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Evidence to Practice
Images courtesy of NASA.
Materials are derived from previous editions as well
as this edition of Space Physiology and Medicine -
Evidence and Practice, 4th Edition. Reproduction for
purposes other than personal use or teaching will
require the Editors' and the Publisher's approval. The
Editors reserve the right to change this materials as
new information arises.
1. Review the foundations of international collaboration in
human space flight.
2. Gain an understanding of the space medicine practice
in multicultural and technologically different
environments.
Learning Objectives
Learning Objectives
Introduction
Historical Context
Détente and Space Medicine
Development of Collaborative (International) Activities
Apollo-Soyuz Test Project
Change in Direction
The 1980s and The Reagan Era
The ‘West-East’ Aspect of Space Medicine
Collaboration
Short Duration vs Long Duration
Development of Multilateral Support for Space
Medicine in the International Space Station Era
Development of Selection Standards for International
Missions
Other International Activities
The Future of Space Medicine
Outline
The International Space Station in orbit
above the Earth (courtesy NASA)
• Human space flight has often
been a nationalistic activity with a
growing international component
• New space powers emerging –
China, India
• International Space Station
• Retirement of the U.S. Space
Shuttle
• Limited access to space
Introduction
(Courtesy of NASA)
Space Act 1958
• Non military environment
• Basis for international collaboration
Election of 1960
• “….to preserve American leadership in the
master of space and technology, to
dominate the new frontier of space…” –
John F. Kennedy, presidential candidate.
Committee on Peaceful Uses of Outer Space
(COPUOS)
International Geophysical Year (IGY)
‘a scientific bridge across political chasms’
Historical Context
1958 – Committee on Space Research
(COSPAR)
1962 – Hugh Dryden / Anatoly Blagonravov –
formed the foundation for scientific
collaboration
1963 – Kennedy and Khrushchev – joint
moon landing discussions1
Beginnings of the ‘space race’
1962 – Kennedy speech at Rice University –
“…land a man on the moon by the end of the
decade…’
1964 – Johnson and Khrushchev relationship
Historical Context
1Krige J. NASA’s International Relations in Space (Chapter 6) in NASA’s First 50 Years: Historical Perspectives, Ed Stephen J. Dick.
NASA SP-2010-4704. 2010. Washington DC
1967 – International Astronautical Federation – International
Academy of Astronautics (IAA-IAA) – Prague
• NASA Manned Spacecraft Center’s Charles Berry, MD
presentation of Gemini results and ‘space medicine’
• ‘The meeting!’ Soviet’s interest in collaboration
• Institute of Medical and Biological Problems, Soviet Academy of
Sciences
Concept of a Joint Working Group for collaboration
• Limited interest by the Nixon Administration (1968-1969)
Central Intelligence Agency Report on Soviet Space Medicine1
Détente and Space Medicine
1Scientific Intelligence Report. The Soviet Space Research Program. Monograph IX, Space Medicine. Central Intelligence Agency. CIA/SI 33-59.August 1959. (http://www.foia.cia.gov/sites/default/files/document_conversions/49/monograph_ix.pdf)
1970 – U.S. and USSR an agreement was reached to establish five joint
working groups
1972 – Nixon and Alexei Kosygin approved the JWGs
Joint Working Group (JWG) on Space Biology and Medicine
Initial responsibilities:
1. Support timely and comprehensive exchange of biomedical results obtained in the course
of preparation and implementation of manned space missions;
2. Support review and acceptance of unified biomedical research methods and procedures,
which will yield comparable and statistically significant data; and
3. Support development of programs and protocols for and implementation of joint biomedical
investigations. An historical summary of the JWG that reports on the wide variety of
activities that the JWG conducted from 1971 through the current time appears in the
literature.1,2
Development of Collaborative
(International) Activities
1Foundations of Space Biology and Medicine Volumes 1-3. Editors Calvin M & Gazenko O. Scientific and Technical Information Office, NASA.
Washington DC 1975.
2Doarn CR, Nicogossian AE, Grigoriev AI, Tverskya GJ, Orlvo OI, Ilyin EA, Souza K. A Summary of Activities of the US/Soviet-Russian Joint
Working Group on Space Biology and Medicine. Acta Astronautica. 2010; 67(7-8):649-58
Evolution of JWG goals1
1. Establish scientific research priorities in biomedical
research, biological sciences, including advanced
bioregenerative life support systems, and clinical
research;
2. Review biomedical and biological research programs in
ongoing and future space missions;
3. Oversee science and clinical research for ISS missions;
4. Exchange information on the results of space
biomedical and biological research and development
Development of Collaborative
(International) Activities
1Doarn CR, Nicogossian AE, Grigoriev AI, Tverskya GJ, Orlvo OI, Ilyin EA, Souza K. A Summary of Activities of the US/Soviet-Russian Joint Working Group on Space Biology and Medicine. Acta Astronautica. 2010; 67(7-8):649-58.
