Dr. William (Bill) Rowe, Part 3 of 3, Sunday, 3-27-11 March 28, 2011
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Dr. William (Bill) Rowe, Part 3 of 3, Sunday, 3-27-11
http://archived.thespaceshow.com/shows/1535-BWB-2011-03-27.mp3
Guest: Dr. William (Bill) Rowe. Topics; Human spaceflight medicine and applications for terrestrial medicine and our personal lifestyles. Please note that you are invited to comment, ask questions, and discuss the Space Show program/guest(s) on the Space Show blog, http://thespaceshow.wordpress.com. Comments, questions, and any discussion must be relevant and applicable to Space Show programming. We welcomes back Dr. William (Bill) Rowe for the third and final part of his three part series addressing space medicine for human spaceflight and how we can benefit from much of this information in our own lives here on Earth. Dr. Rowe referenced many documents found on his website so I urge you to have his site available as you listen to the program. www.femsinspace.com. In addition, here are the direct URLs to the three figures he talked about: Figure 1: www.femsinspace.com/figure1.html; Figure 2: www.femsinspace.com/figure2.html; Figure 3: www.femsinspace.com/figure3.html. During our first segment, Dr. Rowe spent considerable time using Charles Darwin and his work regarding the Galapagos Islands as a model for some of the space medicine discussion for this program. Listen carefully to this discussion as it definitely relates to how we move forward with the interview. Near the end of the first segment, we started talking about artificial gravity, a discussion that carried through to the end of the interview. Dr. Rowe said we needed 1G for longer term spaceflight missions and he talked about the why of that throughout the balance of the discussion, co-mingled with a discussion about nutrition, pharmaceuticals in space, supplements, vitamins, and more. In our second segment, we started out with Dr. Rowe talking about a Vitamin D deficiency and skeletal muscle problems arising humans in space over the longer term. Later in this segment, Dr. Paul Dear called in from the UK to discuss the gene therapy ideas Dr. Rowe discussed in Part 2 of this series. Dr. Dear, who has been a guest on The Space Show several times regarding his N-Prize, works at the Laboratory of Molecular Biology in Cambridge, This is the lab where Crick and Watson discovered the DNA double helix, and the lab has about a dozen Nobel prizewinners. He currently leads a research team in genomics (DNA-based research) working on things ranging from cancer to ancient DNA (mammoths). Dr. Dear disagreed that gene therapy would be the way to go for human spaceflight given it was likely far off into the future. He suggested the use of genetic screening which he said was available and affordable at this time. This was an excellent discussion with the two experts coming to agreement. You definitely want to hear this discussion. In the third segment, Dr. Rowe got a call from Tim in Huntsville who brought up some interesting information regarding gravity here on Earth, specifically around the equator, then asking Dr. Rowe about variations of 1G that might be OK in space. Again, don’t miss this excellent exchange. Later in this segment, we talked about a series of Dr. Rowe’s Letters To The Editor which he pointed out on his webpage and the issue of peer review. Exercise in space was discussed but it remains a difficult task with no really good way of doing it to avoid the complications of being in microgravity. One of Dr. Rowe’s concluding comments suggested that with only about 500 people having been in space, the population size to be studied is way too small and any such studies on such a small population may have some significant errors that would have been corrected in a much larger study. Bottom line, we need to see lots more people in space and we need to collect substantially more scientific data. For your comments and questions, please post them on the blog URL above. You can also email Dr. Rowe at drrowe@femsinspace.com.
8.I am afraid you are wrong about head down bed rest. As models go it is the closest usable model we have to reduced gravity effects. The Russians are doing more dry immersion bed rest and find it is even closer to their experience of spaceflight. But these models are still the best we can have on the ground.
Secondly, I would be careful about placing too much emphasis on elevated NE or anything else. Any ‘level’ sampled at some point or other is meaningless unless you put it in context. The whole metabolic baseline as well as biological rhythm shifts both in space and more slowly in bed rest of all varieties. Unless anyone measures 24-hour sampling at progressive stages of flight or simulation models of its effects, like bedrest, together with changes in its synthetic enzymes like Tyrosine Hydroxylase and metabolites, to get the complete picture at progressive periods of time neither you nor I can place all our faith or dismiss a mechanism on the basis of single sampling. Furthermore it is more than likely that like other humoral systems concentrations are not steady but probably episodic, an unless the whole sustained mean level around which bursts occur is elevated, or you measure the response to a test of challenge, like for instance the Cold Pressor test that is very reproducible in the same person, and find it changed, one really cannot say a whole lot.
