Primary Care > General Primary Care
Headed to Space? Tips for Travel
by Mark Bloom, Editor-in-Chief, Emeritus December 19, 2012
The Federal Aviation Administration (FAA) is conducting early planning for "three commercial spaceports" and European officials are signaling cautious support for space tourism, while one company, Virgin Galactic, is accepting reservations for suborbital flights on a craft named SpaceShipTwo, so how soon will patients be booking pre-flight physicals?
Soon, according to BMJ, which is including a primer about space travel and health in its end-of-year series of offbeat medical research.
Charles A. Berry, MD, of Houston was mildly amused by the prospect of such an endeavor. In the 1960s Dr. Berry was popularly known as the astronauts' doctor when the Mercury, Gemini, and Apollo programs sent Americans tentatively into space on the way to the moon.
Now 89 and still in active aviation medicine practice, Berry was essentially flying blind in those early days. No one really knew what would happen, whether the physiological stresses of zero gravity -- now called microgravity -- would lead to strange unexpected changes that would do strange unexpected things to their distant patients.
The evidence available for Berry was admittedly thin: two intrepid chimps, Ham and Enos, did well, surviving the G forces of ascent and descent without untoward event; and, apparently, so did a Soviet cosmonaut.
As we all know now, Alan Shepard's 1961 suborbital flight was uneventful, and so was Virgil (Gus) Grissom's suborbital flight later that same year. Simple missions -- up and down -- less than 16 minutes.
Back in the days of those 12-minute rides, I was a young reporter covering the Gemini program for Reuters and Apollo for the New York Daily News, and I got to know Chuck Berry well.
In the early days, Shepard, Grissom, John Glenn, and the others who followed all the way to the moon weren't disoriented from fluid shifts and didn't suffer vestibular disturbances when they came back.
Their hearts remained in sinus rhythm and their brains worked just fine. Despite the Cassandra-like predictions of flight surgeons, humans did pretty well during the relative short flights of the Mercury, Gemini, and Apollo programs.
And, for the most part, they have done pretty well in missions to the International Space Station lasting up to a year, although the once-predicted cardiovascular, musculoskeletal, hematological, and other changes, including ophthalmological, have begun to show themselves.
Moreover, no one has worked out a way yet to shield astronauts from lethal solar radiation on a round trip to Mars.
But at this point the goal for commercial space travel is much more modest: Virgin Galactic says it is planning for perhaps	1,000 passengers a year on suborbital flights.
These would essentially be flights of less than 15 minutes, much like the thrilling trips of the early astronauts.
One of Berry's old colleagues, James M. Vanderploeg, MD, of the University of Texas Health Medical Branch in Galveston, is chief medical officer of Virgin Galactic, and he was a co-author of the BMJ paper.
S. Marlene Grenon, MD, a vascular surgeon and an assistant professor of surgery at the University of California San Francisco -- a professed space enthusiast -- was the lead author.
During our conversation, Berry recalled the days when every sniff or cough seemed dire to journalists covering Gemini and Apollo.
But there was little said about one medical problem that, in fact, threatened to delay the first landing on the moon past the "end of this decade" goal set by President Kennedy in 1961.
That was motion sickness, something astronauts were squeamish about admitting because it never affected them as test pilots on earth.
In truth, said Berry, space motion sickness did not appear in the Mercury and Gemini programs because the spacecraft were so small that the astronauts could not move around.
The Russians, with their roomier capsules, were plagued by it.
In fact, said Berry, Gehrman Titov, the second man to orbit the earth, was sick the whole time he was in space.
"We kept telling the Russians we weren't seeing motion sickness," said Dr. Berry. "They thought we were lying."
But with the larger Apollo moon vehicles in 1968 came motion sickness.
Frank Borman, commander of the famous Christmas Eve mission around the moon in 1968, often denied it, noted Berry, but he developed motion sickness and vomited.
He blamed it on sleeping medication.
On Apollo 9, an earth-orbit flight in early 1969, motion sickness hit full force.
The nausea prevented Russell Schweickart from carrying out the first space test of the Lunar Module, the moon-landing craft, for which he had been specially trained.
On the same flight, James McDivitt became briefly disoriented putting on his pressurized space suit. There was an emergency meeting after Apollo 9 and during that meeting delaying the moon landing because of concerns about motion sickness was discussed, a suggestion that was dismissed.
To this day about half of those going into space develop some form of motion sickness in the first hours of weightlessness, till they get used to it.
These days it is more of a nuisance than a problem.
All during his time as doctor to the astronauts, Berry walked a thin line in the engineer-dominated NASA culture.
Specifically, he had to deal with the astronaut office, headed by Deke Slayton and then, later, by Shepard.
It didn't help Berry's case that Shepard and Slayton, two of the original seven Mercury astronauts, had both been grounded for medical reasons.
Slayton was grounded by atrial fibrillation and Shepard by Meniere's disease. Like most test pilots, they didn't totally trust the flight surgeon.
Eventually, though, both were restored to flight status, and both went into space, Shepard famously swinging a golf club on the moon during Apollo 14.
Slayton's Afib resolved spontaneously and Shepard's Meniere's was cured by surgery.
But throughout his career, Berry remained a controversial figure.
The Apollo 7 astronauts developed colds and were uncharacteristically testy and nearly insubordinate with their flight controllers. No one wanted a repetition, least of all Berry.
Seeking to avoid a repeat of that problem during Apollo 11, the first moon-landing mission, Berry was instrumental in establishing a near-quarantine program to prevent the astronauts from coming into contact with anyone who might transmit a cold or other contagious disease.
Then the news emerged that President Nixon planned a breakfast with the Apollo 11 crew on that July day in 1969, just hours before launching.
I ran into Berry in a parking lot outside the headquarters building at the Johnson Space Center, and I asked him whether Nixon's breakfast would be violating that precautionary quarantine.
Berry said he had been making that same point in discussions with his NASA bosses.
I related the conversation in a story for the New York Daily News.
The breakfast was cancelled, and Nixon was furious.
He ordered the NASA Administrator to fire Dr. Berry, an order that NASA ignored.
Today, of course, such quarantines seem quaint and foolish.
Medical clearance for paying passengers doesn't seem to be such a big deal.
Grenon emphasizes that the authors are not attempting set criteria to guide physicians about who can or cannot head into space.
Instead, she and her colleagues offer this advice: "... clinicians should consider developing a resource file for future reference. An example of a resource file may contain findings from the history and physical examination and, possibly, a discussion of the risks of the medical condition for case scenarios where the pathology would be exacerbated by space flight. A delicate balance will need to be established to make this sector viable; the flight of the passenger and other passengers should be kept safe, but too stringent criteria may decrease the market."
And be aware, as Berry suggests, that space travel has a unique appeal. So unique, that some wealthy people "may just want to do it before they die," he said.
Mark Bloom, a nationally known journalist, was the founding Editor-in-Chief of MedPage Today. In his career, he was a leading chronicler of the U.S. space program, and he shares a bit of that experience in this article.
Source Reference: Grenon SM, et al "Christmas 2012: Tomorrow's world. Can I take a space flight? Considerations for doctors" BMJ 2012; 345: e8124.