NASA should develop a strategic health care research plan designed to increase the knowledge base about the risks to humans and their physiological and psychological adaptations to long-duration space travel; the pathophysiology of changes associated with environmental forces and disease processes in space; prediction, development, and validation of preventive, diagnostic, therapeutic, and rehabilitative measures for pathophysiological changes including those that are associated with aging; and the care of astronauts during space missions.
The strategic research plan should be systematic, prospective, comprehensive, periodically reviewed and revised, and transparent to the astronauts, the research community, and the public. It should focus on
providing an understanding of basic pathophysiological mechanisms by a systems approach;
using the International Space Station as the primary test bed for fundamental and human-based biological and behavioral research;
using more extensively analog environments that already exist and that have yet to be developed;
using the research strengths of the federal government, universities, and industry, including pharmaceutical, bioengineering, medical device, and biotechnology firms; and
developing the health care system for astronauts as a research database.
The prototype for a long-duration mission beyond Earth orbit is an interplanetary mission, with Mars as the likely destination. Such a voyage of discovery and return will take nearly 3 years. The crew is likely to be multicultural, international, and of both sexes. They will spend all their time together in a very confined space. The habitability of the spacecraft will be compromised by the need to carry all necessary equipment and nourishment (even if it is replenishable), at least for the voyage to Mars (if supplies have already been stockpiled there), if not for the entire 3 years. Realtime communication with Earth will be impossible, as at the farthest distance from Earth, radio messages and messages transmitted by even more advanced means will take 20 minutes to reach their destination. Finally, the success of the mission and the lives of the astronauts may depend on every