A RISK REDUCTION STRATEGY FOR HUMAN EXPLORATION OF SPACE

A Review of NASA’s Bioastronautics Roadmap

Committee on Review of NASA’s Bioastronautics Roadmap

Board on Health Sciences Policy

Space Studies Board

Aeronautics and Space Engineering Board

David E. Longnecker and Ricardo A. Molins, Editors

INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap A RISK REDUCTION STRATEGY FOR HUMAN EXPLORATION OF SPACE A Review of NASA’s Bioastronautics Roadmap Committee on Review of NASA’s Bioastronautics Roadmap Board on Health Sciences Policy Space Studies Board Aeronautics and Space Engineering Board David E. Longnecker and Ricardo A. Molins, Editors INSTITUTE OF MEDICINE AND NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 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 Award No. NASW-02031 between the National Academy of Sciences and the National Aeronautics and Space Administration. Any opinions, findings, or conclusions expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-09948-X Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Cover credit: NASA/John Frassanito and Associates Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America.

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap COMMITTEE ON REVIEW OF NASA’S BIOASTRONAUTICS ROADMAP DAVID E. LONGNECKER (Chair), Association of American Medical Colleges, Washington, DC JAMES P. BAGIAN, Veterans Health Administration, Ann Arbor, MI ELIZABETH R. CANTWELL, Los Alamos National Laboratory, NM VALERIE GAWRON, General Dynamics, Buffalo, NY CHRISTOPHER A. HART, Federal Aviation Administration, Washington, DC CHARLES E. LAND, National Cancer Institute, Rockville, MD DANIEL R. MASYS, Vanderbilt University Medical Center, Nashville, TN BRUCE M. MCCANDLESS II, Lockheed Martin Space Systems Company, Littleton, CO TOM S. NEUMAN, University of California, San Diego THOMAS F. OLTMANNS, Washington University, St. Louis, MO LAWRENCE A. PALINKAS, University of California, San Diego JAMES PAWELCZYK, Pennsylvania State University, University Park BRUCE S. RABIN, University of Pittsburgh, PA KARLENE ROBERTS, University of California, Berkeley CAROL E. H. SCOTT-CONNER, University of Iowa Hospitals & Clinics, Iowa City RHEA SEDDON, Vanderbilt Medical Group, Nashville, TN JAY R. SHAPIRO, Kennedy-Krieger Institute, Baltimore, MD THOMAS TEN HAVE, University of Pennsylvania School of Medicine, Philadelphia IOM Staff RICARDO A. MOLINS, Study Director (from April 2005) LISA M. VANDEMARK, Senior Program Officer (through May 2005) MELVIN H. WORTH, Scholar-in-Residence BENJAMIN HAMLIN, Research Associate (through April 2004) ERIN MCCARVILLE, Senior Project Assistant (through June 2005) VILIJA TEEL, Senior Project Assistant (from July 2005)

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap COMMITTEE ON AEROSPACE MEDICINE AND THE MEDICINE OF EXTREME ENVIRONMENTS DAVID E. LONGNECKER (Chair), Association of American Medical Colleges, Washington, DC ALFRED F. CONNORS, JR., Case Western Reserve University, Cleveland, OH DANIEL R. MASYS, Vanderbilt University Medical Center, Nashville, TN VAN C. MOW, Columbia University, New York, NY TOM S. NEUMAN, University of California, San Diego THOMAS F. OLTMANNS, Washington University, St. Louis, MO RUSSELL B. RAYMAN, Aerospace Medicine Association, Alexandria, VA CAROL E. H. SCOTT-CONNER, University of Iowa Hospitals & Clinics, Iowa City RHEA SEDDON, Vanderbilt Medical Group, Nashville, TN IOM Staff CATHARYN LIVERMAN, Study Director MELVIN H. WORTH, Scholar-in-Residence NORA HENNESSY, Research Associate JUDY ESTEP, Senior Project Assistant VILIJA TEEL, Senior Project Assistant

