system, and a clear understanding of the important role of research. Given the relatively limited opportunities to do clinical research in space, efficient research prioritization and administration are critical.

Alternative Organizational Frameworks

The committee considered alternative frameworks within which an organizational component responsible for all aspects of astronaut health might evolve. The framework could be external (for example, it could be a component of a larger external health care system, established through a contractual arrangement, or part of a public-private group such as NSBRI), or it could be internal to NASA and could be located at JSC or NASA headquarters. Each type of organizational framework has its own advantages and disadvantages.

External Frameworks

Astronaut health care as a component of a larger health care system NASA could partner with an existing federal health care system with specialized knowledge applicable to NASA’s needs in aerospace medicine, such as the one within DOD, or it could partner with the Federal Aviation Administration (FAA). The National Science Foundation (NSF) has in the past used resources of the U.S. Navy to provide health care during NSF long-duration overwintering missions in the Antarctic. The advantages of this type of arrangement would include the use of an established, comprehensive, and evolving working system. The disadvantages are those associated with the use of any external system, for example, a lack of or a decreased familiarity with and specificity for the needed task, a lack of flexibility to evolve with space medicine, a lack of confidentiality, limited degrees of budgetary authority and policy-making ability, and a lack of familiarity with the international space medicine community. The greatest disadvantage of an external system is its diminished capability to coordinate with the health care research strategy of NASA to produce clinically relevant information so that NASA can provide the highest reasonably attainable standard of health care for astronauts during long-duration missions beyond Earth orbit.

Astronaut health care established through a contractual arrangement NSF is providing health care in Antarctica through a contractual arrangement. Along the same lines, NASA is using Wyle Laboratories to manage its Countermeasure Development and Validation Project and could expand this ar-

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