If you’re fascinated by the idea of humans traveling through space and curious about how that all works, you’ve come to the right place.

“Houston We Have a Podcast” is the official podcast of the NASA Johnson Space Center from Houston, Texas, home for NASA’s astronauts and Mission Control Center. Listen to the brightest minds of America’s space agency – astronauts, engineers, scientists and program leaders – discuss exciting topics in engineering, science and technology, sharing their personal stories and expertise on every aspect of human spaceflight. Learn more about how the work being done will help send humans forward to the Moon and on to Mars in the Artemis program.

For Episode 126 Laura Bollweg and Peter Norsk detail the effects that the microgravity environment has on human health, what we’re doing to counteract some of these effects, and the studies taking place to better understand how the Moon and Mars may have different impacts. This is part four of a six part series on NASA’s Human Research Program. This episode was recorded on November 19th, 2019.

Transcript

Gary Jordan (Host): Houston, we have a podcast. Welcome to the official podcast of the NASA Johnson Space Center, Episode 126, “Fighting Space Effects.” I’m Gary Jordan, I’ll be your host today. On this podcast we bring in the experts, scientists, engineers, astronauts, all to let you know what’s going on in the world of human spaceflight. This is part four of our six-part series on the Human Research Program. Today we’re going to focus on the Human Health Countermeasures Element. One of the five teams at NASA Johnson Space Center working on finding the best methods and technology to support safe productive human space travel, but more specifically seeking to understand the physiological effects of spaceflight, the effects on astronaut health. Giving you further insight into human health countermeasures is Laura Bollweg, Element Manager and Dr. Peter Norsk, Element Scientist and a professor at the Center for Space Medicine at Baylor College of Medicine. Together they lead the group that lends biomedical expertise for the development and assessment in areas such as medical standards, vehicle and spacesuit requirements and countermeasures, which are ways to preemptively fight the effects of space, like for example exercising. And all of this is done to ensure crew health during all phases of flight and to prepare for missions deeper into space. So here we go. The intricacies of what we’re doing to fight the effects of space on human health with Laura Bollweg and Dr. Peter Norsk. Enjoy!

[ Music ]

Host: Laura and Peter, thank you so much for coming on Houston, We Have a Podcast today.

Laura Bollweg: Thanks for inviting us. It’s a pleasure to be here.

Peter Norsk: Yeah, me too. Thank you very much.

Host: So today we’re going to be talking about human health countermeasures. Now, I’m going to start it by asking, and this might be a stupid question, but what’s a countermeasure?

Peter Norsk: A countermeasure is a procedure or an equipment to be used against the negative effects of spaceflight on the human body. So, an example is, if you are prone to fainting after spaceflight, on the ground you would have — you do something in order to make the body resistant to gravity. One example is you use a garment that compresses the lower part of the body and keeps fluid and blood in the upper part of the brain’s perfuse and you drink salt and water before landing. That’s a countermeasure that consists of sill items.

Host: OK, so it’s a way of preventing something from happening, or I guess a response to some effect of spaceflight.

Peter Norsk: Yes, any negative health effects or something that affects performance in a negative fashion for the mission.

Host: OK, so would sitting on my butt and watching TV all day, a countermeasure to fight the amount of TV I want to watch would be work out every once in a while?

Peter Norsk: Yes.

Host: OK, alright. That’s the way I like to think about it at least.

Peter Norsk: Or you could simply shut off the TV and do something sensible.

Host: What are you trying to say Peter? [laughing]

Laura Bollweg: And a countermeasure can have a certain protocol to it. So, you could have a certain exercise regime.

Host: OK, yeah, there you go. Alright, so to get into countermeasures and fully understand what you do for this particular element of human research, let’s go into your backgrounds. Laura, why don’t you start? What’s your background and how does it relate to countermeasures?

Laura Bollweg: Sure, I’m a mechanical engineer from University of Akron and I came to NASA as an intern working shuttle training propulsion. And then over time I changed to teach the International Space Station and was a project manager for developing the simulator for the first ISS crew and trained the second class for the first ISS crew. So, it’s been a long time. And so, I really appreciate spaceflight at operational aspects. And so, I wanted to come to the Human Research Program to get early in the program, to really make a difference in changing things before the vehicle is built, before things are locked down.

Host: Oh Ok. Yeah, because you said you were training crew, so naturally you have that human interaction when it comes to how people interpret how to train with certain things, so you have that human element. And incorporating that ahead of time, naturally, makes sense, right? You want to design something that maybe might not be, or might — you know, instead of designing something that is the most efficient for what it is to do, it’s the most efficient, but with incorporating that human factor in it.

Laura Bollweg: Absolutely. With countermeasures we don’t think about just our specific element, we think about the big picture. So, we might think about human factors, how that plays into the countermeasure, so it’s not just a physiological, but physiological and human factors together.

Host: OK, now Peter, what about you? What’s your background?

Peter Norsk: Well, I’m an MD from the University of Copenhagen, but I actually started my space interest long before that when I was ten years of age in ’63 watching or actually listening to at that time, John Glenn doing his first orbits around the Earth and that inspired me for my whole life. And when I became and MD, I looked up a certain research group and there was only one for space medicine, because Denmark is a pretty small country. So, we were the only ones. And I worked in that group and kind of became the leader of that group for many, many years before I came to NASA about nine years ago. So, before that I did the research on the space station, before that on the Russian Space Station Mir, and before that again on the shuttles, so cardiovascular research, understanding fundamentals of gravity and microgravity on the cardiovascular system.