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap BOARD ON HEALTH SCIENCES POLICY PHILIP PIZZO (Chair), Stanford University School of Medicine, CA LESLIE BENET, University of California, San Francisco DAVID BLUMENTHAL, Harvard Medical School and Massachusetts General Hospital, Boston GAIL H. CASSELL, Eli Lilly and Company, Indianapolis, IN ELLEN WRIGHT CLAYTON, Vanderbilt University Medical School, Nashville, TN DAVID COX, Perlegen Sciences, Mountain View, CA NANCY DUBLER, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY ROBERT GIBBONS, University of Illinois at Chicago LYNN R. GOLDMAN, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD BERNARD GOLDSTEIN, University of Pittsburgh, PA MARTHA N. HILL, Johns Hopkins University School of Nursing, Baltimore, MD DANIEL R. MASYS, Vanderbilt University Medical Center, Nashville, TN JONATHAN MORENO, University of Virginia, Charlottesville E. ALBERT REECE, University of Arkansas, Little Rock MYRL WEINBERG, National Health Council, Washington, DC MICHAEL J. WELCH, Washington University School of Medicine, St. Louis, MO MARY WOOLLEY, Research!America, Alexandria, VA IOM Staff ANDREW M. POPE,, Director DAVID CODREA, Financial Associate AMY HAAS, Administrative Assistant IOM Boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authoring committee and the institution.

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap SPACE STUDIES BOARD LENNARD A. FISK (Chair), University of Michigan, Ann Arbor GEORGE A. PAULIKAS (Vice Chair), The Aerospace Corporation, El Segundo, CA (ret.) SPIROS K. ANTIOCHOS,† Naval Research Laboratory, Washington, DC DANIEL N. BAKER, University of Colorado, Boulder ANA P. BARROS,* Duke University, Durham, NC RETA F. BEEBE, New Mexico State University, Las Cruces ROGER D. BLANDFORD, Stanford University, CA RADFORD BYERLY, JR., University of Colorado, Boulder JUDITH A. CURRY, Georgia Institute of Technology, Atlanta JACK D. FARMER, Arizona State University, Tempe JACQUELINE N. HEWITT, Massachusetts Institute of Technology, Cambridge DONALD INGBER, Harvard Medical Center, Boston, MA RALPH H. JACOBSON, The Charles Stark Draper Laboratory, Park City, UT (ret.) TAMARA E. JERNIGAN, Lawrence Livermore National Laboratory, CA KLAUS KEIL,† University of Hawaii, Honolulu MARGARET G. KIVELSON,* University of California, Los Angeles DEBRA S. KNOPMAN,† RAND, Arlington, VA CALVIN W. LOWE, Bowie State University, MD HARRY Y. MCSWEEN, JR.,* University of Tennessee, Knoxville BERRIEN MOORE III, University of New Hampshire, Durham NORMAN NEUREITER, American Association for the Advancement of Science, Washington, DC SUZANNE OPARIL, University of Alabama, Birmingham RONALD F. PROBSTEIN, Massachusetts Institute of Technology, Cambridge DENNIS W. READEY, Colorado School of Mines, Golden ANNA-LOUISE REYSENBACH,* Portland State University, OR ROALD S. SAGDEEV,* University of Maryland, College Park CAROLUS J. SCHRIJVER,* Lockheed Martin Solar and Astrophysics Laboratory, Palo Alto, CA HARVEY D. TANANBAUM, Smithsonian Astrophysical Observatory, Cambridge, MA

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap RICHARD H. TRULY,† National Renewable Energy Laboratory, Golden, CO (ret.) J. CRAIG WHEELER, University of Texas, Austin A. THOMAS YOUNG, Lockheed Martin Corporation, Onancock, VA (ret.) GARY P. ZANK,† University of California at Riverside NRC Staff JOSEPH K. ALEXANDER, Director SANDRA GRAHAM, Senior Program Officer *   Member until June 30, 2005. †   Member starting July 1, 2005.