Having said that, it does not mean that your theory is not correct; it is just that the evidence to draw absolute conclusions does not exist, least of all in flight where an ‘early morning sample’ is meaningless and it is virtually impossible to know what the astronauts had been doing or was about to do before the sample was taken.
This is my point of view.
Best, Joan
Joan My support for my position comes primarily from 2 sources:
1. Atkov and bEDNENKO’S Hypokinesia and Weightlessness , International U. Press, Madison , 1992 pp 32-34; “A significant increase in the concentration of norepinephrine in heart tissue was found in the test animals after a flight on the Kosmos 936 biosatalite ( Yigranyan 1985) .A nonuniform distribution of epinephrine and norepinephrine in the ventricles and atria was observed in test animals after a flight on the Kosmos-1129 biosatellite : yjeir concentration increased in the ventricles and decreased in the atria.” This was my support for my defense regarding high catecholamines ( adrenaline) after a space mission at that time after presenting my paper at a NASA meeting in Toulouse, France in 1995. The moderator concluded by stating : ” Well Dr. Rowe we’ll find out in perhaps 20 years whether you were right.” Then in 2003 a paper was published : Bursting into space: alterations of sympathetic control by space travel. Eckberg DL, Neurolab Autonomic Nervous System Collaborators , Eckberg DL Acta Physiol Scand 2004 Mar , 177: 299-311. : ” Astronauts return to Earth with reduced cell masses and hypovolaemia .Not surprisingly when they stand , their heart rates may speed inordinately , their blood pressures may fall, and some may experience frank syncope ( fainting).We studied autonomic function in six male astronauts ( average age 40) before, during, and after the 16 -day Neurolab space shuttle mission. Conclusion: We conclude that baseline sympathetic outflow , however measured , is higher in space than on earth, and that augmented nerve responses to Valsalva straining , lower body suction, and post-flight upright tilt represent normal adjustments to greater haemodynamic stresses with hypovolaemia. Finally in my paper on my website : : Potential renovascular hypertension , space missions, and the role of magnesium:— ” the catecholamine ( adrenaline ) levels were not thought to be elevated with SF ( space flight).This concept has now been shown to have been incorrect .Christensen and colleagues 9370for example , have shown that plasma norepinephrine and plasma renin activity ( 38)were increased even to levels above those of the seated ground-based position. Plasma NE ( norepinephrine) was approximately rwice the value of the supine position on the ground , predisposing those in SF to nondipping , as noted above(30).Furthermore it was stated that the reason for this was unclear. Certainly one mechanism may be the reductions of SF Mg. ion levels with, in turn, elevations of catecholaminesalong with elevations of angiotensin and aldosterone ( p 0.0008) with ongoing vicious cycles. ( 1,3.4.17.18,27,39 )William J. Rowe M.D.
Joe
An additional point raised by your question relates to the problems involved in using human subjects but clearly human studies will always play a vital role. I meant to bring up another extremely important issue but I was side-tracked in response to questions and because of time constraints i.e. another nail in the coffin regarding atrophy of the heart with prolonged space missions. When I presented my first Space –related paper at a NASA meeting in Toulouse, France in 1995 I defended my position regarding elevations of adrenaline with space flight after my presentation – based on the Russian studies cited by Atkov and Bednenko, Hypokinesia and Weightlessness : Clinical and Physiologic Aspects, 1992, pp 32-34. Also after relatively brief Space missions experimental animal studies showed: “in the cardiac muscle pronounced atrophic changes ( atrophy due to non-use ) —-“. Furthermore “synthesis of myocardial (cardiac) proteins is suppressed and renewal of its structure is inhibited.”