Host: Very important research. So, you did research on, you have kind of an understanding of what’s happening to the human body in space and naturally you being part of a countermeasures part of things, it’s figuring out ways and how to counteract that.

Peter Norsk: Yeah, in Europe it was more fundamental understanding the basic adjustment and adaptation of the cardiovascular system to weightlessness. So, when I came to NASA it was more kind of using that knowledge, as well as artificial knowledge to counteract the negative health effects of spaceflight. So that’s why I actually went to NASA to have a more applied approach.

Host: OK, now it’s worth mentioning, Peter, that you’ve been on the podcast before. Me and you had a great discussion on we were going through the hazards of human spaceflight and we talked about exactly what you’re talking about, how gravity effects the human body in space. I think the last, and this might be an update, correct me if I’m wrong, but you are now a professor at the Center for Space Medicine at Baylor College of Medicine.

Peter Norsk: Yeah, that’s correct.

Host: Alright, well congratulations.

Peter Norsk: Thank you very much.

Host: How do you split your time? How do you do professor and do NASA research? Or are they very much interwoven?

Peter Norsk: Totally.

Peter Norsk: OK. And that’s why, it requires a little more work too because I have to do lectures and papers that I didn’t do before in my capacity as professor at Baylor College of Medicine. But I enjoy doing it and it actually improves my work at NASA administering scientifically to build with Laura the Human Health Countermeasures Program, Project, actually Human Health Countermeasure Element in the Human Research Program. [Laughter] I’m learning, you know, still learning the acronyms and how things work, but I think I’m getting them.

Host: Yeah, me too. I’m always learning. Now let’s get into it. Let’s go into exactly what you guys are doing. Human Health Countermeasures, Laura, what is this organization? What are you focusing on with it?

Laura Bollweg: Well, Peter and I co-lead the element. Peter develops the scientific strategies. So, everything we do is based on sound, scientific thought and principles. And then we work together to turn those into an implementation plan. And so, the implementation is a little bit more in my side of things. So, he challenges me on a daily basis on how to get the most science in with the research platforms that we have available, including the International Space Station. But we have research platforms on the ground as well.

Host: OK. So, let’s go into, I guess, the implementation a little bit more. What is it exactly that you are implementing? What are the things you’re focusing on to figure out what these countermeasures, what countermeasures we need for successful spaceflight?

Laura Bollweg: So, based on his scientific strategy, we put together something that might — for example, if the countermeasure is projected to be hardware, then put together a hardware validation plan to make sure that the hardware will work. So, we’ve got enough things in the schedule, enough resources, enough of the right skill sets pulling in, so that at the end of the day when it’s time to deliver it to the right program, the hardware or software or whatever the countermeasure is, it’s gone through rigorous engineering thought process.

Host: OK, so Peter, Laura mentioned that the decisions made on what to implement has to be based on sound science. So how do you define that? What is the sound science that you’re looking at?

Peter Norsk: Well, science is one of those mystic words where by you can hide behind and seem very clever and nobody understands what you actually mean. So, people use this word erroneously many times. Science just means knowledge you can trust. That’s it. So how do I gain knowledge I can trust? Meaning, it has been all kinds of questions as to when you got this knowledge, you measure it, what are the inaccuracies? Did you take this and that into account? I mean take that into consideration and controlling for all the unknowns is good science. So, my job is to make sure that we are following the best practice of science that’s already being done in the United States particular, but part in the western world, making sure that those procedures are used also at NASA at an adequate level, even better maybe. And also making sure that these best practices are then being implemented into. If it is something on ISS, in an analog in the best way, and that’s where Laura helps me making sure that is happening because she knows how to do that. I don’t know that. I know what the best practice is, what kind of science and questions we have to ask, she knows what can be done or not be done, how to keep it on schedule. That’s very important with me because I’m always out of schedule. I don’t keep the schedule. But she does. And also making sure, you know, that you can actually try this experiment on the ISS. If I wish to bring up an elephant instead of a mouse to test something, she would tell me, “That’s not possible.” As for having a giraffe, she would say, “No.” And then we end up with human beings or whatever. So, this is kind of the practical way of doing things that the management system actually makes excellent contributions.

Host: So, great science naturally, that has to be done on the International Space Station.

Peter Norsk: Yeah, the problem is that best science, you know we know it’s my job to know how to do that in general.

Host: Sure.

Peter Norsk: But how it ends up is sometimes different because you have constraints doing, you know space science also very operational. There are very many unknowns, there are other considerations. The management system may not always — engineering or leadership system, may not always know, you know not be able to implement the best practices, so we have to compromise and find out where that it makes the whole thing worthwhile or not. So that’s where actually the most difficult decisions sometimes.

Host: So, Laura, what are the constraints of spaceflight that make maybe doing research on the International Space Station a little bit harder?

Laura Bollweg: Well, I think Peter alluded to it. There’s size, you know is it something that is possible to do on the International Space Station, is it the weight? The schedule? We normally have our proposals about 18 months before, so there’s enough time to work through the implementation. There’s also, typically we don’t think about a particular study. We often are thinking of a series of studies and how they come together to answer specific milestones. And so, it’s not just study-by-study, but is there enough, I think a lot of the implementation is, is there enough time to get the research questions we need answered while we have ISS available? It’s an important platform for long duration. And so, we need to make sure that the research gets done during the time frame we have this important research platform.

