[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
HUMAN SPACEFLIGHT ETHICS AND OBLIGATIONS:
OPTIONS FOR MONITORING, DIAGNOSING,
AND TREATING FORMER ASTRONAUTS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON SPACE
COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
June 15, 2016
__________
Serial No. 114-83
__________
Printed for the use of the Committee on Science, Space, and Technology
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://science.house.gov
______
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COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY
HON. LAMAR S. SMITH, Texas, Chair
FRANK D. LUCAS, Oklahoma EDDIE BERNICE JOHNSON, Texas
F. JAMES SENSENBRENNER, JR., ZOE LOFGREN, California
Wisconsin DANIEL LIPINSKI, Illinois
DANA ROHRABACHER, California DONNA F. EDWARDS, Maryland
RANDY NEUGEBAUER, Texas SUZANNE BONAMICI, Oregon
MICHAEL T. McCAUL, Texas ERIC SWALWELL, California
MO BROOKS, Alabama ALAN GRAYSON, Florida
RANDY HULTGREN, Illinois AMI BERA, California
BILL POSEY, Florida ELIZABETH H. ESTY, Connecticut
THOMAS MASSIE, Kentucky MARC A. VEASEY, Texas
JIM BRIDENSTINE, Oklahoma KATHERINE M. CLARK, Massachusetts
RANDY K. WEBER, Texas DONALD S. BEYER, JR., Virginia
JOHN R. MOOLENAAR, Michigan ED PERLMUTTER, Colorado
STEPHEN KNIGHT, California PAUL TONKO, New York
BRIAN BABIN, Texas MARK TAKANO, California
BRUCE WESTERMAN, Arkansas BILL FOSTER, Illinois
BARBARA COMSTOCK, Virginia
GARY PALMER, Alabama
BARRY LOUDERMILK, Georgia
RALPH LEE ABRAHAM, Louisiana
DRAIN LAHOOD, Illinois
WARREN DAVIDSON, Ohio
------
Subcommittee on Space
HON. BRIAN BABIN, Texas, Chair
DANA ROHRABACHER, California DONNA F. EDWARDS, Maryland
FRANK D. LUCAS, Oklahoma AMI BERA, California
MICHAEL T. McCAUL, Texas ZOE LOFGREN, California
MO BROOKS, Alabama ED PERLMUTTER, Colorado
BILL POSEY, Florida MARC A. VEASEY, Texas
JIM BRIDENSTINE, Oklahoma DONALD S. BEYER, JR., Virginia
STEVE KNIGHT, California EDDIE BERNICE JOHNSON, Texas
WARREN DAVIDSON, Ohio
LAMAR S. SMITH, Texas
C O N T E N T S
June 15, 2016
Page
Witness List..................................................... 2
Hearing Charter.................................................. 3
Opening Statements
Statement by Representative Brian Babin, Chairman, Subcommittee
on Space, Committee on Science, Space, and Technology, U.S.
House of Representatives....................................... 4
Written Statement............................................ 6
Statement by Representative Donna F. Edwards, Ranking Minority
Member, Subcommittee on Space, Committee on Science, Space, and
Technology, U.S. House of Representatives...................... 8
Written Statement............................................ 10
Statement by Representative Lamar S. Smith, Chairman, Committee
on Science, Space, and Technology, U.S. House of
Representatives................................................ 12
Written Statement............................................ 14
Statement by Representative Eddie Bernice Johnson, Ranking
Member, Committee on Science, Space, and Technology, U.S. House
of Representatives............................................. 16
Written Statement............................................ 17
Witnesses:
Dr. Richard Williams, Chief Health and Medical Officer, NASA
Oral Statement............................................... 19
Written Statement............................................ 22
Captain Chris Cassidy, United States Navy (USN); Chief, Astronaut
Office, NASA
Oral Statement............................................... 28
Written Statement............................................ 30
Captain Scott Kelly (USN, Ret.), Former Astronaut, NASA
Oral Statement............................................... 35
Written Statement............................................ 37
Captain Michael Lopez-Alegria (USN, Ret), President, Association
of Space Explorers-USA; Former Astronaut, NASA
Oral Statement............................................... 41
Written Statement............................................ 44
Dr. Jeffrey Kahn, Professor of Bioethics and Public Policy, Johns
Hopkins Berman Institute of Bioethics; Chairman, Committee on
the Ethics Principles and Guidelines for Health Standards for
Long Duration and Exploration Spaceflights, Board on Health
Sciences Policy, National Academies of Sciences
Oral Statement............................................... 54
Written Statement............................................ 57
Discussion....................................................... 62
Appendix I: Answers to Post-Hearing Questions
Dr. Richard Williams, Chief Health and Medical Officer, NASA..... 78
Captain Chris Cassidy, United States Navy (USN); Chief, Astronaut
Office, NASA................................................... 100
Captain Scott Kelly (USN, Ret.), Former Astronaut, NASA.......... 109
Dr. Jeffrey Kahn, Professor of Bioethics and Public Policy, Johns
Hopkins Berman Institute of Bioethics; Chairman, Committee on
the Ethics Principles and Guidelines for Health Standards for
Long Duration and Exploration Spaceflights, Board on Health
Sciences Policy, National Academies of Sciences................ 114
HUMAN SPACEFLIGHT ETHICS
AND OBLIGATIONS:
OPTIONS FOR MONITORING, DIAGNOSING,
AND TREATING FORMER ASTRONAUTS
----------
WEDNESDAY, JUNE 15, 2016
House of Representatives,
Subcommittee on Space
Committee on Science, Space, and Technology,
Washington, D.C.
The Subcommittee met, pursuant to call, at 2:43 p.m., in
Room 2318 of the Rayburn House Office Building, Hon. Brian
Babin [Chairman of the Subcommittee] presiding.
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Chairman Babin. The Subcommittee on Space will now come to
order.
Without objection, the Chair is authorized to declare
recesses of the Subcommittee at any time.
Good morning. Welcome to today's hearing titled ``Human
Spaceflight Ethics and Obligations: Options for Monitoring,
Diagnosing, and Treating Former Astronauts.''
I recognize myself for five minutes and an opening
statement.
As a Nation, we have obligations to those we put in harm's
way. As a Congress, we have a responsibility to provide for the
treatment of conditions caused by federal service. As a
legislator that represents the Johnson Space Center and the
Astronaut Corps, I have a duty to care for my constituents.
Since the 1960s, the United States of America has asked its
bravest to travel in space in service to their country. The
government recognizes its obligation to care for those it puts
in harm's way in other instances. For example, we provide for
the care of our veterans and our federal employees when their
injuries are caused by their federal service.
NASA currently provides treatment for active NASA
Astronauts, and management and former astronauts are eligible
for treatment of injuries sustained in their service through
existing programs at the Department of Labor and the Department
of Veterans Affairs.
Over the last 15 years, several reports have highlighted
the potential hazards of human spaceflight and the ethical
obligations that we have as a Nation, and the additional steps
that we might take and need to take to address gaps in meeting
those obligations.
From the dynamic launch environment to the unforgiving
vacuum of space, to the energetic reentry to Earth, human
spaceflight has always placed astronauts in challenging
environments. Even training for spaceflight carries significant
risks.
Up until recently, however, space travel was measured in
days. Mercury, Gemini, Apollo, and the Space Shuttle program
placed astronauts in space for relatively short periods of
time. Now, with the completion of the International Space
Station, our astronauts now spend months in space. The risks
and potential impacts on our astronauts' health are not always
seen immediately.
Captain Scott Kelly recently returned from the ISS after
spending 340 days in space on one mission. This put his
cumulative time in space at 520 days. Extended missions like
his are teaching us a lot about the long-term effects of human
spaceflight.
Weightlessness leads to osteoporosis and loss in bone
density. Long-duration space missions also seem to impact
vision, as 60 percent of ISS astronauts reported worsening
eyesight. Furthermore, radiation exposure increases the
likelihood of cancer. These are just some of the conditions we
know about. Staying in space longer and pushing farther into
deep space will likely present additional risks.
And while NASA attempts to mitigate these risks with
protocols and countermeasures such as exercise, drug
treatments, and spacecraft shielding, there will probably
always be a cost to our astronauts that they bear for traveling
in space.
This raises several fundamental questions. For instance, is
the request for additional authority simply about treating
former astronauts, or is it also about NASA getting better data
on human spaceflight? Are these two issues related? Are there
classes of astronauts such as payload specialists who were not
government employees that aren't covered by existing
authorities? How should NASA administer treatment? Should they
do it in-house or simply reimburse patients for this treatment?
If NASA decided to diagnose conditions in-house, does this pose
a potential conflict of interest when NASA is financially
obligated to compensate former astronauts for conditions caused
by their federal service? How would additional authority affect
existing rights and benefits under current statutes? How would
creating a new program at NASA impact the causation standard
set forth by the Departments of Labor and Veterans Affairs? In
other words, will a new authority make it easier or harder for
astronauts to receive treatment and compensation?
In order to address these questions, Congress included a
provision in the 2005 NASA Authorization Act that asked for a
plan on how to best provide for former astronaut care.
Similarly, the most recent Authorization Act that received
unanimous support in the House and awaits consideration by the
Senate contained a provision asking for a cost estimate for
expanding treatment.
I think everyone here wants to make sure that we are doing
right by our astronauts. They put themselves in harm's way to
advance our knowledge of the universe and by bringing great
pride to our Nation.
I'm also very proud to say that I represent a great number
of these astronauts who call Houston their home. As a health
care professional myself and as their representative, you could
say it's my duty emphatically to make sure these folks are
taken care of properly.
But this isn't simply about addressing a moral and ethical
obligation. There is also a great benefit that we receive from
providing this care. The long-term health information gained by
providing treatment to former astronauts will give us a greater
understanding of radiation exposure, vision impairment, bone
loss, and many other ailments. This in turn will assist us to
develop better monitoring and treatment protocols here on Earth
for everyone, not just astronauts.
I thank today's witnesses for joining us as we discuss
these very, very significant and important issues, and I look
forward to hearing your testimony and your answers to our
questions.
[The prepared statement of Chairman Babin follows:]
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Chairman Babin. I now recognize the Ranking Member, the
gentlewoman from Maryland, for an opening statement.
Ms. Edwards. Good afternoon, and thank you, Mr. Chairman. I
want to extend a welcome to our distinguished panel this
afternoon, and thank you as well for your patience.
Human space flight is inherently risky. That's why NASA
exercises diligence and caution during all phases of a space
mission, including training, vehicle flight testing, launch,
mission operations, and landing.