After months of prolonged exploration on Mars in search of evidence of water, involving traveling long distances, and after return at least 20 months later, how can the atrophied heart withstand high G forces during reentry? What is the risk of congestive heart failure as experienced by Irwin on reentry in just 2 weeks after Apollo 15 and which might be fatal? This is a complication of hypokinesia (decreased movement) and contributes to the complications of microgravity but is clearly a separate issue; duplicating 1 G. might not prevent this complication. This pertains to a similar problem which I used in my last SPACE SHOW regarding the Charles Darwin analogy i.e. Darwin’s traveling by “submarine” through blood vessels, in confined quarters to skeletal muscles and all the while triggering oxidative stress.
It is illogical to head straight for Mars without first determining Man’s tolerance to withstanding a very prolonged period in a hostile dusty environment and also to determine the tolerance to the increased G forces during reentry. Read my letter to editor on my website (www.femsinspace.com) Don’t forsake the Moon for Mars.
I would love to debate such issues as this on a Space Show with Dr. Robert Zubrin but I am certain he would never consent nor could any host be found who would consent to handling the storm which might erupt.
William J. Rowe M.D. FBIS
Regarding the recent E mail request for further clarification as to the vascular mechanisms for insulin resistance, with loss of capillaries triggered by oxidative stress, the space flight – related invariable elevations of adrenaline and vicious cycles with magnesium ion reductions, can contribute to the loss of capillaries; this results in an augmented diffusion distance from capillaries to skeletal muscle and in turn insulin resistance. William J. Rowe M.D. FBIS
I have received an E mail requesting a more detailed explanation regarding the mechanisms for insulin resistance and the reactions of glucose uptake in the skeletal muscles using the analogy of Charles Darwin. I used this analogy to explain that by oxidative stress mechanisms –triggered by obesity related release of cytokines(small peptides) which signal/trigger oxidative stress, there would be,in turn, progressive injuries to the lining of the capillaries with a progressive loss of some capillaries; if this occurred in the vicinity of the uptake of glucose by insulin in the skeletal muscles (Galapagus Islands) after long travel by the ” submarine” (on my home page) through the capillaries there would be insulin resistance.I emphasized that a decrease in the number of capillaries ( destroyed by oxidative stress ) may impair the action of insulin and alter the uptake of glucose in the skeletal muscles. The mechanism is related to the increase in the “diffusion distance” of insulin having an adverse effect on the speed of reaction of insulin. I hope this clarifies the analogy. For those of you with a medical background I direct your attention to a very recent publication : Molecules in motion: influences of diffusion on metabolic structure and function in skeletal muscle. Kinsey ST, Locke BR, Dillaman RM , J of Experimental Biology; 214: 263-274, 2011.) William J. Rowe M.D. FBIS
There are a couple of other points which need to be addressed in response to Joe’s question and statements. The peer review system in science has its share of detractors but its still the best method of insuring progress in science with cautious supervision by one’s peers. Also some may raise the issue that in order to avoid the hazards of potential congestive heart failure during reentry after at least a 20 month mission to Mars– conducive to atrophy of the heart muscle, an adequate exercise program can prevent this. But I have emphasized that both too much and too little exercise can injure a normal heart and that with the increase in body heat in microgravity there is the risk of intensifying the significant magnesium deficiencies which already exist with space flight. Bill Rowe
Intereting show Dr Rowe, I appreciate your attempt to try to educate the rest of us on the problems associated with human spaceflight. I had always thought that it would be harder than some people made out but I must admit I had no idea that it would be as hard as you describe.
You mentioned the lack of vitemin D due to reduced sunlight, is the lighting on the ISS not designed to generate “natural daylight” to compensate for this? Even tropical fish aquariums use lights that do this.
Have inhallers been used to administer drugs in space? Not sure whether this would be possible in zero G but something like a nasal inhaller (as used for some steroids or hayfever medicines) could be tried. Would drugs be absorbed into the body via the nasal passage?