Host: Yeah, time — that the research platform will exist as a platform, but I’m sure time is also a constraint when it comes to astronauts. Right, you’re not the only ones trying to do research on the International Space Station. You have to make sure that it’s going to be something that the astronauts will be able to conduct in their own very tight schedules, something I know is a big constraint. So naturally, you know you can’t do a bunch of — you can’t do everything that you want on the International Space Station, where else could you test some of the countermeasures that you would like to do?

Peter Norsk: Well we have something called analogs. A new word I actually learned when I came to NASA, we called kind of simulation models in Europe. And we simulated the effects of weightlessness by for the major parts by using head down bed rest. Unloading the body and shifting the fluid upwards by a slight two to six degrees head down. And that is being used because you can do it for long durations. Not as long as on the ISS, but maybe for 60, 90 days. And it gives you a lot of the effects physiologically that you will see during unloading during weightlessness. There are limitations to the model, but you can actually exploit those limitations in understanding more the mechanisms if you know what are the differences from that simulation model to actually what’s happening in weightlessness and seeing differences in outcomes of physiological variables. So, it’s a good model. Head out water immersion has also been used, but only for short periods. In Russia they did it for — you know, floating water is actually being very much like weightlessness, and they’ve done it for a couple of weeks, but it’s a very difficult model because you can’t measure many things underwater. It’s more difficult than doing it in space actually.

Host: Oh wow.

Peter Norsk: But these are dry immersion is a model whereby you are not getting wet research, but it’s still much more complicated to do research being submersed in water. Even though it’s dry immersion with a sheet protecting the body against the water, but still with the water pressure around your body. And so, we have chosen to do the head down bed rest study as an analog.

Host: So what questions are you asking in these analogs that specifically relate to countermeasures?

Peter Norsk: We have selected the official article systems that are susceptible to unloading. So that would be the musculoskeletal system, and muscles, bone because you unload it from feet to head, but you still load it actually from front to back, but it’s much less than when you’re upright and walking. And so, if you are recumbent, inactive in a bed rest setting with a few shifts, you can see many of the aspects of demineralization of the bones, as well as atrophy of the muscles. And then using certain exercise techniques, you know how precision on a treadmill with loading the springs you can actually simulate what’s going on, on the treadmill on ISS. And there by see how efficient your countermeasures work and protect bone and muscle. So that’s one thing that’s a very kind of big thing. And we have been very successful with that. But you have to test it finally on ISS after doing it in an analog. But you can prepare for it and you can prepare for the best prescription to be tested on ISS to save crew time. And then also, understanding the fluid shift, the magnitude of the fluid shift into the head, because as you probably will know, and this is our top priority to understand, why the increase pressure in the head of the fluids effect the eye and how it effects the eye and the brain. So, we are doing that. Now we can also do that in a bed rest setting. This is a very recent breakthrough. Actually, since the last podcast that we can create manifestations of those ocular changes called the Spaceflight Associated Neuro-ocular Syndrome, very complicated. The SANS syndrome that is how it affects the eye and the vision, we can do that in bed rest, and use it as a precursor and an analog for spaceflight.

Host: Wow. So OK, now what about, and this you were thinking about, you mentioned something that’s sort of recent from the last podcast.

Peter Norsk:Very recent. This is a breakthrough. It’s a big thing for us. Because using an analog saves time on ISS and we can prepare much better countermeasure testing than we could before.

Host: So, let’s talk about the time it takes to put together an experiment and ask the right questions. You know, what’s happening to the human body is naturally is a good one, and you have that in space, so what’s happening. That process from going from that point, what’s happening, to the process of how can we mitigate this problem? How can we fix it? What does that look like?

Peter Norsk: Well, you know that’s — how long it takes to get it implemented to ISS is a different issue. So, the whole thing for whole experiment, well I think we — there’s an experiment called the fluid shift, which is understanding the relationship between the shift of fluids in microgravity and the ocular, you know the vision changes, the sight changes of the eye. And that started when I came in 2011. We selected it. And it’s just a — I think it’s just about to be — it’s just being completed in data collection in space and it’s not completed as a study yet. So, it takes apparently up to nine years before it’s published. I can give you another example. I did an experiment myself before I came to NASA and into my employment in NASA and that started in 2006 and ended in ’15 as a publication. Again, nine years. So, it takes about nine years for a full study.

Host: Wow.

Peter Norsk: So, it takes a long time but it’s not the same. In laboratory work, in normal Earth-bound setting, it takes much shorter, but that’s because of the access to astronauts is more limited. I think we can test about how many astronauts there, Laura, on an annual basis? About two or three.

Laura Bollweg: Maybe four or five.

Peter Norsk: Maybe four or five sometimes.

Laura Bollweg: It depends how many sign up to do that experiment that particular year.

Peter Norsk: Yeah, so sometimes it takes a long time. Sometimes it goes fast. It differs.

Host: OK, now you mentioned astronauts signing up. This is, you know, this might be — actually I forget if we’ve mentioned this on a recent podcast, but you know you can’t force astronauts to do everything that you want them to do. So, what does that process look like from when you have an idea, when you have some experiment that you want to finally get up on the International Space Station and getting them to conduct the experiment?