In addition to mission risks, astronauts bear significant
personal risks, particularly as they relate to their health.
Health risks during long-duration flights include both short-
term health consequences as well as potential long-term health
conditions that may arise months and sometimes years after an
astronaut's service.
This is a problem. Because of the small number of U.S.
astronauts who have flown in space, and the corresponding small
data set currently available on astronaut exposure during long-
duration flights, characterizing those risks is a major
challenge for NASA. However, if we are to go to Mars, as I have
strongly advocated, mitigating these health risks is critical.
But we also need to ensure that the risks NASA's astronauts
take are recognized and addressed by the American people.
While active astronauts receive comprehensive health care,
former astronauts do not. This needs to change. We need to
ensure that care is provided for all of our NASA astronauts,
not just those who are on active status. Providing ongoing
medical care for active and former astronauts will give NASA
the needed insight to enable earlier detection and treatment of
any potential medical problems that could result from human
spaceflight. It will also provide NASA with the data that are
necessary to help mitigate against health risks related to
future human space exploration.
This is also a recommendation of a 2014 National Academies
report, which concluded that lifetime healthcare for astronauts
is our ethical responsibility. The report's principle of
fidelity recognizes that ``Given the risks that astronauts
accept in participating in hazardous missions, NASA should
respect the mutuality of obligations and ensure health care and
protection for astronauts not only during the mission but after
return, including provision of lifetime care for astronauts.''
NASA responded to the National Academies report by
proposing a legislative change that would give NASA the
authority to provide medical monitoring, diagnosis and
treatment for psychological and medical conditions that are
deemed by NASA to be associated with human spaceflight.
It's worth noting that, as the Chairman indicated, the
bipartisan NASA Authorization Act of 2015, H.R. 810, that was
passed by the House in February 2015, directs NASA to provide a
formal response to the National Academies report. This
response, as directed in the legislation, must include the
budgetary resources required for implementation of the report's
recommendations, as well as any options that might be
considered as part of the response. Had that bill been enacted,
it is likely that our discussion today would have been much
better informed.
That said, Mr. Chairman, it's clear to me that ensuring
comprehensive care of our astronauts before, during, and after
their active service is a high priority. NASA's legislative
proposal provides one option for addressing this issue, and I
hope that we can explore other options as well.
However, the impact each option would have on existing
authorities warrants careful consideration. For example, should
Congress direct NASA to provide astronauts with lifetime
healthcare in return for their service to the nation? Under
this scenario, how would existing astronaut healthcare support
systems be affected, including those provided by the Veterans
Administration for former military astronauts? Or should
Congress pattern astronaut care after NASA's legislative
proposal by directing NASA to provide enhanced medical
screening that would facilitate claims made by former
astronauts for occupational health conditions under the FECA
and VA processes and provide proactive diagnosis and treatment,
if needed, while those FECA and VA processes are underway? In
either scenario, how would such authority be implemented?
In addition, we need to clarify on how NASA intends to
establish the causality link between human spaceflight and any
identified psychological and medical conditions astronauts may
develop. The bottom line here is that we need to do the right
thing.
And so Mr. Chairman, if the Committee intends to address
the issues contained in NASA's proposal, I would hope that we
could craft legislation on a bipartisan basis, and I look
forward to working with you.
Thank you, and with that, I yield the balance of my time.
[The prepared statement of Ms. Edwards follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you very much, Ms. Edwards.
I now recognize the Chairman of our full Committee, Mr.
Smith from Texas.
Chairman Smith. Thank you, Mr. Chairman, and welcome to our
all of our witnesses today including three astronauts. I often
say publicly, and I'll say again now, that I consider
astronauts to be our modern heroes for many, many reasons, and
certainly appreciate their presence here today.
Mr. Chairman, I also believe this is probably the first
hearing we have had dedicated entirely to the subject of
astronauts' health in space, and so it's most timely, and as
you and the Ranking Member both mentioned, it might lead to
legislation that can be helpful to them in the future.
Since NASA selected the first group of astronauts in 1959,
more than 300 of America's finest have ventured into the cosmos
as explorers. Each one of these astronauts represented the
compelling urge of humankind to explore and to discover and the
lure of curiosity that leads us to try to go where no one has
gone before. From Neil Armstrong's first step on the Moon to
Captain Kelly's one-year voyage on the International Space
Station, their peaceful exploration of outer space continues to
inspire our nation and the world.
In an age when spaceflight has come to seem almost routine,
it is easy to overlook how dangerous it is and how little we
know about the long-term health effects of spaceflight.
For almost 20 years, astronauts have lived on the
International Space Station. One of their primary missions has
been to learn about the physiological and psychological effects
of long-duration human spaceflight. Captain Kelly's one-year
mission was in pursuit of a scientific understanding of how the
human body responds to extended space flight.
But even with our 20 years of experience on the ISS, we are
only just beginning to understand the effects of long-duration
missions. Our lack of knowledge becomes especially evident as
NASA prepares for its journey to Mars.
Only 24 individuals have journeyed beyond low-earth orbit.
All of these astronauts flew during the Apollo era and never
for more than a handful of days. Using our current propulsion
technology, a successful mission to Mars will require
astronauts to survive a roundtrip spaceflight of no less than
several hundred days, and unlike our near-Earth environment,
the trip to Mars will offer no natural protection from galactic
cosmic rays and solar radiation.
Today, through its Lifetime Surveillance of Astronaut
Health program, NASA screens and monitors astronauts for
occupational related injury or disease. This program
contributes to our scientific knowledge of long-term health
effects and assists participating astronauts in monitoring for
spaceflight related illnesses and disease.
But this program does not provide for diagnosis or
treatment of those no longer serving, nor for management and
retired astronauts because NASA is not explicitly authorized to
provide such services. These astronauts can receive treatment
from the Department of Labor or the Veterans Administration
now, but this may not be the best process for the former
astronauts or NASA's developing knowledge base.
We as a nation have a responsibility to ensure that our
astronauts, both active and retired, are provided with
appropriate monitoring, diagnosis, and treatment of
spaceflight-related injuries and disease. This is also the
recommendation of the National Academy of Sciences in its
review of NASA's study of astronaut health.
For our nation, the question should not be whether we
should provide these services to our astronauts, but rather how
to do it in a way that best addresses the current and future
needs of our space explorers in America's quest for discovery
of new frontiers.
Thank you Mr. Chairman, and I'll yield back.
[The prepared statement of Chairman Smith follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Mr. Chairman. I appreciate you.
I now recognize the Ranking Member of the full Committee
for a statement, Ms. Johnson from Texas.
Ms. Johnson. Thank you very much, and good afternoon. Let
me welcome our distinguished witnesses.
Mr. Chairman, I'd like to thank you for holding this
hearing on ``Human Spaceflight Ethics and Obligations: Options
for Monitoring, Diagnosing, and Treating Former Astronauts.''
Our NASA astronauts are American heroes, and they are some
of the most accomplished, highly trained, and courageous
individuals who serve our nation in the pursuit of furthering
our exploration of outer space.
Astronauts and our human space program also inspire the
next generation, with many of our youngest Americans dreaming
of one day following in their footsteps and exploring outer
space. And I might add that no child falls asleep when there's
an astronaut speaking in high schools.
It is no surprise that our astronauts are held in very,
very high regard. They accept considerable risks in doing their
jobs and serving our nation. And over the decades that we have
been sending humans into outer space, more than a dozen NASA
astronauts have paid the ultimate price as part of this
service.
That's why I'm pleased that we are examining the
responsibility we have to care for our astronauts, even after
they have left active status including looking at the risk of
cancer, musculoskeletal conditions, and ocular disorders are
just a few of the known health concerns related to human
spaceflight. But there is still much that we are learning and
need to learn about the potential effects of space on the human
body and on human health.
Congress has acted to ensure that others we have put in
harm's way, such as those who have served in our military,
receive lifetime healthcare. It is time we do the same for NASA
astronauts.
The practicalities of how we authorize the provision of
such health care is very important, and I look forward to
hearing from our witnesses on key questions and issues that
Congress needs to consider before we legislate in this area.
I thank you, Mr. Chairman, and yield back.
[The prepared statement of Ms. Johnson follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Yes, ma'am. Thank you.
Now I'd like to introduce our panel of distinguished
witnesses.
Our first witness today is Dr. Richard Williams, Chief
Health and Medical Officer for NASA. In this role, Dr. Williams
is responsible for the oversight of all health and medical
activities at NASA including the medical aspects of all
national and international NASA missions involving humans. He
has extensive experience in the clinical practice of general
surgery, aerospace medicine, and occupational medicine as well
as in administrative medical management. During his 27-year Air
Force career, Dr. Williams served in a wide variety of settings
as a clinical practitioner and medical leader including service
in the contingency deployments. Dr. Williams holds an M.D.
degree from the Virginia Commonwealth University and completed
residencies in general surgery at Wright State University and
an aerospace medicine and occupational medicine at the United
States Air Force School of Aerospace Medicine at Brooks Air
Force Base in Texas. Thank you for being here.
Second witness today Captain Chris Cassidy, a United States
Navy SEAL and the 16th Chief of the Astronaut Office at NASA.
As NASA's Chief Astronaut, he is responsible for flight
assignments, mission preparation, and on-orbit support of U.S.
crews as well as organizing astronaut office support for future
launch vehicles. Captain Cassidy was selected as an astronaut
by NASA in 2004, and he's a veteran of two space flights, STS-
127 and Expedition 35. During STS-127, Cassidy served as a
Mission Specialist and was the 500th person in history to fly
into space. Captain Cassidy has been deployed twice to the
Mediterranean and twice to Afghanistan. He is the recipient of
the Bronze Star with a Combat V and Presidential Unit Citation
for leading a nine-day operation at the Zawar Kili Cave on the
Afghanistan-Pakistani border. Captain Cassidy received a
bachelor of science in mathematics from the U.S. Naval Academy
and a master of science in ocean engineering from Massachusetts
Institute of Technology. Thank for being here. I'm the proud
father of a Navy SEAL myself.
Our third witness today is Captain Scott Kelly, a retired
U.S. Naval Officer and former NASA Astronaut, who is fresh off
his one-year mission in space. Welcome home, Captain Kelly.