Joint publication of ‘The Foundations
of Space Biology and Medicine’- Three
volumes/four books1*
− Edited by Melvin Calvin (U.S.) and Oleg Gazenko
(U.S.S.R.)
I. Space as a Habitat;
II. Ecological & Physiological Basis for Space
Biology & Medicine; and
III. Space Medicine and Biotechnology
Development of Collaborative
(International) Activities
1Foundations of Space Biology and Medicine Volumes 1-3. Editors Calvin M & Gazenko O. Scientific and Technical Information
Office, NASA. Washington DC 1975.
*Discussed and endorsed by the Dryden-Blagonarov agreements in the early 1960s.
JWG platform foundation for
• Apollo-Soyuz Test Project
• Mir/Shuttle Program (Phase 1)
• International Space Station Program
• Others
Development of Collaborative
(International) Activities
• Nixon – Brezhnev agree to joint
docking mission
• Joint space medicine functions
• Challenges/philosophies
• Nitrogen tetraoxide exposure1
• Major contributions
− Development of joint medical operations
plan
− Decompression tests (different cabin
atmospheres
o Apollo – hypobaric – 1/3 atm
o Soyuz – normoxic 1 atm (2 gases)
Apollo-Soyuz Test Project
Nicogossian, AE. Apollo-Soyuz Test Project Medical Report. NASA SP-411. NASA Houston, Texas. 1977.
(Courtesy of NASA)
• Reusable spacecraft
− U.S. Space Shuttle Program
• Orbiting space stations
− U.S.S.R/Russian space stations
• International crew members
• Appropriate protocols and
standards for crew
selection/certification
Change in Direction
(Courtesy of NASA)
• Space Shuttle Program
• Space Station Freedom
− International partners
• Space Station Мир (Mir)
• Buran
• International crews on Shuttle and Mir
• Interkosmos Program
• JWG activities (subgroups) limited
• Bion Program
• Separate space medicine activities
The 1980s and the Reagan Era
(Courtesy of NASA)
• Perestroika
• U.S.S.R Russia
• Bush – Yelstin (June 1992) – The Exploration and
Use of Outer Space for Peaceful Purposes
• U.S./Russian realignment of the JWG1
• Clinton – Yeltsin
• Russia a full partner in redesign of Freedom to the
ISS
• Phased approach
The “West-East Aspect of Space
Medicine Collaboration
1Doarn CR, Nicogossian AE, Grigoriev AI, Tverskya GJ, Orlvo OI, Ilyin EA, Souza K. A Summary of Activities of the US/Soviet-Russian Joint
Working Group on Space Biology and Medicine. Acta Astronautica. 2010; 67(7-8):649-58.
• Gore – Chernomyrdin Commission
− Foundation for medical support of Phase 1
− Phase 1 docking of U.S. Shuttles to the Mir
− Exchange of crews
− Medical Operations Requirements Document
(MORD) - 19951
− Flight surgeon support in Russia
− Space Biomedical Center for Training and
Research at Moscow State University2
− East-West Space Science Center at the
University of Maryland
− Bilateral Medical Operations Working Group
The “West-East Aspect of Space
Medicine Collaboration
1Barratt M. Medical Support of the International Space Station. Aviat Space Environ Med. 1999; 70(2): 155-61.2Grigoriev AI, Burakova B, Loginov VA, Vinogradova OL. Educational programme on aerospace and environmental medicine for medical faculty of
Lomonosov Moscow State University. Adv Space Res 1997; 20:1397-99.
• Shuttle / Mir Program Challenges
• Fire
• Loss of pressure
• Language
• Culture
• Training
• Documentation
The “West-East Aspect of Space
Medicine Collaboration
1. Bogomolov VV, Castrucci, Comtois J-M, Damann V, Davis JR, Duncan JM, Johnston, SL, Gray GW, Grigoriev AI, Koike Y, Kuklinski P, Matveyev VP,
Morgun VV, Pochuev VI, Sargsyan AE, Shimada K, Straube U, Tachibana S, Voronkov YV, Williams RS. International Space Station Medical
Standards and Certification for Space Flight Participants Aviat Space Environ Med 2007; 78(12):1162-169.