Laura Bollweg: Well, first all the research goes through a review board. So, they look at it and determine if it’s reasonable, if the risk is reasonable, if the science they want to collect makes sense and is safe. And then after the research is selected by the Human Research Program to go to flight, it is presented to the crew members for them to decide if they want to participate or not.

Host: OK, so when you have this review board and you’re looking at different experiments that you want to conduct, have a lot of them already been done on the ground and tested in some capacity and you want to now move them up to spaceflight? Or maybe they’re brand new and that’s something that’s very interesting and they want to fly it?

Peter Norsk: Well, partly yes and partly no.

Host: OK.

Peter Norsk: So, if you take one study, again like the fluid shift would be one of our highest prioritized studies, it consists of several sub-studies with different principle investigators for each. So, we select the three and combine them into one. So, each of those, you know the procedures, the measurements have been tested in a laboratory setting very thoroughly by these investigators and this is actually the reason they were selected probably because they have a lot of experience. But what is new is to combine them and use them in either analog setting or in space. And that is totally different from on Earth and therefore it’s new every time and it’s something that’s very exciting the first time we do an experiment. And you actually have to count on having failure in the first couple of experiments before it becomes routine for the whole system. But usually it works out very well. We do have some setbacks, you know with equipment that doesn’t work at some point in time because it’s a very tight schedule, you have to measure this particular variable at this particular time because they have everything set up minute by minute basis or five minute by five minute basis, something like that. And if they fail they have to come back to it and use least time for doing it maybe. So that postpones things to some degree, but not very much. It’s actually extremely impressive how it works for NASA in space, extremely impressive. I am still impressed. And it’s actually because of what Laura and her team and everybody else with that background actually do. Because they have the experience from many, many decades of implementation that makes it possible. And that is also why they push back on the sciences like me, who think we can do everything in space and we can’t. So that is extremely important for success.

Host: Alright, well if you keep asking for elephants it’s going to go that route.

Peter Norsk: Yeah, we gave up that one, giraffe, you know it’s very interesting because the giraffe is a very good model for the understanding extreme fluid shift on Earth, because when the giraffe lowers its head it’s in danger of having brain edema, so it has to use certain mechanisms in order to avoid having too high a pressure in the brain. We do have a smaller problem, but it does exist in weightlessness with a too high of a pressure in the brain as well. And we are concerned about the extradition, the fluid into some brain structures, as well as the eye, and that’s what we’re looking into. It’s not the same as a giraffe, of course, but the model is just more extreme in that regard. So that’s why we have actually looked in, we hadn’t done any studies per se from NASA, but we have looked into the data that’s been done already on giraffes in Africa to understand some of those.

Host: So, looking into some of the past, some of what we have learned from previous spaceflight, and I guess we can incorporate outside of spaceflight and what we understand about these shifting fluids, maybe in like you said, other species, that relate to spaceflight. How have we grown through time?

Peter Norsk: I think we have improved tremendously. We are using a lot of clinical disease models, investigations in patients in order to understand some of the symptoms of spaceflight. It’s not the same, because astronauts are extremely healthy, they’re selected to be healthy, and they go to space and see some of the same changes as we see in patients, but it’s not the same in total because they are not sick. I mean even in space they are totally healthy, but they have some of the same manifestations but not fully. One example again, if you look into the eye changes, the vision changes in space, it actually resembles, and for a long time we thought it was the same, it resembles an increase pressure in the brain in certain patients. It’s called idiopathic intracranial hypertension. So too high of a pressure because of some food disturbances in the production of spinal fluid. And so that’s in some patients will increase. They do have vision changes also, some of them. So, we thought it was the same thing, but it turns out that when you compare certain measures during spaceflight, with that patient but it’s not the same. And the manifestations are also a little bit different in the eye. So, you have some similarities, some differences. We still use patient models to understand differences to understand the mechanisms of spaceflight and I just tell you it will be a surprise every time. And we are still being surprised by what is actually happening with the fluid distribution in space, which we didn’t know before just a few years before. I’m talking about right now. So, spaceflight is unique in that regard.

Host: So, Laura, when it comes to what I’m hearing is, you know you can study fluid shifts, but you have to do it from all of these different perspectives. You have to look at history, you have to maybe bring in other species and maybe if you look at all of these different angles something might surprise you along the way. So, what is human health countermeasures doing to manage all of the driving forces that Peter keeps coming to you with, and “Oh I want to do all of this research.” What do you do to manage and prioritize what’s important and what we’re going to focus on?

Laura Bollweg: That’s an excellent question. We look at strategic planning and not just implementation of specific studies but look at a series of studies. And what we do is really novel. If you look around the world, there really is no place that strategically takes a series of studies, plans it out as a project with milestones that consider where do we go next? So, we have what we call decision points where we stop and think where do we want to go next based on the findings we have and then carve out a path forward. There really is no place that I know of in the world that takes that approach, that takes the scientific rigor and puts management milestone rigors with it so that we can deliver on time with validated countermeasures. And so that’s one of the reasons I’m really excited to be in the Human Research Program is because, there’s a lot of excellent research that’s done with (National Institutes of Health) NIH, but really the stepping stone approach in putting all the resources together in a very funneled way, to produce real countermeasures is something novel and special that we have at NASA.