I've had the distinct pleasure and honor of meeting and
visiting with Captain Kelly on several occasions before and
after his historic mission. In 1996, Captain Kelly was selected
by NASA. He has logged more than 520 days in space on four
space flights and served as Space Shuttle Pilot on STS-103 in
1999 and was the Mission Commander on STS-118 in 2007. Captain
Kelly also served as a Flight Engineering for ISS Expedition
25, and as the Commander of ISS Expedition 26. In March of
2015, Captain Kelly launched for a one-year mission to the ISS
serving as a Flight Engineer for Increments 43 and 44 and
Commander for Increments 45 and 56. Captain Kelly returned to
Earth on March 2nd, 2016, after his historic 340-day mission
aboard the ISS. Captain Kelly received a bachelor of science
degree in electrical engineering from the State University of
New York Maritime College and a master of science degree in
aviation systems from the University of Tennessee in Knoxville.
Thanks for being here, Captain Kelly.
Our fourth witness today is Captain Michael Lopez-Alegria,
President of the Association of Space Explorers-USA, a retired
U.S. Naval Officer, and former NASA Astronaut. Captain Lopez-
Alegria has over 35 years of aviation and space experience with
the U.S. Navy and NASA and a variety of roles including Naval
Aviator, Engineering Test Pilot, and Program Manager, NASA
Astronaut, and International Space Station Commander. He is a
four-time astronaut, having flown on Space Shuttle Missions
STS-73, STS-92, and STS-113, and serving as Commander of ISS
Expedition 14, flying to and from the ISS aboard Soyuz-IMA-9.
He holds NASA records for the most extravehicular activities,
or spacewalks, or EVAs, 10 EVAs and cumulative EVA time of 67
hours and 40 minutes. Captain Lopez-Alegria received a bachelor
of science in systems engineering from the U.S. Naval Academy
and master of science in aeronautical engineering from the U.S.
Naval Postgraduate School. He is also a graduate of Harvard
University's Kennedy School of Government Program for Senior
Executives and National and International Security. Thank you
for being here today, Captain.
Our final witness today Dr. Jeffrey Kahn, Professor of
Bioethics and Public Policy at Johns Hopkins Berman Institute
of Bioethics, and Chairman of the Committee on Ethics,
Principles and Guidelines for Health Standards for Long
Duration and Exploration Spaceflights for the Board on Health
Sciences Policy at the National Academies of Sciences. His
research interests include the ethics of research, ethics in
public health, and ethics in emerging biomedical technologies.
Dr. Kahn speaks widely both in the United States and abroad and
has published four books and over 125 articles in bioethics and
medical literature. Dr. Kahn received his B.A. from the
University of California-Los Angeles, Ph.D. from Georgetown
University, and MPH from Johns Hopkins Bloomberg School of
Public Health.
The Committee also invited a representative from the
Department of Labor to discuss how the Department of Labor
currently provides for treatment of federal employees under the
Federal Employee Claims Act, or FECA. The Committee sent
Secretary Perez or anyone in the agency that he would like to
designate an invitation to appear. Unfortunately, the
Department of Labor could not find anyone to appear, which is
very surprising since there are 17,000 employees at the
Department of Labor.
Furthermore, we only asked them to comment on what they
already do. Executive Branch officials have a responsibility to
Congress and to the taxpayers of the United States to provide
testimony and inform the legislative process. I am disappointed
that a federal agency was unable to assist Congress, failing to
fulfill this fundamental responsibility. It is no wonder that
NASA wants to handle these issues themselves.
I would now like to recognize Dr. Williams for five minutes
to present his testimony.
TESTIMONY OF DR. RICHARD WILLIAMS,
CHIEF HEALTH AND MEDICAL OFFICER, NASA
Dr. Williams. Mr. Chairman and Members of the Committee,
thank you for this opportunity to appear before you today to
discuss the critical issue of astronaut healthcare. This is an
issue that has consumed me in my role as Chief Health and
Medical Officer for NASA, and I am very grateful that the
Committee is using its limited time and resources to focus on
this critical agency priority.
Astronauts are exposed to unique hazards that no one else
on Earth has experienced. Microgravity and space radiation are
just two of the exposures that are only found when we venture
into space. Some conditions such as reduced muscle mass caused
by exposure to microgravity are somewhat foreseeable while
others are complete surprises. Certainly, the visual problems
and increased risk of cataracts astronauts experience was not
expected or predicted.
For active astronauts, NASA currently provides medical care
and treatment. We also use data from the treatment of active
astronauts to figure out ways to minimize negative impacts to
astronaut health.
Some of the things we do include monitoring for radiation
exposure, using exercise to combat microgravity effects, and
continued health monitoring. While these efforts can't entirely
mitigate exposure to space, they are valuable.
However, when it comes to former astronauts, the situation
is different. We invite astronauts to participate in our
voluntary Lifetime Surveillance of Astronaut Health program.
This includes a limited health status evaluation on an annual
basis at the Johnson Space Center Flight Medical Clinic.
However, if there are questions or concerns from this
evaluation, NASA can only encourage astronauts to follow up
with their personal healthcare providers. This presents a
number of problems. NASA cannot do all the tests it believes
need to be done to effectively monitor former astronauts as
some of these tests would be considered personal healthcare. If
personal physicians do tests and evaluations, we often do not
have access to the data unless the astronaut aggressively
pursues getting this data to us. And healthcare providers often
don't understand the need for some of the targeted tests that
we require for occupational health surveillance and would not
routinely order them.
For example, some astronauts should probably be receiving
yearly MRI scans of the area around their eyes. MRI scans are
not normally used as preventive screening; they are usually
ordered in response to illness or injury.
I need to emphasize how small this population is. There are
only 280 living astronauts that have flown in space--280. That
isn't even enough to take a good consumer product survey, let
alone try to predict what effects human spaceflight might have
on the human body 10, 20 or 30 years down the road. An average
doctor or nurse practitioner no matter how skilled they are has
no exposure to or understanding of these issues.
With only 280 people to collect data from, we need to get
as much data as possible from every one of them. With only 60
percent of our former astronauts participating in the current
surveillance program, expanding our authority to provide for
extensive testing would be a great incentive to increase this
number. We believe 80 percent or more would participate if our
authority to provide testing and monitoring was expanded.
Being able to gather data on astronauts' medical conditions
and understand the health impact of spaceflight exposures over
time is essential to provide crew health and safety during
long-term journeys beyond low-Earth orbit. If we're serious
about going anywhere beyond low-Earth orbit, we'll need to
understand these risks.
Ethically, we will make sure all decisions astronauts make
about their healthcare and personal information are completely
voluntary. This brings me to an issue that may even be more
important than our need for data, and that is our ethical
obligation to our astronauts. When the United States government
puts individuals in harm's way, our government has an
obligation to care for them. Our military personnel are
provided the care they need for the hazards and dangers they
have faced in service to our country. The Institute of Medicine
has in multiple studies pointed out that NASA has an ethical
obligation to the astronauts who have dared exposures no other
human beings in history has faced.
To meet the health needs of our astronauts and to live up
to our ethical obligations, I urge Congress to act to ensure we
can safeguard the well-being of our former and future
astronauts.
Mr. Chairman, I would be glad to answer any question you or
any other member might have.
[The prepared statement of Dr. Williams follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Dr. Williams.
I now recognize Captain Cassidy for five minutes to present
his testimony.
TESTIMONY OF CAPTAIN CHRIS CASSIDY,
UNITED STATES NAVY (USN);
CHIEF, ASTRONAUT OFFICE, NASA
Captain Cassidy. Mr. Chairman and Members of the Committee,
I sincerely appreciate the chance to appear before you today.
Thank you very much.
As the Chief Astronaut for NASA, this issue is not only
critically important to the agency but also of great importance
to myself, both professionally and personally. In my role as
the Chief, I serve in the most senior leadership position for
active astronauts. I am the principal adviser Administrator
Bolden through NASA leadership and the chain of command on all
aspects of astronaut operations. This covers a wide variety of
tasks from astronaut training, operations, and safety to
advising on spacecraft design and even finding astronauts to
speak in order to inspire our nation's students and the public
and to keep those high school students from falling asleep.
We take healthcare very, very seriously. Other than our
crew, the most precious resource on the International Space
Station is time. We have an international mix of six crew
members on the Space Station, and each of them has only 16
hours of awake time per day. Every minute of this period is
treated as a critical resource similar to that of air, water or
food. This time is used to accomplish the hundreds of
scientific experiments to execute the many tasks required to
keep the ISS functioning yet we still schedule two hours of
exercise every single day. This is done simply because it's the
best way we have found to counteract the effects of
microgravity exposure. Without a doubt, there are many other
tasks that could be accomplished with those two hours. However,
absolutely nothing is more important than keeping our
astronauts as healthy as we possibly can.
Our knowledge of the kinds of health changes associated
with the exposure to space has increased as more astronauts fly
on the Space Station. Conditions have surfaced after long-
duration spaceflight that were not apparent in short-term space
exposure. For example, muscle atrophy and the associated bone
loss have been experienced on longer-duration flights that were
not a concern on shorter missions.
There are other major risks to long-term exposure to space.
There is far more radiation in space without the protection of
Earth's magnetic field. There is also experimental evidence
that radiation encountered in space as compared to gamma or X-
rays commonly encountered on Earth is more effective at causing
the type of biological damage that ultimately leads to cancer.
This means that astronauts need to be more closely monitored
for cancer for the rest of their lives versus someone who has
not flown in space.
Right now, NASA only has limited authority to provide
medical monitoring for former astronauts. Our current program,
the Lifetime Surveillance of Astronaut Health, does basic
health screening but can't provide for the advanced monitoring
and testing that is needed. Expanding the tests and conditions
NASA can proactively monitor would greatly assist in
establishing the evidence base that we need. It would also
increase the numbers of astronauts who participate. With only
about 280 living people who have flown in space, and about 60
percent of those former astronauts participating in a limited
health evaluation, every additional astronaut who can be part
of this population is vital.
The other reason for doing this extensive monitoring is to
catch medical conditions in the early stages before they become
more serious. Proactive monitoring gives us a much better
chance of treating diseases in the early stages with a greater
likelihood for a positive outcome.
The lack of advanced monitoring worries me for another
reason. We are involved in helping to evaluate our new
generation of spacecraft, and the lack of data hampers us in
our efforts to go beyond low-Earth orbit. How do we design
vehicles to protect against the long-term effects of
microgravity and radiation exposure if we still aren't certain
of what those effects entirely are?
