Enlarge /. As trustworthy as your grandparents' medicine cabinet from 1988 may be, you cannot just transport all of this into space and safely accept results.
Barbara Alper / Getty Images
Nobody can hear you sneeze in space. But if an astronaut has the flu, it can be a big problem. Because the nearest walgreens are hundreds of miles away, any medication an astronaut may need for a space mission must be packaged beforehand. This makes designing a pharmacy for space extremely complicated.
In addition, the room itself naturally poses potential medical problems. This extreme environment is known to distort the human body, move liquids, and shrink bones, among other things. However, weightlessness can also affect how drugs are metabolized, which can make drugs less effective or even toxic.
Despite 60 years of humanity sending people into space, there is alarmingly little research into how medicines work differently outside the planet. Self-medication in space was common, but there is no good record of who took what, when they took it, and how it helped or not. There are indications that certain drugs can be less effective in space and that radiation can even break down drugs – but experts are not sure.
"When you go to the doctor, there are basically three things you can do for yourself," said Dr. Virginia Wotring, a professor at the International Space University in Strasbourg, France, told Ars. "You can do surgery, you can advise you to change your behavior – you know to quit smoking or whatever – or they can give you medication . Which means (for space travel) that a doctor's best tool will be the medication kit … This is something that deserves attention that astronauts should know. "
Enlarge /. Falcon 9 starts its most important mission yet: to put NASA astronauts Bob Behnken and Doug Hurley into orbit.
The great unknown
If all of the careful preparation that NASA astronauts Dog Hurley and Bob Behnken have recently taken to drive to the International Space Station in the middle of a pandemic does not reveal this, the astronauts are already adhering to extremely stringent health regulations. Even in healthier times, they are quarantined for weeks before the start. Not much of their behavior needs to be changed. Surgery in space is extremely risky and fortunately has never happened before. By default, medication is the best choice for treatment outside of this world, which makes the lack of research on the subject increasingly strange.
"At this point, we expect drugs to be absorbed and distributed to the tissues and metabolized and excreted in space in the same way," said Worting. "That couldn't be the truth."
For example, a 2014 study measured astronauts' sleep deprivation on board the International Space Station (ISS) and the medications that brought them to rest, such as: B. Zolpidem, brand name Ambien. The researchers, some from Harvard Medical School, found that astronauts often took a second dose in the middle of the night, presumably because the first dose didn't provide enough relief.
Increasing medication can mean an increased risk of side effects or, in the case of ambien, potential drowsiness in an emergency. Imagine trying to respond consistently after suddenly waking up to a warning alarm while being "poisoned by the environment".
In order to better understand the riddles about the effectiveness of medication for long-term stays in space, Wotring developed an iOS app with which six crew members on board the ISS 2017 voluntarily logged their medication. Every time they took a pill, the astronaut did write down the drug name, dose, indication for taking the drug and whether they thought it was working, and any side effects.
Wotring and her co-author, LaRona Smith, a clinic administrator at the Johnson Space Center, collected 5,766 medication use records – around 38 times more than all previous space flight records combined. "We were expecting more data," said Wotring. "I was totally thrilled when we saw how much data was received." The results were published in the journal Aerospace Medicine and Human Performance last January.
Wotring and Smith found that average drug consumption was slightly higher than on Earth. Sleep was the most common reason for taking a medicine, but mild pain relievers such as ibuprofen were also often swallowed. "Most of the drugs were considered partially effective," they wrote. Although the app apparently suffered from usability problems and the study was completed prematurely (insert Apple Snark here), according to Wotring, NASA is in the process of adopting a similar protocol so that it can better track its cosmonaut's drug needs. Until then, there are still many unknowns.
“We know that the human body exhibits physiological changes in space flight. It makes sense that the effects of drugs can vary in astronauts' changed physiology, ”said Dr. Tina Bayuse, senior pharmacist at Johnson Space Center Pharmacy Operations, in an email. In 2002, she became the senior pharmacist for NASA's first and only pharmacy.
"Changes in gastric motility can affect drug intake," said Bayuse. “Changes in fluid displacement can affect the distribution or metabolism of drugs. The result of one of the known physiological changes can lead to drugs that cause more side effects or are less effective. "