REVIEW OF NASA’S Longitudinal Study OF Astronaut Health
David E. Longnecker, Frederick J. Manning, and Melvin H. Worth, Jr., Editors
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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract/Grant No. NASW-03031 between the National Academy of Sciences and the National Aeronautics and Space Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the Institute of Medicine Committee on the Longitudinal Survey of Astronaut Health and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
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COMMITTEE ON THE LONGITUDINAL STUDY OF ASTRONAUT HEALTH
DAVID E. LONGNECKER (Chair), Senior Vice President and Corporate Chief Medical Officer and Robert D. Dripps Professor of Anesthesia,
University of Pennsylvania Health System, Philadelphia, Pennsylvania
ALFRED F. CONNORS, JR., Charles H. Rammelkamp Professor of Medicine,
Case Western Reserve University, and
Chair,
Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio
ROY L. DEHART, Director,
Vanderbilt Center for Occupational and Environmental Medicine, Nashville, Tennessee
R. J. MICHAEL FRY, Retired Head of Cancer Section,
Oak Ridge National Laboratory, Indianapolis, Indiana
DANIEL R. MASYS, Director of Biomedical Informatics and Professor of Medicine,
University of California, San Diego
VAN C. MOW, Stanley Dicker Professor of Biomedical Engineering and Orthopaedic Bioengineering, and Chair,
Department of Biomedical Engineering, Columbia University, New York, New York
TOM S. NEUMAN, Professor of Clinical Medicine and Associate Director,
Emergency Medical Services, San Diego Medical Center, University of California, San Diego
THOMAS F. OLTMANNS, Edgar James Swift Professor of Arts and Sciences,
Department of Psychology, Washington University, St. Louis, Missouri
RUSSELL B. RAYMAN, Executive Director,
Aerospace Medical Association, Arlington, Virginia
WALTER ROBINSON, Associate Professor of Pediatrics and Medical Ethics,
Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts
ELAINE RON, Senior Investigator,
Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Rockville, Maryland
CAROL SCOTT-CONNER, Chair,
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
M. RHEA SEDDON, Assistant Chief Medical Officer,
Vanderbilt Medical Group, Vanderbilt University Medical Center, Nashville, Tennessee
DEBORAH ZUCKER, Assistant Professor of Medicine,
Tufts University and Clinical Investigator, Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts
Study Staff
FREDERICK J. MANNING, Study Director
NATASHA S. DICKSON, Senior Project Assistant
BENJAMIN HAMLIN, Research Assistant
INDEPENDENT REPORT REVIEWERS
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report:
John R. Ball, American Society for Clinical Pathology
John Boice, International Epidemiology Institute
F. Andrew Gaffney, Vanderbilt University
Thomas A. Louis, Johns Hopkins University
Jay H. Lubin, National Institutes of Health
Jonathan D. Moreno, University of Virginia
Deborah J. Wear-Finkle, Maine Cognitive Therapy Center
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by ROBERT M. EPSTEIN, Harold Carron Professor of Anesthesiology Emeritus at the University of Virginia, appointed by the Institute of Medicine, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Preface
As part of its ongoing commitment to the nation’s space program, NASA’s medical leadership asked the Institute of Medicine (IOM) to review specific aspects of the scientific basis, policies, and procedures associated with the Longitudinal Study of Astronaut Health (LSAH). NASA created the LSAH in 1992 to address a variety of issues, including both the health of astronauts during space flight and the longer-term health issues that might be associated with space flight and flight training.
The IOM Committee on the LSAH held most of its deliberations at the new IOM facilities in Washington, DC, where the group pondered a variety of health care issues related to space flight, astronaut training, and subsequent astronaut health. We spent many hours developing an in-depth understanding of the LSAH, the major risk factors related to space flight and flight training, and the subsequent health of astronauts. The highlight of the committee’s experiences took place at the Kennedy Space Center (KSC) on January 15-16, 2003, when the committee met with numerous NASA scientists associated with the LSAH, all of whom were gathered at KSC for the scheduled launch of STS-107, the Columbia orbiter flight devoted to life sciences. The committee heard numerous scientific presentations on January 15, including those by the flight surgeons associated with the STS-107 Columbia crew. After an informative session of scientific presentations and deliberations, the committee was escorted to a night viewing of the launch site, and early Thursday morning, January 16, we attended the NASA prelaunch briefing and the subsequent launch of STS-107. Although there were occasional intervals of concern during the last 24 hours of the launch count-down, in general the launch cycle was almost routine; some described it as one of the smoothest launch cycles in recent years. In mid-morning, STS-107 lifted off (perhaps “leapt off” would be more accurate) the launch pad and disappeared into a gorgeous blue sky within five minutes. The flight controllers, crew, NASA administrators and staff, the throngs of visitors, and the committee were thrilled by this sight. The realities of the committee’s assignment were brought into sobering focus on the morning of February 1, when the image of
Columbia returning to the earth’s atmosphere suddenly became multiple images over the clear Texas skies. For me, and for many others on the committee, both the launch and the disintegration of Columbia are forever printed into our visual memories.
The events of February 1 served to remind the committee of the perilous nature of space flight, and brought back memories of Challenger in 1986 and Apollo 1 in 1967. In all, the issues we address in this report are important, vital, and meaningful. However, beyond the long-term issues of thyroid function, behavioral medicine, cataracts, and cancer, all of which are addressed in this review, there remains the harsh reality that space flight is an inherently risky endeavor and space flyers are at risk both during training and in flight. Our recommendations address ways to mitigate at least some of these risks where possible or to compensate for health risks that cannot be anticipated or eliminated. Our committee dedicates this volume, and our many long hours of meetings, reading, analysis, deliberation, and writing, to Rick Husband (Commander of STS-107), William McCool (Pilot), Kalpana Chawala (Flight Engineer), David Brown, M.D. (Mission Specialist), Laurel Clark, M.D. (Mission Specialist), Michael Anderson (Payload Commander), and Ilan Ramon (Payload Specialist). Requiescant in pace.
David E. Longnecker, Chair
Committee on the Longitudinal Study of Astronaut Health
List of Tables
1-1 |
Physical and Health Measures Collection Schedule - 2003 LSAH, |
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2-1 |
Mean (Standard Deviation) Age in Years and Body Mass Index (BMI) at Selection of LSAH Participants, 1959-1991, |
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2-2 |
Cause-Specific Mortality among Longitudinal Study of Astronaut Health Participants Selected from 1959 to 1991, |
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2-3 |
Relative Hazard Ratios and (95% Confidence Intervals) Comparing High Exposure-Group to Low Exposure Astronaut Groups for Cataract Risk at Age 60 and at Age 65, |
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2-4 |
Number and Type of Cancers Diagnosed in NASA Astronauts and LSAH Comparison Group Participants, |
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3-1 |
LSAH Research Questions and Appropriate Study Populations, |
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3-2 |
Minimum Detectable Relative Risk (Astronauts versus Comparisons) at Different Criteria for Statistical Significance (two-tailed α) with Power = 0.80., |
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3-3 |
Percentage of Active JSC Civil Servants, Ex-JSC Civil Servants, and Ex-Astronaut LSAH Participants Appearing for Scheduled Physical Exams, 1993-2001, |