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap AERONAUTICS AND SPACE ENGINEERING BOARD WILLIAM W. HOOVER (Chair), United States Air Force (ret.), Williamsburg, VA EDWARD M. BOLEN, National Business Aviation Association, Washington, DC ANTHONY J. BRODERICK, Aviation Safety Consultant, Catlett, VA JOHN-PAUL BARRINGTON CLARKE, Georgia Institute of Technology, Atlanta RAYMOND S. COLLADAY, Lockheed Martin Astronautics (ret.), Golden, CO ROBERT L. CRIPPEN, Thiokol Propulsion (ret.), Palm Beach Gardens, FL DONALD L. CROMER, United States Air Force (ret.), Fallbrook, CA PRESTON HENNE, Gulfstream Aerospace Corporation, Savannah, GA S. MICHAEL HUDSON, Rolls-Royce North America (ret.), Indianapolis, IN JOHN L. JUNKINS, Texas A&M University, College Station JOHN M. KLINEBERG, Space Systems/Loral (ret.), Redwood City, CA ILAN M. KROO, Stanford University, CA MOLLY K. MACAULEY, Resources for the Future, Washington, DC GEORGE K. MUELLNER, The Boeing Company, Long Beach, CA ELON MUSK, Space Exploration Development Corporation–SpaceX, El Segundo, CA MALCOLM R. O’NEILL, Lockheed Martin Corporation, Bethesda, MD AMY PRITCHETT, Georgia Institute of Technology, Atlanta DEBRA L. RUB, The Boeing Company, Anaheim, CA CYNTHIA SAMUELSON, Logistics Management Institute, McLean, VA PETER STAUDHAMMER, University of Southern California, La Qunita HANSEL E. TOOKES II, Raytheon International, Inc. (ret.), Palm Beach Gardens, FL RAY VALEIKA, Delta Airlines (ret.), Powder Springs, GA ROBERT S. WALKER, Wexler & Walker Public Policy Associates, Washington, DC

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap ROBERT E. WHITEHEAD, National Institute of Aerospace, Henrico, NC THOMAS L. WILLIAMS, Northrop Grumman, El Segundo, CA NRC Staff GEORGE LEVIN, Director MAUREEN MELLODY, Program Officer

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap 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 review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: David W. Gaylor, Gaylor & Associates Al Harrison, University of California, Davis John Kindinger, Los Alamos National Laboratory David M. Klaus, University of Colorado Russell Rayman, Aerospace Medicine Association Richard L. Summers, University of Mississippi Medical 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 John R. Ball, American

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Society for Clinical Pathology, and Mary Jane Osborn, University of Connecticut Health Center. Appointed by the National Research Council and the Institute of Medicine, they were 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.

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap Contents     EXECUTIVE SUMMARY   1 1   INTRODUCTION   17      The President’s Initiative,   20      Charge to the Committee,   21      Methodology,   22      Overall Assessment of the Bioastronautics Roadmap,   23      Structure of the Report,   24      References,   24 2   CONSIDERATIONS REGARDING THE BR CONTENT   25      Overarching Issues,   26      Fusing the Relationships Between Human Factors and Technology in the BR,   34      Specific Issues,   40      References,   54 3   CONSIDERATIONS REGARDING THE BR PROCESS   60      Risk Assessment,   60      Determination of Acceptable Risk,   67      Risk Communication,   68      Keeping the BR Current,   69      Independent Health and Medical Authority,   70      References,   71

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap 4   CONSIDERATIONS REGARDING THE BR CONTEXT   73      Organizational Characteristics and Risk,   73      Analysis and Prioritization to Meet the Launch Schedule,   75      Addressing the Challenges Posed by the Small Sample Size,   78      Efficiency and Technology Issues,   80      The Case of Advanced Human Life Support,   82      References,   83     APPENDIXES     A   Bibliography of Related National Academies Reports   87 B   Methods   89 C   Status of Countermeasure and Technology Readiness Levels   97 D   Bone Fracture Risk Associated with Prolonged Exposure to Microgravity   115 E   Integration of Data-Based Evidence and Expert Opinion in Decision Making   120 F   Biographical Sketches of Committee Members and Staff   124     INDEX   135

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A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA’s Bioastronautics Roadmap List of Tables, Figures, and Boxes TABLES 1-1   Bioastronautics Roadmap Risk Rating Categories and Priority Definitions,   20 2-1   Countermeasure Readiness Level (CRL) and Technology Readiness Level (TRL),   30 FIGURES 2-1   Countermeasure and Technology Readiness Levels,   31 3-1   Results of the CB/SD/BSMT Consensus Workshop Held May 25-26, 2004, in Houston, Texas,   66 BOXES ES-1   Summary of Recommendations,   14 1-1   President Bush’s Vision for U.S. Space Exploration,   22

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