2. Morgun VV, Voronin LI, Kaspransky RR, Pool SL. Barratt MR, Navinkov AL. Development of US-Russian Medical Support Procedures for Long-
Duration Space flight: The NASA-Mir Experience. Aviat Space Environ Med 2002; 73(2): 147-55.
3. Bogomolov VV, Samarin GI. Medical health and performance care on orbital station Mir, in: Orbital Station Mir Space Biology and Medicine. 2001, Vol.
1, Medical Care in Long Term Space Flight, pp. 20–41.
(Courtesy of NASA)
• Memorandum of Understanding Concerning
Cooperation on the Civil International Space Station
between NASA of the U.S. and International Partners1
− Canadian Space Agency
− European Space Agency
− Japanese Space Agency
− Russian Space Agency
o MOU has 21 Articles
Crew health is addressed in Article 112
The “West-East Aspect of Space
Medicine Collaboration
1International Space Station Intergovernmental Agreements, Treaty signed January 29, 1998 by the parties.
http://www.nasa.gov/mission_pages/station/structure/elements/partners_agreement.html (last accessed January 15, 2015).
2Duncan JM, Bogomolov VV, Castrucci F, Koike Y, Comtois J-M, Sargsyan AE. Organization and Management of the International Space Station
(ISS) multilateral Medical Operations. Acta Astronautica 2008; 63 (7–10):1137–147.
• Two different philosophies for human space flight
• U.S. Approach – Shuttle – Short Duration
− 135 missions of less than 17 days each
− Five vehicles (two catastrophic losses)
− Significant activities
− Construction of the ISS
− Limited communications
• U.S.S.R Approach – Space Stations – Long Duration
− Long duration aboard Mir
Short Duration vs Long Duration
• Bilateral MOUs – Article 11.4
• “NASA and the IP will each provide a single point of contact for
medical support who will have full responsibility on behalf of its
respective agency to resolve issues related to the development of
a common system for medical support.”
• Multilateral Medical Policy Board (MMPB)
− Develops policy and responds to needs/issues of lower level MSMB and
MMOP
• Multilateral Space Medicine Board (MSMB)
− Certifies crew members and flight surgeons
• Multilateral Medical Operations Panel (MMOP)
− Operational level organization responsible for all medical support personnel
and systems
• Each is governed by a charter and works closely with the Multilateral
Mission Integration and Operations Control Board (MMICOB)
Multilateral Medical Support for ISS
• Framework for medical
policy
• Research moving forward
for exploration –
Multilateral Health
Research Program for
Exploration (MHRPE)
Multilateral Medical Support for ISS
(Courtesy of NASA)
• Development of Selection Standards for
International Missions
• New participants (China)
• Exploration
• Research initiatives – known and unknown
• Unique Training
• Commercial Efforts
Future of Space Medicine Practice
Future of Space Medicine Practice
Professional
Development
US ESA Canada Russia China Japan
Internship/Residency Required Required Required Required
Post graduate training Aerospace Medicine [3
civilian in U.S. and 2
military]
Aviation Medicine Provided by the Russia
Military Medical Schools;
Institute of Medical
Problems [IMBP]and the
Gagarin Cosmonaut
Training Center (GCTC)
Military and China’s
Manned Space Agency
Military;
Tsukuba Space
Center and US-
based
Aerospace
Medicine
Residencies
Additional Specialty Preferred [surgery,
internal medicine, family
practice, etc.]
Preferred Not specified Preferred Preferred
Certifying body American Board of
Preventive Medicine and
the Accreditation Council
for Graduate Medical
Education.
National Ministry of
Health and/or
Education
and respective
Space Agencies
A doctoral degree is
granted by the IMBP
National Medical System
and different Ministries
Natiuonal
Societies and
Ministry of
Health board
certification
Proficiency Training Flight Surgeon
certification at the NASA-
JSC1
Approval by MSMB
Flight Surgeon
certification at the
NASA-JSC1
Approval by MSMB
Flight Surgeon
certification at the
NASA-JSC1
Approval by MSMB
Additional training at the
GCTC and Moscow
Mission Control Center
Specialized training by
the Military and the
Space Medico-
Engineering Institute of
Beijing
Flight Surgeon
certification at
the NASA-
JSC1
Approval by
MSMB
Unique cultural
knowledge
Multicultural sensitivity
and language training
Language training NA NA
Aviation piloting skills Desired Desired Desired NA Desired
Prior military experience Desired Preferred Required
Special Duty Designation 1. ISS
Mission
Surgeon
1. Crew surgeon
ISS Flight Surgeon and
national crew member
surgeon
ISS Flight Surgeon
and national crew
member surgeon
ISS Flight Surgeon and
national crew member
surgeon
? ISS Flight
Surgeon and
national crew
member
surgeon
•Includes: crew health monitoring, medical kit content and use, space systems familiarization, high performance aircraft flight familiarization, console duties in the
Mission Control Center, medical selection and retention evaluation of astronauts and aircraft pilots, crew post flight recovery and rehabilitation, astronaut family care
and support.