In response to Andy Hill’s questions I had not considerd the use of artificial light on the ISS as a partial solution to the vitamin D deficiency problem which is unfortunately common both on earth and in space. Since however there is invariable malabsorption vitamin D will have to be given subcutaneously but as I have pointed out, at this time, there is no replenishable silicon subcutaneous device to administer it. Similarly pharmaceuticals can not be administered through the nasal route because the circulation of the nasal passages might be impaired eventually through mechanisms similar to those I have published regarding the impairment in finger tip circulation in reference to my Apollo 15 Space Syndrome.I mentioned that the replacement of vitamin D deficiencies on earth would require a dose of 800-1000 I.U. / day but studies will have to be conducted to determine the proper subcutaneous dose and also determine which pharmaceuticals, minerals, and vitamins deteriorate in spaceand when. Finally I emphasized in one of my interviews that there are few if any subcutaneous pharmaceuticals; the companies are at this time not interested in developing them because there is very little demand with the exception of insulin. Many thanks for your question. Bill Rowe
If it is not known how much vitamin D is lost due to lack of sunlight and what is lost due to malabsorption because of the micro gravity environment then the first step needs to be research on this problem. Have no trials been done on this on the ISS with comparason to subjects on earth in the same restricted light environment.
A good test would be monitoring an astronaut on the ISS then once their levels had returned to normal monitor them again in an ISS mock up on Earth to see the differences caused by micro gravity. You could even try different lighting schemes in space and on Earth to see if the situation can be improved.
Perhaps astronauts could take a light box to space to get a dose of daylight, I remember seeing that some people on Earth are treated in this way for some types of illness (I think it was depression, although I am not sure).
In response to Andy Hill’s point regarding a reasonable research project for determining how to avoid space flight-related vitamin D deficiencies and I might stress the important replacement required is vitamin D-3, I am gratified that Andy understands just ONE of thousands of space flight-related deficiencies i.e. complications, triggered by BOTH hypokinesia ( decreased movement ) and microgravity. I could spend 24 hours a day dreaming up research projects for space flight for the next year at least and not finish; many of these problems are ” swept under the rug”. Why? For many reasons — some political. A major problem is NASA’s refusal to provide sufficient information ! Thomas Jefferson, America’s 3rd. president, stated: ” It is the duty of government to share information with all its citizens.” In one of my letters to the editor, published in the non peer- reviewed magazine SPACEFLIGHT by the British Interplanetary Society — with no axe to grind but to disseminate internationally the truth, I began my letter with that quote of Jefferson’s. William J. Rowe M.D. FBIS.
Dear Joe
I greatly appreciate your complimentary and provocative remarks both after my last and previous interviews. You raise the issue of the problems involved in using human subjects but clearly human studies will always play a vital role. I meant to bring up another extremly important issue but I was side-tracked in response to questions and because of time constraints i.e. another nail in the coffin regarding atrophy of the heart with prolonged space missions. Before I presented my first Space –related paper at a NASA meeting in Toulouse, France in 1995 I defended my position after my presentation – based on the Russian studies cited by Atkov and Bednenko, Hypokinesia and Weightlessness : Clinical and Physiologic Aspects, 1992, pp 32-34. Experimental animal studies showed : “ in the cardiac muscle pronounced atrophic and dystrophic changes ( atrophy due to non-use ) —-“. Furthermore “ synthesis of myocardial ( cardiac) proteins is suppressed and renewal of its structure is inhibited .” After months of prolonged exploration on Mars in search of evidence of water, involving traveling long distances, and after return at least 20 months later, how can the atrophied heart withstand high G forces during reentry ? What is the risk of congestive heart failure which might be fatal? This is a complication of HYPOKINESIA ( decreased movement ) and has nothing to do with microgravity. This pertains to a similar problem which I used in my last SPACE SHOW regarding the Charles Darwin analogy.i.e. traveling by submarine in confined quarters for 550 miles. I would love to debate such issues as this on a Space Show with Dr. Robert Zubrin but I am certain he would never consent nor could any host be found who would consent to handling the storm which might erupt
I enjoyed listening to Dr. Rowe, as always. It takes my full concentration to follow his dialogue. I respect his opinion that it takes 1G of gravity to negate the bone loss effect of zero gravity. His opinion is based entirely on his strong belief and credentialed medical background. He says his opinion has been thoroughly peer reviewed. The fact is it is a peer reviewed opinion that is not substantiated with cold hard facts and real data. Everyone is entitled to their opinion whether people like it or not. In this case, his peer reviewers liked his opinion. I guess that is their opinion too. In fact, anyone can have an opinion based on strong beliefs, especially those with valid credentials. It is a question that remains unanswered and will no doubt delay and increase our expense for our quest for deep exploration. The question will someday be answered if humans truly desire to explore other planets before they destroy every means to explore beyond Earth orbit. This is going to be an extremely difficult task since the rulers put human space exploration very low on their agenda, especially now and likely for the next 20 years. The crash of 29 took 25 years to recover. This current situation is not much different since it is following the crash course quite closely. Ah, history repeats itself. Sorry for the divergence.
