The committee recognized that health care will, of necessity, be limited during space flight, and it will not be feasible to manage all medical conditions optimally during the three reference missions. The current status of CRLs clearly illustrates the magnitude of the problem for bioastronautics in general and for autonomous health care specifically. To prepare for risk mitigation and autonomous medical care to the extent possible, it may be helpful to consider the research issues in three categories, based on the type of problem and the nature of the research required to address the problem. These categories are the following:
Biological issues: biological and pharmacological questions requiring basic research with cell cultures, animals, drugs, and so forth, in the space environment (most likely during the ISS and lunar missions).
Operational issues: adaptations needed to make equipment and procedures operate effectively in microgravity or the environment of the ISS or exploration vehicle. Some of these studies can be conducted during parabolic flight with brief microgravity or simulated on Earth, whereas others will require validation in flight.
Health care delivery issues: conditions that could be treated during a mission and the equipment and supplies required to implement that treatment. Some of these issues can be studied in analog environments; others may be explored by “thought experiments” with expert clinicians, on the basis of current and expected future development of novel diagnostic and therapeutic capabilities. Both approaches should be supplemented with digital simulations of acute responses and chronic adaptation that use models of contemporary research findings.
The BR addresses fundamental issues of wound and fracture healing and acknowledges that further studies must be done in the space environment. Anecdotal evidence suggests that lacerations and abrasions heal slowly in the space environment (Kirkpatrick et al., 1997). The complex interaction between the immune system, inflammation, and wound healing implies that alteration in any part of the system might affect the functioning of the system as a whole (Yang and Glaser, 2002). If a specific issue related to wound healing is identified, basic research to determine the nature of the deficit might yield an insight into the specific therapy. For example, high-dose corticosteroids impair wound healing, and this deficit is at least par-