Table 16-1. Training and designations of U.S. and select space faring countries of space medicine specialists
Contributions of international cooperation in
space medicine.
Summary
Program Contribution [s] Importance Comments
US-USSR JWG
1970
Exchange of knowledge Exchange and
integration of ideas,
knowledge, and lessons
learned.
A forum for projects planning and international
collaboration
ASTP First International medical
requirements document.
First medical consultations between
the two mission controls.
Identify unique and
common space
medicine practices in
support of dissimilar
space craft design.
Due to technical difficulties and late
completion not officially signed off by the
project office.
Medical consultations between flight surgeons
of different nations.
Bilateral and
multilateral
Shuttle/Space lab
working groups
[1980]
Developing international space
medicine practices and investigations.
Establishment of the Medical Policy
and Aerospace Medicine Boards.
Developing training for international
space medicine specialists. Cross
cultural consideration in space
medicine.
Sharing the cost and
accelerating knowledge
acquisition.
Planning and coordinating complex clinical
experiments in space. Creating a new class of
space travelers (payload specialist), astronaut
scientists, and space participants which
requiring a new set of medical selection and
retention standards.
Joint US-USSR
bed rest project
Adoption of the USSR head down tilt
as a test-bed model of space flight.
Standardization of laboratory
procedures and research protocols
Complemented,
updated and extended
the ASTP medical
requirements document.
Prepared the foundations for the NASA-Mir
and ISS programs.
Table 16-2. Evolution and Contributions of International Cooperation to Space Medicine Practice – Part 1
Program Contribution [s] Importance Comments
Shuttle The Shuttle research capability
permitted international crew members to
participate in flight opportunities.
Provided a strong
foundation for
collaboration and
development of and
understanding of
common operational
activities.
The Shuttle was the program that made the
construction of ISS possible.
Prepared the foundations for the NASA-Mir and
ISS programs.
NASA/MIR This joint mission built upon the
engineering capabilities of the ASTP
and permitted the exchange of crew
members and an enhance
understanding of space medicine
challenges.
It brought together two culture of short
missions using the Space Shuttle and
the long duration missions of the USSR.
This program provided a
wealth of knowledge on
a variety of operational
problems, encountered
on the Mir complex.
These problems
consisted of loss
pressure, space craft
collision during docking
fires, toxic spills, etc.
Medical documentation
and systems developed
for this program served
as the foundation for the
ISS program.
Paved the way for the multilateral space
medicine development.
Table 16-2. Evolution and Contributions of International Cooperation to Space Medicine Practice – Part 2
Program Contribution [s] Importance Comments
ISS Five International Partners, representing
countries from around the world
designed, built and now operate a large
habitable space station in low Earth
orbit.
The science and
knowledge gained are of
great value.
It has provided a unique
opportunity for
commercial companies
to support resupply
missions to the ISS.
This international cooperation is establishing
the necessary knowledge to go to the next step.
Table 16-2. Evolution and Contributions of International Cooperation to Space Medicine Practice – Part 3
1. International cooperation in space medicine dates to the mid-1960s.
2. Politics, national academic training, and space technology have played a significant role in the development of space medicine in different space faring nations.
3. The ASTP was the first true interaction in space medicine. The foundation laid here provided the necessary support for the Mir/Shuttle Program (Phase 1), thereby, setting the stage for international cooperation in space medicine for the ISS and beyond.
4. The experience gained from the beginning of the ISS Program has created strong foundation in space medicine, especially in future space exploration missions beyond Earth that will likely be international in nature.
5. Language, culture, politics and management styles have not been shown to be major deterrents in collaboration. Space medicine has often transcended political ideology and geographic boundaries
Key Points to Remember
1. How did international cooperation in space medicine develop?
2. How did the JWG come about and what was its impact on the international programs that followed?
3. How is medical policy developed in the International Space Station Program and what is the impact of future commercial endeavors?
4. What are some of the challenges that must be overcome when crews are international?
5. What is the number of humans who have flown in space and what country have they come from?
Self-study Topics