Host: So, it sounds like that integration at combining these elements are really important to have those checks and balances of the science and the management aspects of things. What really peaked my interest though is when you were saying that if you’re looking further out, right, you can only plan so far because when it comes to science something might surprise you. And you say, you might have to carve out another path because something might come up and say this is very interesting, we should dedicate resources in the resource in the future to investigating this path and going down that way. So, what is that like from planning perspective of planning and integrating all of these things but doing it to a certain point that has to include a certain amount of flexibility when it comes to discovering new things.

Laura Bollweg: Yes, each year we get a chance to re-plan. And again, we have these decision points where we can stop and pause, Peter and other scientists can review all the scientific findings. And if the assumptions that went into our plan and our resources aren’t valid anymore, we can bring that story forward. That’s something that the Human Research Program really encourages us to do is to be able to change our path if the science does surprise us, or I should say when the science surprises us.

Host: Yeah, so naturally being, you know human health countermeasures, we’re going through all the elements of the Human Research Program, you’ve mentioned human research program. We’re going through all of these elements. They’re not siloed right? You’re not making your own decisions and going up your own little chain. There is crosstalk with all of the other elements to make sure that everyone’s in line. And I think one of the more interesting things that we’ve discovered or at least talked about in some of these recent podcasts is that you can come up with an idea for a countermeasure, something you may realize maybe we should implement this, and this is the best way to counter these possible effects. But then you discover that these countermeasures produce their own side effects and now you have to investigate those and make sure that it’s not going to affect too much downstream. So, what is that like relationship wise, with all of the other elements and making sure that you’re talking to one another and realizing the effects of these decisions?

Laura Bollweg: We definitely have integrated projects where we’re working on a same goal with other elements. In fact, I was the element manager for Human Factors and Behavioral Performance and have recently moved to Human Health Countermeasures. So, we definitely are well integrated. And just like other managers have done this cross training, we are familiar with the other areas and then we organized these projects. I don’t know if you want to mention the [Cognitive Behavioral Sensory] CBS project as one of the scientific projects that we —

Peter Norsk: Yeah, that’s one very good example of integration between disciplines. So, we have three different disciplines being integrated in that project. One is all the sensory motor work. We are doing sensory motor means the balance system and the relationship between what you see, what you feel balance wise in the inner ear, as well as what you feel from your limbs and muscles, integrated into keeping balance. I mean walking as a human being shouldn’t be possible when you look at it because it should be very easy just one side or back and forth because you’re very long compared to the support of your feet. But because of the sensory motor system and the nervous system and regulations in the balance system, you can keep your balance all the time. Now, that’s more difficult after spaceflight, so that’s one issue we have that you are totally confused and like a drunk person who has been drinking too much after spaceflight. They hadn’t been drinking, just to make sure, but it looks like it sometimes. And therefore, we want to mitigate that. That’s one exam. So that is now being integrated into research with everything that’s going on in the brain, apart from that particular issue, you know cognition, as well as perception and memory and things like that, behavior. And so that, we are combining those two pieces of research and then we also, so we are looking into the behavioral sciences, a sensory motor, and the cerebral structural changes of the brain in one part in order to understand interaction between the different systems. So actually, this is very interesting for me because before I came to NASA I had never worked together with behavioral scientist or psychologist. And actually, as a medical doctor, you don’t really regard these people as anything right. And then you come to NASA and you see what they are doing is very, very important for the brain function and for your balance system. So, we worked together on a day-by-day basis and there’s a structure for that at NASA to do that, so that’s created by managers like Laura and her colleagues, which scientists would never invent. Scientists are very siloed and very focused on their own performance. They’re also very selfish. Now this is taken out of the sciences at NASA by the management system make much better science. So, I think everybody agrees it’s a good thing, but you have to be forced to it sometimes. And that works very well and it actually limits resources being spent. It makes it more efficient. You have better science this way. But it’s also, it can be difficult at times to have people understanding how to work together but that’s management.

Host: So, when you’re working together, and you are trying to come up with decisions for the future on what things to implement for spaceflight when it comes to human health countermeasures, what specific countermeasures parts do you actually take to the table and try to enforce? Or what is your perspective when brining that to the table?

Peter Norsk: The perspective is that you do the research to understand first what’s going on. The next thing is what are the mechanisms? The third thing is that based on that how big is the risk? And then fourthly, how do we mitigate if it is necessary? And the mitigation is the treatment against it or the counteraction of what that weightlessness does to that system. So, one example again, is you have fluids to the head increase pressure in the eye. And you are not only concerned about the vision changes but permanent damage to the eye and some parts of the brain. You have to move the fluid back. How do we do that in space? Well, one way of doing it is maybe to draw it back by sub pressure around the lower body to keep the drawing the fluid back. And if you maybe do that intermittently at some point in time it may be enough or not enough to mitigate the effects of those manifestations. That’s a countermeasure. That will be a box around the lower body that has to be delivered to NASA to fly in deep space to mitigate this issue if it appears in the person. So that’s one vision for that. It’s more complicated than that. This just being simple. All the garment and the fluid loading after landing so people don’t faint, because of the orthostatic intolerance. It could be we have immune changes in space where by the confined environment and the stressful environment induces changes to the immune system that makes us more susceptible to infections and allergic reactions. So, if that’s too much and effects performance, we have to mitigate that by nutritional countermeasures, better food, maybe some pharmacological agents, some medication that is not harmful. Aspirin actually helps a little bit, as well as some other medication and then also changing the procedures, the operational environment so that the stress fullness is less on each individual. So, things like that.

