Carol Scott-Conner: Deep-space medicine

What goes into a medical kit for a trip to Mars? What risks could astronauts face as they travel farther than ever before? Space travel of unprecedented distances and durations may some day be a reality, but only if health-related questions are asked and answered today.

One of the experts NASA turns to is Carol Scott-Conner, MD, emeritus professor and former head of surgery in the University of Iowa Carver College of Medicine—onlyCarol-Scott the second woman to be appointed to lead a surgery department in the United States. Since 2002, Scott-Conner has been involved in research conducted by the National Academies of Sciences, Engineering, and Medicine to support NASA, helping to identify and prepare for challenges that could arise during long-term space missions. Currently, she chairs two committees of the Academies’ Health and Medicine Division (formerly known as the Institute of Medicine): the Committee to Review NASA’s Evidence Reports on Human Health Risks, and the Committee on Aerospace Medicine and Medicine of Extreme Environments.

Scott-Conner spoke with Medicine Iowa about collaborating with the brightest minds in their fields to shape the future of extraterrestrial medicine.

Q: What kind of research is this?

A: It’s not research in the sense of going to the lab. This is a convening of experts who examine all of the evidence. The original question NASA asked was, “If we want to send humans beyond low-Earth orbit, what are the major health issues, and what research should we be doing today to prepare ourselves?” We looked at a whole host of issues. That resulted in a summary of best knowledge at the time.

NASA has since separated that summary into about 35 risks and created reports on each. One of the committees I chair is examining those reports. We look at where they are, what NASA is projecting to do for research, and what they’ve identified as the unknowns. We give that a reality check against the best outside experts.

Q: What issues are being explored?

A: Some of them are very mundane things: What do you put in your medical kit? What meds do you take? What instruments do you take? Should you have a physician with you? What if the physician gets sick?

What you want to do is something that was pretty nicely brought out by the film The Martian, with all the “MacGyvering” he does. You want to give them things to improvise with. Send them with plenty of duct tape—or the medical equivalent of duct tape. Many of the other problems are quite space-specific.

Q: What issues have interested you the most?

A: Radiation exposure is one. Beyond low-Earth orbit, radiation is more intense and different—a higher dose of a worse kind of radiation. The biologic effects are like cannonballs compared with pellets of birdshot.

They measure astronauts’ exposure, just like we do in the hospital with dosimetry badges. NASA would prefer to send experienced astronauts, of course, but they’ve already accumulated some exposure. If we want to send somebody to Mars but their cumulative exposure would exceed a tolerable limit, what should we do? Just increase the acceptable limit?

The subcommittee that formed under my direction to study this question included a group of stellar biomedical ethicists. They worked out a multistep process that was ethically sound, practical, and defensible. It involves evaluating the importance of the mission. Does it justify putting humans at risk? Next, is everything being done to minimize exposure? And so on. The standards themselves do not get changed.

Q: How did you get involved in this work?

A: I got a call from a former NYU professor who was working for the Institute of Medicine. They were looking for a surgeon to support a committee working with NASA. I named some surgeons doing research on surgery in zero gravity, but he said they all had conflicts of interest. And then I said, “If you can’t find anybody else, I’d be interested.” He said, “Send me your C.V.” The next thing I knew, I got an invitation.

I like to tell this to young people in academics: Don’t be afraid to volunteer. You may be just what they’re looking for. In my case, I think it was the fact that I was doing a combination of surgical oncology while taking trauma and burn calls at night. Those are their big issues: concepts you have to know as a surgical oncologist—radiation and all of that—and the injuries.

Q: Were you interested in space travel before then?

A: I was fascinated by it when I was young. My dad was a physicist who worked for the U.S. government. I was an only child, and he would talk to me about the basic principles of rocketry, like the difference between solid-fueled rockets and liquid-fueled rockets. I remember going out at night to look for Sputnik. So I grew up with it. And I liked to read science fiction. I love the idea of going to Mars.