I work with our Astronaut Corps on a daily basis. This
isn't just an abstract issue for me. I know these men and women
and their families. Their dedication, enthusiasm, bravery and
diligence while they voluntarily accept the risks and dangers
of spaceflight, that should not be an excuse to not be thorough
with their health. We need to do everything in our power to
understand and minimize the hazards they face in order to
further protect future generations of Americans who will one
day live off of our planet.
Mr. Chairman, I would be happy answer your questions, and I
look forward to them. Thank you.
[The prepared statement of Captain Cassidy follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Captain Cassidy. I really
appreciate that.
I now recognize Captain Kelly for five minutes to present
his testimony.
TESTIMONY OF CAPTAIN SCOTT KELLY
(USN, RET.),
FORMER ASTRONAUT, NASA
Captain Kelly. And Mr. Chairman, I have a short video, if
you don't mind, an introduction video.
[Video playback]
Mr. Chairman and Members of the Subcommittee, thank you for
the opportunity to appear before you today to discuss the
importance of understanding the medical impacts of human
spaceflight on astronauts and the proposed legislation on
astronaut health. This issue is of critical importance to me
and to our nation's future space exploration initiatives.
I recently returned with my colleague, Russian Cosmonaut
Mikhail Kornienko, from nearly a year in space aboard the Isa,
which serves as our best asset for understanding how human
physiology behaves in a microgravity environment. Until at
least 2024, the Space Station will continue to provide a
platform for research on astronaut health and many other
scientific investigations.
The major objective of this Year in Space mission was to
expand the experience and knowledge base required to safely
send humans deeper into our solar system. A Mars mission is no
easy feat and could require astronauts to be in space for three
years or more. During this mission, we conducted more than 400
experiments in the fields of biology, material sciences,
chemistry, and physics. Many of these experiments focus on how
the human body responds to weightlessness and other effects of
long-duration spaceflight.
One of these experiments, which was dubbed the Twins Study,
gave researchers the unique opportunity to study my physiology
while I was in space compared to my twin brother, retired
Astronauts and Navy Captain Mark Kelly, who was on Earth. Data
acquired from this Year in Space Mission will help NASA make
determinations that will directly affect decisions regarding
crew safety in the years to come in areas from the design of
future spacecraft to medical and psychological risk mitigation.
Although I've been home for 100 days, much of the data is still
being analyzed by researchers from around the world.
You know, much attention is paid to the risks astronauts
face while launching aboard rockets or returning to Earth in a
giant fireball. Much less attention is given to the other risks
we face, which are much more insidious but potentially just as
fatal. The environment astronauts are exposed to while in space
is unlike anything we experience here on Earth. Specifically,
we're exposed to high levels of radiation and carbon dioxide,
and a microgravity environment which causes loss of bone and
muscle, vision impairment, and effects on our immune system, to
name just a few. These are very real issues that need to be
solved before the human race is able to reach destinations
beyond the Earth and the Moon.
When I returned after 340 days, I was surprised how
differently I felt compared to my long-duration mission of 159
days. My muscles more quickly stiffened, and because my skin
hadn't touched anything for nearly a year, it was extremely
sensitive and became inflamed. I developed a hive-like rash on
every surface of my skin that came in contact with ordinary
surfaces on Earth during normal activities like sitting or
lying in bed. My legs were swollen due to the fluid shift
imposed upon my body by gravity. I even had flu-like symptoms
that appeared to have been a result from my extended time in
space.
Exposure to the space environment has permanent effects we
simply do not fully understand. The Lifetime Surveillance of
Astronaut Health program NASA has in place to study astronaut
long-term health is too limited to provide the data needed to
ensure the safety of our space explorers. If we are to go
beyond low-Earth orbit, NASA needs the ability to proactively
and aggressively monitor, diagnose and treat astronauts who
serve our country in the name of science and exploration.
Expanding healthcare coverage for our U.S. Astronaut Corps will
enable NASA to more effectively and efficiently support it and
collect the data necessary to push out further into our solar
system.
Furthermore, continued investigation of space-related
ailments and mitigation steps will help in treating similar
ailments on Earth such as osteoporosis, muscle wasting
diseases, high blood pressure, glaucoma, and certain brain
disease, to name just a few. There are already FDA-approved
treatment modalities which are a result of space-based
research.
Although Mars and other long-term NASA objectives seem to
be many years ahead of us, laying a secure foundation for
astronaut health is imperative to the continuance of our
nation's ability to explore. Healthcare for our astronauts is
critically important. Our astronauts are exposed to numerous
health risk factors while in space, and while we are aware of
some of the impacts, we just need more data from astronauts in
space and on the ground to better understand these negative
effects of this harsh environment.
The proposed legislation on astronauts health will not only
help us learn more about the impacts of human spaceflight but
also will serve to protect the health of those who push the
boundaries in the name of exploration on behalf of our nation.
We are on the cusp of a new Space Age, one in which greater
numbers of Americans will travel to space and go further than
ever before.
I was honored to play a small role in paving the way for
those future pioneers but want to make it clear, this Year in
Space mission was not my achievement; it was the achievement of
thousands of dedicated professionals that believe, like I do,
that the benefit of human spaceflight is vital to the continued
success and development of our nation and our species.
Mr. Chairman, I'd be happy to respond to any questions you
or other members of the Subcommittee may have. Thank you.
[The prepared statement of Captain Kelly follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Captain Kelly. We really
appreciate your testimony.
And now I recognize Captain Lopez-Alegria for five minutes.
TESTIMONY OF CAPTAIN MICHAEL LOPEZ-ALEGRIA (USN, RET),
PRESIDENT, ASSOCIATION OF SPACE EXPLORERS-USA;
FORMER ASTRONAUT, NASA
Captain Lopez-Alegria. That's all right. Thanks, Chairman
Babin, Ranking Member Edwards, and Chairman Smith, and Ranking
Member Johnson and all the Members of the Subcommittee. Thanks
for organizing this hearing and for asking me to give you some
comments on the proposed legislative language as the President
of the USA Chapter of the Association of Space Explorers.
ASE is an international nonprofit professional and
educational organization that has only one prerequisite for
membership: having made at least one orbit of the Earth in
space. Our vision is a world where living, working and
exploring in space will be as familiar to humanity as life on
our home planet.
We count among our members over 400 current and former
astronauts and cosmonauts from 37 nations and are organized
into four regional chapters: Russia, Europe, Asia, and ASE-USA,
by far the largest with 214 living members.
There's a standing joke at the NASA Johnson Space Center in
Houston that if you ask five astronauts for their opinion on an
issue, you'll get at least six answers. Nonetheless, the
response I received from the membership of ASE-USA was absolute
unanimity in support of the change that would allow NASA to
provide enhanced monitoring, diagnosis, and treatment of the
effects of health hazards that are associated with having flown
in space.
I heard from former astronauts who left the agency from
several months to several decades ago, and many of the stories
were strikingly similar. My written statement mentions some of
the known health hazards that are unique to the spaceflight
environment, and members of the ASE-USA convincingly confirmed
that that list is real with many personal accounts of
musculoskeletal, vision, bone density, and most grimly, cancer-
related medical issues.
In some case, their maladies were flagged during annual
exams that are offered by NASA as part of the Lifetime
Surveillance of Astronaut Health but in all cases, further
diagnosis and any treatment is at the expense of the astronaut.
There is ample precedent for targeted surveillance and
treatment for occupationally related medical conditions both
within the government, for instance, healthcare for veterans as
well as screening for DOE and DOD nuclear workers as well as by
non-government employers for their workers in mines, foundries,
and in civilian nuclear power industry.
But as compelling as some of my former colleagues' medical
situations are, the most persuasive argument for this type of
legislation is that understanding the human physiological
response to spaceflight is imperative to inform future policies
and procedures for managing health risks in space.
In the absence of methodical medical surveillance and care
for those exposed to these health risks, we are irretrievably
losing an invaluable source of data and severely hampering our
plans to extend human exploration beyond low-Earth orbit.
The current and former astronaut cadre is the only study
population that can facilitate our understanding of past and
future space-related health risks. It is unforgivable to not
monitor their health and collect and analyze the relevant
associated data.
I'm a participant in a previously mentioned LSAH. Each year
I travel to Houston and receive a medical check that includes
collecting my vital signs, blood and urine samples, exams of my
vision, hearing, and lung function, an EKG, and a brief
physical exam by a flight surgeon. Every few years, it is
recommended that I undergo a colonoscopy to look for polyps or
tumors that may have appeared as a result of my exposure to
ionizing radiation while on orbit. The procedure is completely
voluntary, and if I do choose to have it done, the results are
not a priori shared with NASA. This is just one example of the
lack of monitoring that negatively affects our understanding of
the epidemiology of spaceflight.
Another valuable test that might be performed is high-
powered MRI of my eyes to look for anatomical changes. Like
about 60 percent of long-duration astronauts, I suffer from
microgravity ocular syndrome, sometimes called vision
impairment and intracranial pressure. VIIP is emerging as one
of the most significant and least understood health risks for
human exploration beyond low-Earth orbit. It seems absurd that
we do not actively study those who have suffered from it.
During my seven months aboard the ISS, my bone mineral
density decreased by over ten percent. While the density itself
recovered after a couple of years, we don't fully understand if
the structure of the bone and therefore its resistance to
fracture has returned. A test like QCT, quantitative computed
tomography, cannot only measure bone mineral density but also
assess the geometry of the bone and the stress-strain index, a
much better measure of fracture resistance. This test is also
not performed as part of LSAH.
What I found perhaps most startling in responses from the
ASE-USA membership was how many reported that they have dropped
out of the LSAH program. A relatively routine physical that
lacks targeted surveillance of known space-related health
hazards, let alone any kind of in-depth diagnosis or provision
of treatment, is simply not compelling enough for many former
astronauts who might live far from Houston to take time from
work and family to make the trip. This means that not only is
NASA deprived of any data related to spaceflight-specific
health risks, even the routine surveillance that is part of
today's LSAH is often being done by local medical providers and
the associated information is lost to NASA.
There is a moral and ethical obligation on the part of any
employer to exercise due diligence to study all occupational
hazards that its employees encounter in the workplace to
understand the short- and long-term health effects of those
dangers to use all reasonable methods to prevent these risks
from negatively impacting the well-being of its current and
future workers and to provide care for former employees who
suffer health issues as a result of their service.
There are a number of significant human health risks
associated with flying in space. Many of these perils are
unique to the spaceflight environment and most evade our full
understanding. It's clear that we must do our utmost to
mitigate these risks for the cadre of current and future
American astronauts by assiduously monitoring the health and,
where applicable, treatment of their predecessors. This
information is absolutely imperative for the design of
missions, vehicles, and countermeasures for the human
exploration of space beyond low-Earth orbit.
