has been almost 50 years since the last time humans visited the moon during the Apollo moon missions. Canada, as one of 14 international space agencies, is at work to return to the Moon and beyond. CSA has identified contribution by the talents of Canadian astronauts as well as the extensive efforts of Canadian researchers and Canadian vendors with enabling technologies in support of deep space.

There is no question that technology will be successfully developed to build the Lunar Gateway Platform, and the eventual living quarters on the Moon. However, we have highlighted a few of the known challenges ahead before humans can safely travel and remain for extended time beyond the protection of earth.

Susanne Fleet, founder of HealthTech Consulting and our past chair of ITAC Health Board shared “ deep space medicine has significant challenges, along with major benefits for humans in space, as well as on earth. With tight timelines under discussion, there is need for expanded collaboration and acceleration of new solutions to enable future colonists. Challenges of deep space medicine provide the perfect storm, for new entrepreneurs, academic researchers and experienced commercial vendor partners to contribute and collaborate in finding solutions to these deep space challenges.”

Shared health data with voluntary consent to relax privacy constraints will benefit all deep space colonists in addressing health risks in deep space, including those risks identified by Dr. St James. It is easy to foresee that we will experience a similar path forward for the citizens on another colony, called EARTH, to consent to sharing our personal health data for the common good of the colony.