Developing a framework within which a health care system for astronauts can evolve is best accomplished through the designation of a single organizational component. Whether this component is internal or external to NASA, it should be headed by an individual with the appropriate training, experience, and authority (1) to develop the system along with standards for performance; (2) to coordinate all related external and internal resources, including basic, translational, and clinical biomedical and behavioral research; and (3) to administer the component’s policies and procedures. The committee is concerned that fragmentation of the necessary elements of the framework will work to the detriment of the health of the astronauts. Important to the committee in this regard are the elements of coordination with other organizational units within NASA, integration of astronaut health with other components of the space mission, and authority to determine what is in the best interests of astronaut health.
The committee learned of numerous examples of a lack of coordination among different organizational components of NASA. One pertinent example, also commented on by the Space Studies Board (SSB and NRC, 1998a), is the lack of coordination among the Ames Research Center, JSC, and National Space Biomedical Research Institute (NSBRI) for countermeasure development, the process that NASA views as being critical in providing answers to unsolved clinical questions. It is understandable that in any large and complex organization different components may work on similar issues. It is also notable that JSC and NSBRI have begun to coordinate countermeasure development. Nevertheless, for many reasons, including that of the difficulty of making general and prospective valid conclusions from a small number of observations or with a small amount of data (the problem of studies with small numbers of participants, that is, the “small n” problem mentioned in Chapter 2), it behooves NASA to coordinate all activities related to astronaut health.
The work of NASA originated in engineering, and its most stunning successes have been technological. Indeed, the committee heard in discussions with astronauts that even the most biologically oriented of astronauts,