Thank you again for this opportunity, and I look forward to
answering questions from the Subcommittee.
[The prepared statement of Captain Lopez-Alegria follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Dr. Lopez-Alegria.
And now I recognize Dr. Kahn for five minutes.
TESTIMONY OF DR. JEFFREY KAHN,
PROFESSOR OF BIOETHICS AND PUBLIC POLICY,
JOHNS HOPKINS BERMAN INSTITUTE OF BIOETHICS;
CHAIRMAN, COMMITTEE ON THE
ETHICS PRINCIPLES AND GUIDELINES
FOR HEALTH STANDARDS FOR LONG DURATION
AND EXPLORATION SPACEFLIGHTS,
BOARD ON HEALTH SCIENCES POLICY,
NATIONAL ACADEMIES OF SCIENCES
Mr. Kahn. Thank you. Chairman Babin, Ranking Member
Edwards, Committee Chairman Smith, and Ranking Member Johnson,
thank you for the opportunity to present testimony on this
timely and vitally important subject today. I am a Professor of
Bioethics and Public Policy at the Johns Hopkins University
Berman Institute of Bioethics in Baltimore, and I should say
after the introduction of my fellow witnesses, a rank
underachiever.
I appear before you today in my capacity as Chair of the
Institute of Medicine--now the National Academy of Medicine--
Committee on Ethics Principles and Guidelines for Health
Standards for Long Duration and Exploration Spaceflights, which
issued its report in April 2014, as Representative Edwards has
already noted.
In addition, I should note that I'm currently Chair of the
Board on Health Sciences Policy for the Health and Medicine
Division of the National Academies, and a member of the
Division's standing Committee on Aerospace Medicine and
Medicine of Extreme Environments.
In those contexts, I will describe recommendations
contained in the report of the committee I mentioned related to
protecting and sustaining astronaut health.
First, I want to say that my committee's report in 2014 was
not the first to identify the ethical obligations to protect
astronaut health, as has been noted by others. As outlined in
the 2001 IOM report titled Safe Passage, and as noted in the my
committee's report as well, the new challenges that will be
faced in long-duration and exploration spaceflight necessitate
a new look at the ethics principles for these missions, and I
quote now from Safe Passage: ``Current ethical standards for
clinical research and practice with astronauts were developed
in an era of short space missions when repeat missions were the
norm and a return to Earth within days was possible. In future
missions beyond Earth orbit, however, a diverse group of
astronauts will travel to unexplored destinations for prolonged
periods of time. Contact with Earth will be delayed, and a
rapid return will be impossible. Long-duration missions beyond
Earth orbit, space colony habitation, or interplanetary travel
will create special circumstances for which ethical standards
developed for terrestrial medical care and research may be
inadequate for astronauts. These ethical standards may require
reevaluation.'' That again is from 2001.
My committee in 2014 noted that NASA, as an employer, a
federal agency responsible for innovation and exploration, a
research sponsor, and an international partner, has moral
obligations to formally recognize and act on responsibilities
that logically flow from the ethics principles outlined in our
report if long-duration and exploration spaceflights are to be
ethically acceptable. Among the six principles we identified,
two are particularly relevant for discussion in the context of
health care for former astronauts. Those principles are (1)
fairness, and (2) as already noted by Representative Edwards,
fidelity. Let me quote from the report. ``Fairness is the
principle that requires that equals be treated equally, that
burdens and benefits be distributed fairly, and that fair
processes be created and followed. NASA's decision making
surrounding missions should explicitly address fairness,
including the distribution of the risks and benefits of the
mission, crew selection, and protections for astronauts after
missions.''
An important ethical challenge of exposing humans to the
risks of long-duration and exploration spaceflight is that the
burden of the health risks associated with these missions falls
to a limited number of astronauts and their families as well
while the benefits of the proposed missions accrue primarily to
future astronauts and to society more broadly.
In addition to being a concern of appropriate risk-benefit
balance about going at all, the appropriate risk-benefit
distribution must also be considered. Asking individuals to
accept great risk, either in likelihood or magnitude of the
harm to be caused, can be partially balanced by making a
commitment to provide long-term health care and health
monitoring.
The second principle we identified is fidelity, and again I
quote from the report. ``Fidelity is the principle that
recognizes that individual sacrifices made for the benefit of
society may give rise to societal duties in return. Given the
risks that astronauts accept in participating in hazardous
missions, NASA should respect the mutuality of obligations and
ensure health care and protection for astronauts not only
during the mission but after they return, including provision
of lifetime health care for astronauts.''
Those who consent to incur long-term health risks for
society's benefit are entitled to fidelity, reflected in
society's commitment to minimize any harms that emerge,
whenever they emerge. The committee noted that this concept of
fidelity or reciprocity resonates with the basic, widely shared
understanding that it is unjust to allow some people alone to
bear burdens which, in all fairness and justice, should be
borne by the public as a whole. As a practical matter, the
public cannot physically share the risks that astronauts will
bear. It can, however, share the costs and burdens of ongoing
risk mitigation efforts.
An astronaut's consent becomes binding and irrevocable at
the moment the mission launches. Astronauts are free to
withdraw their agreement to participate prior to launch of
course, but from the launch moment forward, it becomes nearly
impossible to turn back, and astronauts likely will encounter
uncertain and unquantifiable risk exposures and endure
potential harms to health that will persist after the mission.
The irrevocability of participation in spaceflight creates an
ethical imperative to define long-term duties owed to the
participating astronaut.
In this context, the principles identified by our committee
report support the minimization of risk of harm, the treatment
of injuries or health conditions during the flight, and the
ongoing monitoring and provision of health care after the
flight. This binding duty to provide ongoing surveillance,
monitoring, and health care during the lifetime of the
astronaut is part of the continuum of risk management that
begins with engineering and design efforts to minimize risk and
continues through the flight and post flight. Our committee
concluded that the ethics responsibilities that result from
sanctioning high-risk activities include continuous learning
and engagement in health-related activities that protect
astronaut health, support ongoing evaluation of health
standards, improve mission safety, and reduce risks for current
and future astronauts.
Employers that knowingly expose employees to risks have an
ethical responsibility to provide protection to the extent
possible and to address the harms that occur when protections
fail or turns out to be inadequate. Robust research and health
monitoring or surveillance programs that fully inform all who
are involved, including astronauts and their families, are
required.
Furthermore, the committee maintained that the nation,
through NASA, has the ethical duties to protect and sustain
astronaut health based on the ethics principles of fairness and
fidelity. Providing lifetime health care to astronauts respects
the commitment that our astronauts have made and the risks they
have taken on society's behalf.
Thank you.
[The prepared statement of Mr. Kahn follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman Babin. Thank you, Dr. Kahn. All fascinating
testimony. I thank every one of you witnesses for your
testimony, and now I recognize myself for five minutes for
questions.
The first one I'd like to direct to Dr. Williams. How would
additional authority affect existing rights and benefits under
current statutes? And would creating a new program at NASA
impact the standards that are set forth by the Departments of
Labor and Veterans Affairs for compensation and treatment? In
other words, will a new authority make it easier or harder for
astronauts to receive the treatment and compensation that they
are due?
Dr. Williams. Thank you for the question, sir. I don't
think that there'll be a major impact to existing
infrastructure. As a matter of fact, we envision using an
existing claims infrastructure working very closely with our
partners in the Department of Labor, and we're developing the
same relationships with the Department of Veterans Affairs to
approach this as a facilitated claims process, providing the
expertise and space medicine and disease-specific experts as
well as the evidence base that we've accrued so far to help
determine the likelihood of association with occupational
exposure as disease develops in our former and retired
astronauts.
With regard to your question about whether I think this
will make it easier to advance the plausibility of association,
I think it likely will, sir. I think endorsement by the
Congress in recognition that these unusual exposures can cause
disease in our astronauts, I think that will send a powerful
message and will enable us to be more successful in taking care
of them.
Chairman Babin. Absolutely. Thank you very much, Doctor.
The next question I'd like to direct to our three
distinguished astronauts. If NASA is given authority to provide
additional treatment for astronauts beyond existing programs at
the Department of Labor and Department of Veterans Affairs,
should NASA provide that treatment in-house at NASA or
reimburse patients for private-sector treatment? Captain
Cassidy, how about you first?
Captain Cassidy. Mr. Chairman, that's an excellent
question. I think that there's some degree of care that can be
handled in-house at the Johnson Space Center but I also think
that there should be some flexibility in order to take care of
the former astronauts who potentially in their older age have a
hard time getting back to Johnson Space Center, or because of
their condition can't make that trip.
Chairman Babin. Right. Okay.
Captain Kelly?
Captain Kelly. Sir, I don't really have anything to add
other than what Chris said, but I think, you know, the emphasis
on some of these guys, as we age and traveling back and forth
to Houston could be problematic.
Chairman Babin. Sure. Thank you.
And Captain Lopez-Alegria?
Captain Lopez-Alegria. Yes, Mr. Chairman, pretty similar. I
think clearly there are some things that the clinic at Johnson
Space Center could not do from a medical perspective. We
couldn't, you know, treat somebody with chemotherapy, for
instance, at JSC, but I think to the extent possible, we should
try to keep it in-house just to facilitate the transfer of the
data, which are very important to the discussion, but agree
with my colleagues about that being impractical in some cases.
I think that we should endeavor to make it happen when possible
but realize that that won't always be the case.
Chairman Babin. Sure, and then just to follow up, if NASA
does decide to diagnose and treat conditions in-house, does
this pose a potential conflict of interest when NASA is
financially obligated to compensate former astronauts for
conditions caused by their federal service? If one of you three
would like to take a stab at that?
Captain Cassidy. Well, let me start by saying--and Scott
will back me up on this--as military aviators, we have an
adversarial relationship with our flight surgeons generally. I
was expecting that to be the case at NASA and could not have
been more wrong about that. The relationship that we enjoy is
very unique, and there's no doubt in my mind that our best
interests are at heart when they give us treatment. So I would
have a great level of confidence that the people with whom we
all have personal relationships would be very disposed to help
us to the extent possible, and I don't see there being a
conflict of interest. I think that it if you're saying the
conflict of interest would mean they would be reluctant, I
don't see that as a likelihood.
Chairman Babin. Right. Anybody else? Pretty much in
agreement?
It's an interesting comment you make, because I was an Air
Force dentist, and occasionally we had to put DNIF on
somebody's records, and they were not happy: duty not to
include flying.
