Review of NASA’s Evidence
Reports on Human Health Risks

2013 LETTER REPORT

Committee to Review NASA’s Evidence Reports
on Human Health Risks

Board on Health Sciences Policy

Carol E. H. Scott-Conner, Daniel R. Masys,
Catharyn T. Liverman, and Margaret A. McCoy, Editors

INSTITUTE OF MEDICINE
            OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Committee to Review NASA’s Evidence Reports on Human Health Risks Board on Health Sciences Policy Carol E. H. Scott-Conner, Daniel R. Masys, Catharyn T. Liverman, and Margaret A. McCoy, Editors

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • 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. This project was supported by Contract NNH13CK19B, Task Order NNH13CK20D, between the National Academy of Sciences and the National Aeronautics and Space Administration. The views presented in this publication are those of the editors and attributing authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-29652-6 International Standard Book Number-10: 0-309-29652-8 Additional copies of this report available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2014. Review of NASA’s evidence reports on human health risks: 2013 letter report. Washington, DC: The National Academies Press.

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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. C. D. Mote, Jr., 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. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE TO REVIEW NASA’S EVIDENCE REPORTS ON HUMAN HEALTH RISKS CAROL E. H. SCOTT-CONNER (Chair), University of Iowa Carver College of Medicine, Iowa City DANIEL R. MASYS (Vice Chair), University of Washington, Seattle SUSAN A. BLOOMFIELD, Texas A&M University, College Station KAREN S. COOK, Stanford University, CA ELEANOR A. O’RANGERS, Space Medicine Associates, LLC, Belcamp, MD SCOTT E. PARAZYNSKI, UTMB Center for Polar Medical Operations, Galveston (Resigned) JAMES A. PAWELCZYK, Pennsylvania State University, University Park ROBERT L. SATCHER, JR., University of Texas MD Anderson Cancer Center, Houston JACK STUSTER, Anacapa Sciences, Inc., Santa Barbara, CA PREM S. SUBRAMANIAN, Johns Hopkins University School of Medicine, Baltimore, MD GAYLE E. WOLOSCHAK, Northwestern University Feinberg School of Medicine, Chicago, IL LAURENCE R. YOUNG, Massachusetts Institute of Technology, Cambridge IOM Staff CATHARYN T. LIVERMAN, Study Director MARGARET A. MCCOY, Study Director CLAIRE F. GIAMMARIA, Research Associate JUDITH L. ESTEP, Program Associate ANDREW M. POPE, Director, Board on Health Sciences Policy v

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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: PETER CAVANAGH, University of Washington Medical Center, Seattle HARTMUT DERENDORF, University of Florida, Gainesville NAOMI L. GERBER, George Mason University, VA WARREN N. HARDY, Virginia Tech–Wake Forest Center for Injury, Biomechanics, Blacksburg DAVID KLAUS, University of Colorado, Boulder ANDREW G. LEE, Houston Methodist Hospital, TX KRIS LEHNHARDT, George Washington University School of Medicine and Health Sciences, Washington, DC MICHAEL A. WILLIAMS, Sinai Hospital, Baltimore, MD Although reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report be- fore its release. The review of this report was overseen by JOHN R. BALL, American College of Physicians, and ROBERT A. FROSCH, Harvard University. Appointed by the Institute of Medicine, they were responsi- vii

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viii REVIEWERS ble 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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Contents COMMITTEE’S TASK AND STUDY PROCESS 2 RISK OF INJURY FROM DYNAMIC LOADS 5 RISK OF CLINICALLY RELEVANT UNPREDICTED EFFECTS OF MEDICATION 13 RISK OF SPACEFLIGHT-INDUCED INTRACRANIAL HYPERTENSION AND VISION ALTERATIONS 24 SUMMARY 34 REFERENCES 35 APPENDIXES A Meeting Agendas 41 B Committee Biosketches 45 ix

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