Host: OK. It seems like there’s — I like the steps that you kind of laid out, kind of figuring out what’s the problem, understanding the mechanisms. You mentioned risks. And it seems like one of the biggest parts that this organization contributes to is that next part. Once you identify a risk and identify maybe how impactful it is to the success of the mission, this is where you start investigating, well how can we counteract this risk?

Peter Norsk: Yeah, we have two sets of — you know we have the health that can create, you know you have effective weightlessness during long time can create some effects on maybe bone demonization that lasts forever and then that’s detrimental for a lifetime if you don’t mitigate in flight. So that’s one health risk that has to be mitigated for ethical reasons as well. And then you have performance, decrements performance, that’s not really a health risk but makes your — endangers the mission because your performance too low and therefore you have to mitigate that also. These are different types of countermeasures. So, the behavioral scientists are very concerned about performance, and we are very much concerned about the risk to health.

Host: To health. That’s where the difference is, OK.

Peter Norsk: Yeah, I would say where the sensory motor system and the balance disturbances is more performance oriented because you usually recover a couple of days after landing on a planetary surface. But I mean for those two first days you need to be able to do something in order if something happens. When you land on Mars, you have to be able to get out of the vehicle and into your spacesuit if something happens immediately. And therefore, we had to mitigate that.

Host: OK, so this is where you’re starting to understand where these different elements are coming into play. We’ve already done I think it was part two of this series was on the human factors and behavioral performance. You said they’re trying to answer questions that are trying to maximize the performance of these astronauts, but it sounds like when it comes to this organization it’s more about making sure that they are going to be healthy throughout all the phases.

Peter Norsk: Yeah. Well, we also work into performance but you’re correct. And also, for behavioral scientists they’re also concerned about, of course, the damages to the brain that may be health oriented.

Host: So that crosses over?

Peter Norsk: Yeah, yeah. So, it does cross over.

Host: So, when it comes to, Laura, you mentioned some of your past experience with crew training and involving the crew and there was elements of human factors there as well. Coming to Human Research Program and being so close to the science end of things, how has your perspective changed since that previous role and now looking at how the science is done from that end of things?

Laura Bollweg: I think I’ve gained a lot of respect for our scientific community, the rigorous way they approach things. It can take some time and real thought to follow what their processes are, but it’s very rigorous. And so, we have a human system risk board that’s independent of the Human Research Program. And what they do is help educate us. It’s a team of doctors, astronauts, managers that help characterize for each of our risks what the likelihood of that risk occurring is and what the consequence is for different types of missions. And so, they put colors against our risk and that helps us prioritize. For example, when Peter was talking about the SANS risk, that is considered a red risk and therefore it is a high priority because the likelihood and consequence is considered very serious. And so, I think we have a very rigorous methodology for how we approach things, how we prioritize them, and then solve these challenging questions for exploration.

Host: So yeah, and that’s a big key point is when you’re categorizing and identifying these risks, you mentioned a couple of them, but when you — it sounds like there’s a red, probably a yellow and a green right? Those are the other ones? But when it’s red that would, and correct me if I’m wrong, be a severe risk to the health of the astronaut and perhaps the success of the mission.

Laura Bollweg: Yes, usually it’s considered either under operational mission impact or long-term health.

Host: I see, OK.

Peter Norsk: Yeah, these distinctions are very important, but you know it goes together. One example is the degradation of the muscle strengths if you don’t exercise probably in space because you are deactivated by weightlessness, that’s a fixed both health and performance. So, we need to find out how strong to have to stay in order to perform well enough. You may actually accept some degradation but to a certain level. And defining that is not easy. But that’s what we’ve been doing for a long time. And but also, it’s a decrement to health if you have too much degradation of the model because then it’s very difficult to reestablish the strains. So, if you get too far down. People in wheelchairs have totally, this use model, you would never be able to re-exercise them back to normal. So, I mean there’s both a health and performance aspects of everything we do. The first is performance and then you have effects on health.

Host: OK, so if we’re looking at the International Space Station now, we have 20 years, almost 20 years continuously of human habitations, a lot of experience when it comes to astronauts living and working in space for a long time. So, if we were to take a snapshot of today, what countermeasures are in effect now to ensure the health of the crew when they’re on six-month missions aboard the International Space Station?

Peter Norsk: Yes. One is the exercise system on ISS is very efficient. It works. It protects bone and muscle pretty well. But the challenge is to have a smaller vehicle going into deep space because you can use that big exercise system, but it works. So, we know that. We didn’t know that maybe 20 years ago we didn’t know that. So, we know that now and we know what kind of loading we have to expose the body to in order to keep bone and muscle in tact at a level that’s acceptable. Another one is the landing avoiding or mitigating fainting by the garment and the fluid loading. This has been totally quantified in detail. It has worked for a long time, but we didn’t quite know how well, but now we know it works after long durations of spaceflight. And that will be the countermeasure for orthostatic intolerance in the future. So, these are very, very strong countermeasures. And then you have a countermeasure like, we don’t have it for the SANS, which is the most important problem we have right now, but we have ideas that it may be moving fluid from the upper body to the lower body, using not a box but kind of developing a box into a portable structure on the body that can float in space and still be performing well enough with that on, so kind of a suit around the lower part of the body that also back on a continuous basis. But that’s a vision. It hasn’t been developed yet. And another thing is mitigating and counteracting the immune changes that we see in space. And we have improved a lot of that on ISS. Without ISS the immune problem would still be probably one of the most important ones, but now they’re kind of being degraded to a lower level because it turns out that the exercise system, the procedures we are using, the food that they are eating, the medication that they have, but not using regularly but could be, all of that in combination mitigate many of the immune changes and has improved over time that has been shown recently by all these scientists. So, this is very, very promising. But we still have some ways to go in order to make it fully efficient. And then you have a sensory motor system has been totally characterized after flight. So, the balance systems, the confusion, the drunkenness I described it as — they’re not drunk. They don’t drink in ISS. Except there were rumors on the Mir space station but I don’t think it’s true.