Let's see. I think I'm out of time so I will yield back,
and we will call on the next one, the Ranking Member from
Maryland, Ms. Edwards.
Ms. Edwards. Thank you, Mr. Chairman, and thank you again
to the witnesses. Your testimony was really--was very thorough.
One of the questions that I had as we came up, and
particularly for Captain Lopez-Alegria, if you could tell me
whether the care is provided in-house or out-of-house in terms
of the surveillance data that are gathered, and Dr. Williams,
please contribute as well, it seems to me that you all are
already close to or you already have a tool that could--a
screening tool that could easily be used more broadly, whether
that's at Johnson or at some private care facility, and the
question is whether we can authorize both the mechanism for
surveillance but also separately the provision of health care,
in which case you would be able to capture more than the 60
percent, I think, of the Astronaut Corps, retired and active,
who are currently participating. Would that be right?
Captain Lopez-Alegria. Well, I think your last point would
absolutely be right, that you would have far more participation
than we have. I don't know enough about what the current limits
of the authority on the screening that are in place right now,
but I do know that some of the tests that I mentioned in my
oral testimony, which could be done, which hare very
specifically targeted to hazards that are known to be caused by
flying in space, are not being done, and I think that if that
authority does not exist, which I assume it doesn't, who would
be doing them, then they should be.
Ms. Edwards. Dr. Williams?
Dr. Williams. Yes, ma'am. We--our current authority to
provide that ongoing health monitoring to former and retired
astronauts is limited. Our ability to spend appropriated funds
in providing that diagnosis and much more so in providing
treatment in that group, we don't feel like we have the
authority to do that. So although we have the basic framework
in place, which is the Lifetime Surveillance of Astronaut
Health, we believe that that framework can be greatly enhanced
and greatly expanded and become much more comprehensive with
specific authority to provide diagnosis and treatment.
Similarly, we think that our ability to engage and treat
serious illness that arises in the Astronaut Corps will be
greatly facilitated by the--for the lack of a better word, I'd
say the facilitated claims process we envision with our
partnerships with the Department of Veteran Affairs and the
Department of Labor.
Ms. Edwards. So, I mean, I want to get to this, because I
think there's a separate question. If we give the authority
that then allows for the provision of health care, we could do
that either through those who are covered by VA, those who are
covered under the FECA, or other kinds of private health care.
The question then becomes, can we develop a tool that
encompasses all of the kind of surveillance that you would need
both to provide current health care but also to look down the
line in terms of providing prevention or looking forward to the
future Astronaut Corps, and you're saying that we would need--
you would require a separate legislative authority in order to
be able to do that?
Dr. Williams. Yes, ma'am. I think based on the very small
number of cadre of the astronauts and the very unique exposures
and the need for targeted surveillance and broad preventive
surveillance in this group targeted toward those exposures that
we know more about than anyone else on the planet, I think that
NASA having that care--we do have within our agency a
comprehensive healthcare delivery system that is aimed at the
active Astronaut Corps, and leveraging our abilities along
those lines on behalf of the retired and former astronauts
including helping coordinate their care wherever they live I
think would go a great way toward making sure that we take care
of them and recovering as much data as possible to establish
our evidence base.
Ms. Edwards. And Captain Cassidy, I take it that you
believe that we--that Congress has to provide a broader
legislative authority to provide those services?
Captain Cassidy. Yes, ma'am. I think that it's--my
experience base is with the active astronauts, and like my two
colleagues here, I don't have a whole lot of experience with
what it's like as a former astronaut to go through that. I've
talked to both of them, but where I think we can do--I know we
can do a better job at pulling this data together, and the
execution of how we do that, where it happens, what tests are
done, and the mechanism for payment I think are things that can
be further honed and discussed as we move forward and actually
get this going, but those are things that I think we could
collectively get a better story on.
Ms. Edwards. And Dr. Kahn, can you tell me, is there any
other sector that you can think of where there's an employer
who has an employee who engages in risk for the purposes of
completing their employment where there isn't a comparative
ethical obligation for care?
Mr. Kahn. Thank you, Representative Edwards. It's a really
interesting question. In fact, part of the work of the
committee that I had the privilege to chair, we tried to find
parallel occupational examples, and in fact, it's quite unique
is the short answer. And so when people leave occupational
environment, they tend to have either a new job or they become
retired and then they're covered by other means. So astronauts
are really frankly in a unique category that way.
Chairman Babin. Thank you, Ms. Edwards.
I now call on the gentleman from Alabama, Mr. Brooks.
Mr. Brooks. Thank you, Mr. Chairman.
Captain Kelly, thank you, sir, for being here today and for
your service to America's space program. As many are aware, you
and your twin brother, Mark Kelly, are providing scientists
with a wealth of information on the effect that human
spaceflight has on the body. NASA is set to share the results
of the study next year. Are you in a position where you can
give us any previews of what they're finding so far by sharing
with us the most surprising or interesting things that you have
noticed so far?
Captain Kelly. Well, I mentioned in my testimony the
difference between my initial 159-day flight and 340, my
symptoms immediately upon return. I have gotten some data back,
my bone mass, muscle mass data, some of the data on my vision,
that for me I was kind of surprised that it was relatively flat
in comparison to the 159 days. In other words, being in space
for twice as long didn't mean that I lost twice as much bone
mass. It was pretty similar. So I think some of these we do
have, a good understanding to how to mitigate the risks to bone
and muscle loss so we can stay in space longer.
The data with regards to my brother and the comparison with
me, a lot of those samples just came back on SpaceX, my
biological samples, so, you know, like most research, you
collect the data, you analyze the data, you write the reports,
have it peer-reviewed. I think that type of genetic data, the
effects of the radiation environment, the effects on my immune
system, things like that as it compares to my brother are just
going to take much longer.
But I was actually, you know, pleasantly surprised that my
bone and muscle data was pretty much flat between the two
flights, although, you know, how I felt when I got back was
much different.
Mr. Brooks. And this is a question for each of you, though
I'd like to start with the astronauts, Captain Cassidy first
and working our way around, and then on the two ends of the
table, and whoever wants to follow them, feel free.
With current technology, can NASA safely send an astronaut
on a Mars mission without resulting significant adverse health
risk, and if not, what should be done to safely protect
astronauts on a Mars mission?
Captain Cassidy. Sir, that's a fantastic question because
that's where I think our nation should go, to Mars, and that's
where our vision is, and so how do we do that effectively and
safely is a fantastic thing to consider, and clearly, radiation
monitoring and protection is critically important there. Do I
think that we could do that mission safely right now? We could
do it as safely as we think we can, and there are certain risks
that we don't know, and that's where collecting this data
between now and going to Mars will keep my future colleagues
safer.
Mr. Brooks. Captain Kelly?
Captain Kelly. Yes, sir. You know, my time on the Space
Station, I was really inspired that building and operating this
vehicle was the most difficult thing we have ever done, and I
think it's proven that if we decide to do something and we set
our mind to it and put the resources behind it, we can be
successful, whether that's going to Mars or curing cancer if we
decide that that's what we're going to do, and we devote the
appropriate resources to do it, we can do it.
Now, there are challenges with going to Mars. Chris
mentioned radiation, which I completely agree with. I think the
physical challenges, that would be the number one concern I
would have is protecting the crew members on that long trip
away from the protection of Earth. I think there are also, you
know, challenges in the systems that keep us alive onboard the
Space Station. You know, these are designed to work for long
periods of time in low-Earth orbit but having them that can,
you know, operate consistently, reliably, get us to Mars and
back, is a challenge, but I think it's clearly a challenge that
if we decide that's what we want to do, then we can accomplish
it.
Mr. Brooks. Well, with respect to the number one concern
that both of you have mentioned, radiation, do we have the
technology now to protect our astronauts from the radiation of
a long-term flight to Mars and back or do we need to develop
new technology?
Captain Kelly. You know, I think there's two ways to
approach that. One is, you get there really fast so you're not
exposed to the radiation environment for as long, and the other
one is some means of, you know, insulating the crew members
from it, and you know, I'm not an expert on this, but my
understanding is, if you have a propulsion system that
potentially has a magnetic field as part of it, that can act
like the magnetic field of the Earth to protect us from certain
types of radiation, but again, I'm not an expert in this area.
Mr. Brooks. Captain Lopez-Alegria?
Captain Lopez-Alegria. Thank you, Representative Brooks.
You know, I think could we do it technically, technologically?
Perhaps. It would be incredibly expensive the things that you
mentioned and my colleagues have mentioned about radiation. You
could shield. That takes mass. That makes the vehicle heavier.
That makes the vehicle more expensive. The current propulsion
technology, we've heard how long it would take the mission.
We'd have to bring our food with us. There are so many things
that it's possible to do. I think a breakthrough in technology
would make a lot of those problems go away or at least become
much more easy to solve.
One thing that I do think is going to happen in almost any
case, it's going to be very difficult to have any kind of a
reasonable abort possibility once you're on your way, and so
this country's going to have to have a different risk
acceptance posture, not just for radiation exposure, which is
right now three percent above the normal population is what we
admit for a risk of exposure-induced death, that would probably
have to change. But also just the notion that somebody could
have an unforeseen medical problem on the way which today we
could have the crew member on the ground in a matter of hours,
it would take potentially months to get them back.
So we could do it. I think we have to go through some
evolutionary processes in the way we think both at NASA and as
a country for it to happen.
Mr. Brooks. Well, my time is expired, but if the Chair
would permit for Dr. Kahn and Dr. Williams to answer, that'd be
great, but if not----
Chairman Babin. No, certainly, go ahead, if you have
something to add to that.
Mr. Brooks. Dr. Kahn or Dr. Williams, would either of you
like to add anything to a Mars mission safety, technological
advances we might need to ensure health safety.
Dr. Williams. I think my colleagues covered it quite well.
Physiologically, we believe that we could send people on a
Mars-duration mission out and back, you know, all the other
safety concerns notwithstanding. We believe we could do that.
Physiologically, I think it's safe to say that those astronauts
would be forever changed. In all likelihood, they'd have a
greater risk of developing a fatal cancer during their lifetime
and the associated changes in bone and muscle. I mean, they may
have a greater fracture risk and the cataracts and all the
things we've talked about.
One of the great challenges are the unknowns, and there are
unknowns and unknown unknowns with regard to the increased
duration of spaceflight. So that's what makes it so imperative
for us to continue our studies and to continue gathering as
much data as we possibly can in support of an eventual Mars
mission.