My proposal is to incrementally rule out intermittent exposure to partial gravity using our existing space laboratory designed specifically for that purpose. It is something we can do now and can afford to do now. All we need is permission and a few devoted scientists trained in this field that would eagerly carry out the steps, assuming we ever send true scientists to our orbiting space research laboratory, in addition to the constant train of station operators and maintainers that have devoted their honorable lives to live in the ultimate space adventure destination. They need to take the initial baby step with experimenting on testing lab rats in existing centrifuges on the ISS. This costs the least amount of time and money and is ultimately much safer than using human guinea pigs to produce results using any other means, including manned outposts on the Moon. Doing it any other way costs magnitudes more and is comparatively and inherently unsafe to the humans put in harms way as a means of finding out. There are many other ways to do this; however, they all have one thing in common. They entice our leaders to take a huge political risk and pay a huge amount of money to the entity proposing it. That is the primary reason we have not accomplished any real health improvements for people living in space. They are currently obsessed with extending and increasing on-orbit exercise regiments for these people since it at least keeps them busy by giving them something to do so they don’t get bored while operating and maintaining the ISS, i.e., the true reason they are up there. After all we have done up to this point, they still lose bone and muscle mass and probably suffer in the long term from radiation exposure which remains undisclosed for obvious reasons. There is nothing that wrong with this approach since it could work, or at least, manipulate the illusion that it could work. People buy lemon cars all of the time and later wish they had not bought it. People eventually learn from their mistakes and most chose not to make them in the future which makes it even more difficult to make human space exploration a reality.
These leaders should stop and take a big breath and consider what they CAN do right in their own backyard, so to speak, with the stuff they have readily available.
We are currently getting away with using humans living in space as guinea pigs to observe, from a safe place, the incredible damage inflicted upon them. The simple means to orchestrate this ongoing dilemma is if these people volunteering to live in space do not agree up front to allow themselves to knowingly suffer bone loss and other health issues like extremely elevated radiation exposure, they are simply cast aside for the next volunteer to take their place. They will never run out of volunteers. All the while, their health information is kept from the funding public as an obvious way to keep program detractors from using this information in a negative way to dilute the current way we do business in space. I don’t blame them for continuing this since I have come to accept that it is how the real world works.
You can also screen out only those who have a genetic resistance to bone and muscle loss and space radiation, however unlikely, by the time you find out that indeed the person can withstand 500 days in space, AND you are miraculously ready to immediately send this person and others like him/her on an even longer trip to Mars and back, their total accumulated time allowed in space has run out. It’s like proving to the world you can run a world record marathon and then you get told you have won the ultimate adventure opportunity of your life by forcing you to run an even faster marathon the next day. Come on. Is it realistic to demand this from a devoted human being in pursuit of their life’s dream? Most people who live in space for 400+ days have gotten it out of their system by then and never return to space because they have been there and done that.
Others claim to be building a new and untested rocket engine capable of high acceleration to minimize the transfer times to distant destination, i.e., going for the throat of the lemon car buyers. Ha! That will be the day when an obvious lemon car salesman makes that sell. I, like many other suckers, want to be proven wrong because no one can take our hopes away.
These flawed attempts at extending human duration in space will continue for quite some time since the evolution of our country’s space program revolves entirely around the government subsidized profit made in creating massive numbers of jobs to build the magnificent rockets that transport them up there. They are simply not interested in focusing on productive space research since it does not produce jobs, i.e., votes.