Host: OK.

Peter Norsk: They did smoke on Mir, but they didn’t drink. So maybe a little bit, I don’t know. But on ISS we don’t do that. And therefore, so they’re not, but I mean that characterization of what systems are affected to what degree, how long it takes to come back to normal with doing nothing, has been extremely available for us to develop the right countermeasure. And the countermeasure now is actually also part of the exercise system and we still need to test some additional countermeasures in order to make it more efficient. We know now also what you need to do preflight, how to train people to have a better balance system even after six months or more of flight. So that is a huge advantage for our future missions, which we didn’t have before the ISS. Without the ISS, I don’t think it would be possible to go into deep space and Mars. With the 20 years of experience it’s now possible to do that.

Host: That is so important and it’s actually really coming to light just how important exercise is in all of this. When you were going through all of the countermeasures that are implemented right now, exercise, you got the bone and muscle, check. It helps a little bit with the immune side of things, check. I wouldn’t have thought that one before. But countermeasures can come in all these different shapes and sizes. You got the exercise naturally yes, the whole way that astronauts live and work in space, having the exercise in the food and the sleep and everything maybe isn’t countermeasured by itself. You mentioned technology. Certain technology to help with making sure they don’t faint when they come back, which is huge, right? So, countermeasures can come in all different shapes. It’s absolutely fascinating how that all works and is implemented. And I think the biggest takeaway here is the fact that — and you mentioned this several times, the space station was the key to all of this.

Peter Norsk: Space station was key to all of this and it’s been worthwhile to do this because it wouldn’t have been possible to go into deep space and Mars without the space station. We still need it by the way. We would like to use it more. It’s available at least onto 2025, but I think it needs to be extended beyond that because I have difficulties envisioning that we shouldn’t have a platform permanently in orbit around the Earth when we are preparing at the same time to go to the Moon and Mars. But it’s of course up to people at higher level than me.

Host: Yeah, a closed platform has been proven to be valuable of course. So, we have all these countermeasures that we know work on the space station because we put them into work now and they’re keeping the astronauts pretty healthy. I remember, I forget who we talked to recently, but said that there are some instances where astronauts come back healthier than they, or maybe stronger in a way because of how much they work out, which is pretty awesome.

Peter Norsk: Yeah.

Host: I know there’s talk of one-year missions, because you know one of main things that may not be apparent from what we’ve described so far, how important the International Space Station is, but it’s a test platform. It’s a great way to test stuff real close, so that when we do go to the Moon and ultimately to Mars that we have a really good understanding of what’s happening to the human body. So what additional insights might a one-year mission provide us?

Peter Norsk: Well, one big, big question is duration of spaceflight and duration of being exposed to weightlessness. We know for six months you can prevail and mitigate it with a lot of resources being used to do that. The Russian’s have had five persons as we — five individuals in space for one year or more. The United States has had one close to one year and then it’s mostly six months. So, our experience with longer duration flights in six months is very limited. And the research that’s been done is very limited. The record was done by Valeri Polyakov in 1995 when he landed in Kazakhstan after 438 days in space in one continuum. And he did very, very well, but he had exercised a lot and he’s also a medical doctor who knows what to do or not to do in flight. So that was successful as only one person. And the testing afterwards, but probably also very limited compared to what we would like to do today. So, we are planning for one-year missions in ten subjects in order to have a strong statistical basis for our conclusions. And doing many of the same experiments we’ve been doing in the past during six months of flight, in order to see if adding six months will make things worse. If so can we mitigate and counteract it with the current countermeasures? Is the exercise efficient? Is the immune changes still be improved or will they be worse? What about the fluid shifts? Will that stay at the same level? Will it be improved or what? We don’t know that. And that is pivotal for preparing to go for longer duration in deep space. So it’s duration and also creating a baseline for what we will later find and explore in deep space, because when people are going to the Moon and Mars, it will be longer and longer durations and it needs to be compared to low-Earth orbit because the deep space radiation is added to that in deep space, which we don’t have now in low-Earth orbit, so you will also see the effects of radiation and duration in combination at that time. So, with one-year missions around the Earth creating a base line for those tests.

Host: OK, so Laura, how does the countermeasures element, human health countermeasures, how are we taking these ideas, these priorities that we have, you know we really want to do, we really want to test a one-year mission. We want to have all these analog studies that study human health. How do you take all of these ideas and implement in the future both in the analog direction, but then also ultimately in flight to test crew members for long periods of time?