Mr. Brooks. Dr. Kahn, do you have anything to add?
Mr. Kahn. I would just add to what Dr. Williams just had to
say, that the committee that I chaired actually understood that
there were such great unknowns and unquantifiable risks, and
rather than try to answer the question that you posed about
what technological breakthroughs would be necessary, whether we
could do it today, we gave them a framework to think about the
ethics of exceeding existing standards and how to think about
that since, as Captain Lopez-Alegria said, there are existing
health standards and we have to evaluate those standards in
light of the mission that is being proposed, and that's what
the committee that I chaired had to say.
Mr. Brooks. Mr. Chairman, thank you for your indulgence.
Chairman Babin. Yes, sir. Thank you.
I'd like to now call on the gentleman from Virginia, Mr.
Beyer.
Mr. Beyer. Thank you, Mr. Chairman. I thank all of you very
much for being here.
Dr. Kahn, given the difficulty of establishing causality
for medical conditions that may have resulted from human
spaceflight one of the options would be to have NASA take care
of all the medical problems that astronauts would have in the
years to come. What are the pros and cons of such an approach?
Mr. Kahn. Thank you, Representative Beyer, for that
question. I think that's actually a really important question,
and I'll speak to it from the ethics perspective because that's
what I know, and in fact, the committee that I chaired
discussed that, and we came to the conclusion that the
causality question is impossible to answer, and that we as a
country and a society owe astronauts protection and provision
of care throughout their lifetimes without asking the question
about whether--what they might suffer from in terms of injury
or health needs was a result of their time in space or not.
Mr. Beyer. Thank you, Dr. Kahn.
I met earlier today with the Fire Chief for the County of
Arlington in Virginia and talked specifically about this issue
with the presumption of heart-lung disease, the presumption
that if they got heart disease or lung disease later, that it
was presumed to be from rushing into burning buildings, and he
said it actually expanded in Virginia over the law to things to
do with the GI tract also. So this just extends it to all those
who go into space for us.
Mr. Kahn. And as you heard from others, there's new
information coming out all the time, and so what we don't know
today may be something we learn about in the future, and so the
committee that I chaired really did not find the causation
question a compelling one as a matter of limitation of
provision of the--of lifetime healthcare benefits.
Mr. Beyer. I am struck today by the two big reasons we have
at this hearing. On the one hand is the ethical considerations,
the responsibility to take care of people who are sacrificing
for all humankind. On the other hand, there's the simple
practical data reason that we want to learn as much as we can
to be able to move forward.
Dr. Williams, what about when Captain Kelly retires and
goes to work for a private space person, you know, SpaceX or
Orbital, how does that influence the government's
responsibility to take care of him and his space things, the
space-related conditions for years to come?
Dr. Williams. Yes, sir, another great question. I think
there's plenty of precedent in the U.S. government that we
would consider that to have no impact at all on our ethical
obligation to take care of Captain Kelly and on our desire to
gather as much data as we can to inform our database and to
help us protect crews in the future, so I think there's no
accrual, no effect at all, sir.
Mr. Beyer. I was very impressed, fascinated by reading,
Captain Kelly, all the impacts of your 340 days in space,
everything from the rash to the flu-like symptoms and all the
things we don't know yet, the unknown unknowns.
So Dr. Kahn, from an ethical standpoint, especially after
the recent death of Muhammad Ali, I mean, my mother never
wanted me to box, right? The concussion and what the NFL is
trying to deal with, concussions right now we see, those are
voluntary sports. At what point do the ethical considerations
become so great that we become reluctant to send men and women
into space for the long voyages?
Mr. Kahn. At what point would they? Is that the--is that
your question?
Mr. Beyer. You know, we send young men and women to go
fight for us overseas because they're defending the country and
we know we're going to lose some. We don't ever want to lose
anybody despite Elon Musk saying the other day, ``We're going
to go to Mars and some people are going to die.'' Do we go into
this knowing with certainty that some of these health effects,
the long-term health effects, are going to be inevitable?
Mr. Kahn. I think what we want to be sure of, as sure as we
can be, that we can protect the men and women who go into long-
duration spaceflight to the greatest extent possible, and that
we learn along the way, so among the things that hasn't come
out yet today is this notion of long duration, so we're talking
hundreds of days in transit until there's some new propulsion
system, and so we can learn along the way. So data will come
back to Earth from the experience of astronauts as they fly,
and we should use that and learn and use that to decide about
whether people should spend more time in protective cocoons in
the--on the way or whether there should be some other means by
which we should modify exposure along the way. So I think it's
a notion of learning as we go but we don't go until we're
sufficiently confident that it's safe enough, and then it's up
to NASA to decide when and if it's safe enough.
Mr. Beyer. Thank you very much.
Mr. Chairman, I yield back.
Chairman Babin. Yes, sir, thank you, and I'd like to
recognize the gentleman from Colorado, Mr. Perlmutter.
Mr. Perlmutter. Thank you, Mr. Chairman, and thank you for
having this hearing. It's fascinating and it's important.
Gentlemen, thank you for your service.
Dr. Kahn, I want to start with you because I thought your
two sort of pillars of fidelity and fairness really kind of lay
out the thinking on this for me.
You know, if somebody--these three gentlemen next to you
are explorers and they put themselves at risk to explore in the
name of the United States, in the name of science, in the name
of adventure, in the name of I don't know what, lots of things,
and they now have put themselves at risk. So it's my opinion,
based on your two principles of fidelity and fairness, that we
have a responsibility to provide both the medical care that
they may need on into the future and the research that they
provide us as to their health.
So did your committee agree with you on this fidelity and
fairness? It certainly resonates with me.
Mr. Kahn. Yes. Sorry if I wasn't clear, Representative
Perlmutter. The--my testimony represents the conclusions of the
committee that I chaired, and everything I said actually is a
summary of what's in our report, which was issued in 2014, and
so that was the consensus of those 16 people who have a variety
of expertise, some like mine but actually two former astronauts
were members of this committee, along with scientists and
physicians and occupational health specialists.
Mr. Perlmutter. The reason I'm sort of thinking about this,
and Dr. Williams, you can chime in if you choose, you know, in
my district we have Rocky Flats, where we built the nuclear
triggers for our bombs, and we had a lot of workers out there.
They've developed a number of maladies as a result, some I
guess anticipated some not anticipated, and we came up with a--
we the Congress--came up with the Energy Employees Occupational
Illness Compensation Program, which has worked in some regards
and hasn't worked very well in other regards because, you know,
whether it's bone mass or some issue of radiation or something
like cataracts, completely unexpected, we've seen maladies that
were never expected. So in your analysis, Dr. Williams or Dr.
Kahn, how do we be inclusive? Do we just--see, right now, the
burden is on the worker to say that the illness came from
working at Rocky Flats. I'd just like to say hey, if you worked
at Rocky Flats and you're sick, we're going to take care of
you. If you're an astronaut and you got up there, we're going
to take care of you. But it gets expensive. We've got to be
prepared for potential costs if we build our astronaut base. I
mean, what was your committee considering? And Dr. Williams,
have we estimated what costs we might see in the future?
Mr. Kahn. So the committee that I chaired did not--was not
asked and did not try to estimate the cost, so we identified
what we thought were, as you articulated, the pillars--we
called them principles of ethics that would support
recommendations which included a recommendation for lifetime
provision of health care for astronauts but we did not go past
that into the practical question of how much it would cost for
how many people or for how many years we're discussing.
Mr. Perlmutter. Dr. Williams?
Dr. Williams. Yes, sir. I think when you articulated the
sentiment that if we send you in harm's way as astronauts, we
want to take care of you, I think that's what NASA absolutely
wants to do.
The practicalities of doing that with this legislation, we
can--we have to be aware of the problems, hopefully at the
earliest stage possible in order to remediate them, and that's
the monitoring portion of our--the health monitoring portion of
our proposal, which is quite detailed and quite targeted and
broadly preventive in nature. And then I think with this
authority, work very closely--under the envision model, work
very closely with folks in existing claims structures--the DOL
and the VA, whoever we need to--to lean very forward and be
very proactive in--with regard to working--providing evidence
and best expert opinion to try to receive favorable
consideration of claims and acceptance of diseases as they
arise.
Mr. Perlmutter. Well, for all of us on this Committee, you
know, I think I showed you, Captain Kelly, when you were up on
Space Station, you know, 2033 we can do this. I mean, we really
want--I don't know, you know, exactly what the timing is going
to be. That'll be for the technicians and the engineers and you
astronauts and the scientists to figure it out, but we want to
get there, but we want you not to put your lives at stake. I
mean, there will be some level of risk. I know I as a Member of
Congress on behalf of the 750,000 people that I represent want
to make sure that when you do put your lives at risk that--and
your health for who knows how long down the road, we as the
United States of America help you with your health care.
Hopefully there's no problems, but if there are, we help you.
And so I just thank you for your service, gentlemen. Docs,
thank you for looking at this. This is important stuff. Thank
you.
Chairman Babin. Thank you. Thank you very much. Thank you,
Mr. Perlmutter.
I think there's a little time left if we could go back
through for another round of questioning if the witnesses are
agreeable and the members. Why don't we this? Instead of 5
minutes, we'll have a 2-minute question period, okay? And Mr.
Perlmutter, we're going to keep you at 30 seconds.
Okay. I'm going to start out with Dr. Williams. Similar to
the question that Mr. Perlmutter asked, NASA has indicated that
extending existing monitoring of former astronauts would
increase the cost to NASA from approximately $400,000 a year to
around $800,000 a year. A recent University of Nebraska Medical
Center report indicated that providing medical care for all 367
astronauts and their families would cost between $2.4 and $6.5
million a year. How much money would NASA's current proposal
cost per year? Do you know that?
Dr. Williams. We think the direct portion, health
monitoring portion, would be in the neighborhood of doubling
our current cost to $800,000 a year. Right now, we spend 400 a
year for that portion. We believe if we--including remediating
providers in the community for testing and imaging and so on
and so forth, we think that would drive that cost up, and
anticipating increased participation rates, we think it would
drive it to $800,000.
With regard to the remediation of illness and injury, the
astronauts do display a very strong, healthy worker effect.
They pursue very healthy lifestyles. They're committed during
their careers and after their careers to maintaining good
fitness and making good lifestyle choices. So when you compare
chronic diseases and malignancies and so on and so forth to
almost any comparison groups at this point, the astronauts
compare very favorably. After latent period of exposure passes
in the next 10 to 20 years, that's an unknown quantity at that
point.