Laura Bollweg: Well, we take all of the scientific strategy and we make a pristine scientific strategy that is understandable by the managers. And then we start balancing it against the facilities that we have, the money we have, the skill set, the research community we have and have a pretty large spreadsheet [Laughter] and then we formulate a workable plan based on that. And so, we often times there’s some back and forth because we might have to make some compromises to the ideal science strategy because of schedule pressures. Another schedule pressure we have to honor, of course is to deliver on time. So, if something is needed for an Artemis mission, if something is needed for a long duration mission, we have to understand when those due dates are and make sure we build a schedule that meets those due dates. So, it’s a real partnership between the science and the management, and that’s why we’re designed the way we are to kind of work together closely and put together that’s scientifically ideal but practical.

Host: Are we looking at certain things for — are you budgeting certain ideas or efforts or elements towards more questions that we may want to answer on the Moon with the Artemis program because maybe, you know the countermeasures are good for microgravity, sure, but are they good on the Moon? Will they translate nice? Is there that effort already in the human health countermeasures?

Laura Bollweg: Yes, and I’ll ask Peter to expand on this, but he’s already brought up the radiation, so with the shorter duration missions, of course we lose duration, but we’re going to gain some radiation information and we’ll have smaller isolated more confined environments. So, we’ll be losing some stressors, like duration, but gaining other ones that are important scientifically.

Peter Norsk: Yeah, one big unknown, when you mention the Moon, but you could also mention Mars as the next step, that is to understand the level of gravity on the Moon and the effects on the human physiology. It’s just not known. It’s virtually impossible to simulate that in a one-G environment on Earth. So, the ideal thing would be to have a huge centrifuge in space being rotated at several, you know like the Moon-like g, or the Martian g, that would be perfect for testing that without going there actually, but it can’t be done for technical reasons, so we don’t know that. And therefore, we need to do a lot of testing on the lunar surface when that becomes possible as a lunar base ever to do this and I guess there will be in the mid ’20s to the end of the ’20s. And we will do testing to see if 1/6^th G, which is very low by the way, protects somehow against the negative effects of a low gravity environment. So, we don’t know that. And we don’t know what the thresholds are for those protections, and we don’t know how the Martian gs will work. That’s open 38 percent of Earth gravity, a little more than one-third. So, we don’t know that. And my guess would be that the Moon is very much like weightlessness and there’s actually some protection on Mars that is good because it will then decrease our resources for mitigating some of the negative effects and that makes it more possible to stay for a long time. I think that’s a perception of what we don’t know. It’s purely a guess. And I can tell you every time I guess I’m incorrect. [Laughter] So, we need to do the testing.

Host: Yeah, this is where the good research comes into play. I think one thing that I took away from that, which I find interesting is you know, you talk about microgravity and you talked about the, for example, exercise as being implemented as a countermeasure right now in microgravity. Sure, you know, exercise is probably important, you said you’re guessing, is probably important on the Moon but I think the word “threshold” came up to my mind because maybe it’s not quite the same.

Peter Norsk: Exactly.

Host: You know, because it’s a lot of time dedication. That much exercise. So, at what point are you mitigating the effects, but still being efficient in the way that you’re doing it?

Peter Norsk: Exactly. And that’s one of the questions we are asking. So, it’s an excellent question. We can’t answer it right now. We need to do some of the testing. We can simulate it during parabolic flight where you can find different trajectories and you can do it at these levels, but it’s only for 20 seconds and it’s proceeded by high G levels that disturbs what you are observing in the low G levels. But you can do something. You can simulate in the water with certain kind of loading. You can de-load people by using a hoist, called [Active Response Gravity Offload System], ARGOS by the way. ARGOS, yes. And but it’s not optimal because you do not have the fluid shifts and if you do it on the water you have the fluid shift but then you have the resistance of the water. So, I mean, it’s not the same thing. So, we need to do testing on the Moon and that’s hopefully what will happen in the ’20s.

Host: It’s a very exciting time. Laura and Peter. Thank you so much for coming on, Houston, We Have a Podcast, and going into detail about Human Health Countermeasures. Really a pleasure talking to you guys today.

Peter Norsk: Thank you.

Laura Bollweg: Thanks for having us.

[ Music ]

Host: Hey, thanks for sticking around. Really good conversation we had on Human Health Countermeasures with Laura Bollweg and Peter Norsk today. A very interesting conversation. I really hope you enjoyed it. This is, again, our fourth in our six-part series on the Human Research Program. There’s a lot more to check out. You can find us on NASA.gov/podcast to check out us, as well as our many other colleagues at NASA who are all doing podcast right at that website. If you want to know what’s going on in the Human Research Program, great website for that too, NASA.gov/hrp. You can really get a breakdown of what they’re doing and find out how to get involved in some of the research. We are on the NASA Johnson Space Center pages, of Facebook, Twitter, and Instagram. If you want to talk to us use the hashtag #askNASA on your favorite platform to submit an idea for the show, just make sure to mention it is for Houston, We Have a Podcast. This episode was recorded on November 19th, 2019. Thanks to Alex Perryman, Greg Wiseman, Pat Ryan, Norah Moran, Belinda Pulido, Jennifer Hernandez, Brett Redden, Emmalee Mauldin and the Human Research Program Team for helping to bring this all together. And thanks again to Laura Bollweg and Peter Norsk for taking the time to come on the show. We’ll be back next week.