But right now, we would anticipate based on historical
precedent no more than one case, maybe two cases every one or
two years of significant illness that would be expensive, and
by ``expensive,'' I mean that would be in the, you know,
$500,000 range for a catastrophic case of cancer or something,
and that's what we believe we would be dealing with in the
short term, sir.
Chairman Babin. And one quick question here for you, Dr.
Williams, and Captain Cassidy. The Department of Labor and
Department of Veterans Affairs both provide treatment for
conditions derived from federal service. Are there classes of
astronaut such as payload specialists who are not government
employees and therefore would not be covered by existing
authorities? Do you all know the answer to that?
Captain Cassidy. Sir, currently at NASA we have active
astronauts and management astronauts. Management astronauts are
folks that still work at NASA but are no longer in the line for
a space mission, and we used to have in the past payload
specialists. We no longer have that designation. However, from
our perspective, anybody that goes on a space mission on a NASA
mission should be covered.
Chairman Babin. Right. Dr. Williams?
Dr. Williams. And sir, for classes of astronauts like
payload specialists, we believe that no matter what method that
they use to enter the agency as a detailee or what method of
employment they have, that there would be a pathway forward
under existing structure to treat them just like we would any
astronaut in clearly military or civilian service and pursue
helping them.
Chairman Babin. Thank you. Thank you very much.
And I now call on the gentlewoman from Maryland, Ms.
Edwards.
Ms. Edwards. Thank you very much, Mr. Chairman, and thanks
for the second round.
Dr. Williams, I want to go back to the VA system because I
understand that about 60 percent of the astronauts that have
flown in space are military or retired military--we have two
here on this panel--and as such, any occupational injuries or
conditions are currently handled by the VA. Have you actually
directly addressed with the VA how occupational-related health
conditions for former military astronauts as a result of
spaceflight will be handled if this legislative proposal is
enacted?
Dr. Williams. We have reached out to our contacts in the
Veterans Administration and we are initiating discussions with
them similar to those that we have initiated with the
Department of Labor, and we would envision in implementation of
this legislation partnerships going forward on both fronts to
build this facilitated claims process with NASA playing a key
role in determining accepting the diseases.
Ms. Edwards. I mean, it is a little bit problematic, you
know, 60 percent of the astronauts are retired military, and we
have--you haven't engaged the VA in this discussion before
presenting legislative proposal, but I hope that that happens
really soon and that you're able to share that information with
us.
Captain Kelly and Captain Lopez-Alegria, you both are
retired military. Have you used the existing VA system?
Captain Kelly. I think it's important--I think it's
important to point out that there are--astronauts come from all
different backgrounds. Some of us are retired military. I'm
personally, as is Mike, covered under Tricare for life as a
retired military member. If you were a member of the military
and you didn't retire, I believe the VA would still cover you.
There are members of the Astronaut Corps that are civil
servants. Some of those civil servants retire from federal
service, in which case they do have retired civil service
health care, but then there are other people that may fly for
one flight or more and then leave federal service without any
kind of long-term health care benefits until they were
potentially eligible for Medicare. So there are different
categories, and I think this system, this legislation, if
enacted, would benefit them and people in different ways
considering the fact that, you know, we already have health
care coverage that is pretty good.
Ms. Edwards. And in effect, at least bring the payment
within one house, if not the care within one house?
Captain Kelly. Certainly, and I think that the important--
the other important factor, as previously mentioned, was the
fact that we can collect all this data whereas if I'm, you
know, living in another state and I'm being treated under the
Tricare system, NASA doesn't directly benefit from any of that
information, and also the fact that, you know, those health
care providers may not even know what they should be looking
for in these types of, you know, cancer or radiation-based
illnesses.
You know, it's interesting, Mike and I--I was going to
point this out, and I don't think he would mind mentioning it,
but we're going to meet with one of our colleagues tonight who
lives in the area that has recently been diagnosed with stage
IV pancreatic cancer, and he's, you know, flown in space on a
number of occasions, and you know, we never know whether that's
actually directly related to his spaceflight but it's possible
that it is.
Ms. Edwards. Thank you very much. I mean, a reminder, it
took us 30 years after Vietnam to finally recognize the long-
term impacts of Agent Orange.
Chairman Babin. Yeah, absolutely.
The next one, Mr. Beyer, the gentleman from Virginia.
Mr. Beyer. Yes. Thank you, Mr. Chairman.
And Dr. Williams, I know you're not a statistician but I
understand from reading lots of science magazines that
essentially we need to get to 10,000 DNA complete
disarticulations into the database before we're really going to
be able to figure out what some of these DNA connections are.
You know, we have 250 retired astronauts. Sixty percent are
in--so 150 are in the LSAH program right now. If we move to 80
percent, that gets us 200. What are the--what's the
implications for us of the limited sample size, the limited
size of the database?
Dr. Williams. It's something we've always struggled with,
sir, whether we're actually doing space-based research with a
small population and trying to, you know, reach conclusions or
whether we're trying to do epidemiology on this very small,
very uniquely exposed group of folks. The only thing--the thing
I think that is most important to note is that given the group
is so small, the data from every single one of them is precious
and the data from every single one of them is important, and
anything we can do to maximize participation in our program,
both for the surveillance and recovery of healthcare data in
the event of injury and illness, is critical.
Mr. Beyer. A question for any of the three captains but
perhaps especially for Captain Kelly. We had a Mars hearing
here a couple weeks ago, and with, you know, the big companies
that are developing all the places to get there, and Andy Weir
came, who wrote The Martian, and at the end he threw out the
proposal that we should be thinking about using rotational
energy to create artificial gravity on the way up. So how much
of the consequences that you all have felt have been radiation
related versus gravity-free-related, and I say that because I
think for Ed and for me, the highlight of this Committee so far
has been when you and Dr. Lindgren did your flips at the end of
the flight.
Captain Kelly. Well, you know, I believe all the symptoms
that we have, the stuff that we can feel when we get back, is a
result of the microgravity environment versus radiation. I
think the radiation effects are, you know, more long term and
unknown, you know, of someone that does develop a cancer,
whether or not that was due to the radiation, I don't think we
can ever say for sure because it may have--you know, we get
radiation here on Earth as well. It just increases our risk of
those type of cancers.
So as far as, you know, having an artificial gravity to
mitigate those risks, I think, you know, based on how I felt
after being in space for a year, if I was going to travel to
Europa, for instance, and it's going to take, you know, many,
many years to get there, I think--and then you have to perform
after being in space for multiple years and you had to perform
away from Earth, I think that type of artificial gravity would
be crucial. If we're going to fly around the Moon or fly around
Mars, for instance, and it's going to take, you know, three
years and you'd be in space for three years or if you're going
to land and be on the surface for a few weeks, being in space
for an extended period of time is going to have a negative
effect but fortunately you're coming back to Earth where, you
know, there's a big, you know, system to support you. So
artificial gravity in that type of mission I think is less
critical.
Mr. Beyer. Great. Thank you very much.
Mr. Chair, I yield back.
Chairman Babin. Yes, sir. Thank you, Mr. Beyer.
And now for the gentleman from Colorado, Mr. Perlmutter.
Mr. Perlmutter. For my 30 seconds.
Chairman Babin. No, we'll give you two.
Mr. Perlmutter. So this is to all of you. So as things have
developed and we've heard from Mr. Musk and SpaceX that, you
know, their intentions to try to get astronauts to Mars in the
2020 time frame or sometime, and we know that there's going to
be more commercial endeavors in space. So we have a small pool
to do research on. Should we consider those astronauts that are
on a private capsule? Should they be covered by something like
this? And I'll start with the three captains and then go to the
ethicist, I guess.
Captain Lopez-Alegria. Well, I've been in this room a lot
wearing my hat as president of a commercial spaceflight
federation, so your comments about democratization of access to
space are near and dear to my heart. I think that we would love
to have the data from those folks that are going to be going,
you know, first on suborbital but at some point on orbital
flights. I do not think it is the responsibility ethically but
I will leave that to the ethicist, but it seems to me that it
would have to be a voluntary program for them, but what is
clear is that the data that we are gathering in LSAH and
hopefully with this expanded authority, our flights and our
careers have been paid for by taxpayer dollars and we owe those
taxpayers those data to help them make informed decisions about
spaceflight.
Captain Kelly. I don't really have anything to add other
than what Mike said. I think that makes a lot of sense.
Captain Cassidy. And sir, I concur as well.
Mr. Perlmutter. Okay. So to the doctors, do you want to
have a bigger pool? Do you want them in there, or should we
cover them? What do you think?
Mr. Kahn. Well, so I'll start. I think in terms of coverage
that if it's commercial spaceflight, then those companies ought
to take on that obligation, so I do think there's an obligation
but not on the part of the government to protect those people
but on the part of Elon Musk or whomever.
In terms of the data, that to me is something that ought to
be encouraged but I think it's hard to obligate on the part of
individuals. So, you know, I think as our astronaut colleagues
here will say, there's very few of them, and every bit of the
data that is precious, and with the proper protections, there
should be, I think, a lot of willingness to participate, but I
don't think you can force people to do that.
Dr. Williams. And sir, I think our database and our
experience base would form the risk assessment database that
the commercial companies are going to have to use. That's going
to inform their risk decisions when it comes to a health
standpoint and undertaking some of these longer missions.
I agree with my colleagues. From a practical perspective,
our health care infrastructure, and I'm sure our research
community too would pursue helping them as much as we could by
sharing our experience and our data as much as we can, and also
we would seek to facilitate their gathering of data. We have a
lot of experience in doing that. And if there were
opportunities to leverage their data on behalf of future human
spaceflight, we would welcome the opportunity to do so.
Mr. Perlmutter. Thank you very much.
Thanks, Mr. Chairman. I yield back.
Chairman Babin. Yes, sir. Thank you, Mr. Perlmutter.
I want to thank the witnesses. It's been an extremely
edifying hearing, and to be honored with the three astronauts
and the two doctors, thank you all for your many years of
service to your country, and really I want to thank you from
the bottom of my heart.
The record will remain open for two weeks for additional
written comments and written questions from the Members.
So without any further ado, this hearing is adjourned.
[Whereupon, at 4:27 p.m., the Subcommittee was adjourned.]
Appendix I
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Answers to Post-Hearing Questions
Responses by Dr. Richard Williams
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Responses by Captain Chris Cassidy
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Responses by Captain Scott Kelly
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Responses by Captain Michael Lopez-Alegria
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Responses by Dr. Jeffrey Kahn
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