Shingles' younger targets; civilian space travel: Upstate Medical University's HealthLink on Air for Sunday, March 17, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a microbiologist explains why shingles is showing up in more young adults these days.

Jennifer Moffat, PhD: ... It can infect us and stay in our bodies for life. It is "latent"; we say latent, meaning it's hidden in our nervous system for our whole life. And this is a property of other viruses too, but Varicella zoster virus is also famous for being one of the most contagious viruses, especially in childhood. ...

Host Amber Smith: And a researcher talks about preparing civilians to live and work in outer space, safely.

Michael Marge, EdD: ... Microgravity is quite a dangerous place to work and live in, and without countermeasures, it's going to be very difficult to survive. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, we'll explore what life will be like for civilians living and working in outer space. But first, why is shingles showing up in young adults and how is it connected to chickenpox?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A painful infectious disease that usually impacts people over 50 is showing up in younger adults. So today I'm talking about possible reasons for this with Dr. Jennifer Moffat. She's an associate professor of microbiology and immunology at Upstate, and she studies the Varicella zoster virus, which causes chickenpox and shingles.

Welcome back to "HealthLink on Air," Dr. Moffat.

Jennifer Moffat, PhD: Well, thank you for the invitation, Amber. I'm delighted to be here today to talk to you about the virus, the diseases and how we can treat them and prevent them.

Host Amber Smith: Well, I'd like to start by asking you to tell us about the Varicella zoster virus. When and how was it discovered?

Jennifer Moffat, PhD: It was known to humanity for a long time. In fact, the word "shingles," which it causes, comes from a Roman word, "cingulum," for the belt. And so it was known as "the belt of fire." In fact, that is often found around people's waist and chest. So it's been with humans for a long time, but it was in the 1950s that we were able to culture it and grow it.

And that was done by Thomas Weller in England.

Host Amber Smith: So how is it similar to or different from other viruses? What distinguishes it?

Jennifer Moffat, PhD: What is really important about it is that it can infect us and stay in our bodies for life. It is "latent"; we say latent, meaning it's hidden in our nervous system for our whole life.

And this is a property of other viruses too, but Varicella zoster virus is also famous for being one of the most contagious viruses, especially in childhood. Chickenpox spreads rapidly right through a classroom, and shingles infections can trigger another outbreak of chickenpox in kids.

Host Amber Smith: So does it infect just humans, or other animals, too?

Jennifer Moffat, PhD: It is uniquely infecting humans. It cannot infect any other animal, but other animals have their own version. There's a monkey chickenpox, but it's not the same virus.

Host Amber Smith: And I understand it spreads easily from person to person. But is it airborne or is it on surfaces?

How does it spread?

Jennifer Moffat, PhD: It spreads through our breath droplets, our respiratory spread. So when a person has chickenpox, some of the virus is growing in their throat, and it can then spread through talking, playing and so on, in the air. And when a person has shingles, it was just recently discovered that the saliva contains the virus. Even though the rash may be on your back, it can spread through your respiratory droplets, but really it can also spread through the rash. And the blisters contain a lot of virus, so scratching it puts it on the fingers, but mainly it's spread through the air.

Host Amber Smith: How long have you been studying Varicella zoster virus? This has been your whole career, right?

Jennifer Moffat, PhD: Yes, 30 years ago, at this time of year, is when I started my postdoctoral fellowship (specialized training) to work on a new thing for me, which was this virus. I was at Stanford University Medical Center in the pediatric infectious diseases department.

It really set me off. I just took it and never let go. So I've been building up a lot of research years, 30 years now, and it's a small field, so I'm more and more considered one of the world experts.

Host Amber Smith: Well, let's talk, if we can, about how chickenpox is related to shingles. Can you describe both of the diseases, how they're contracted and how they are similar?

Jennifer Moffat, PhD: Yeah. Well, we all are familiar with chickenpox, mainly as a childhood disease. And its official disease name is Varicella. So that's the first half of this virus's name. Varicella is chickenpox, and kids spread it, from one kid to the other, in families, classrooms and so on. And we were all familiar with the rashes and so on.

It wasn't known until the '50s, really, that shingles was the same virus that popped out in adults. And the other name for shingles is zoster. So the Varicella zoster virus is now known as the one that causes both. It's the same virus. So when a child is infected, from their playmates and siblings, the virus infects their nervous system immediately. So even before the rash pops up, during the incubation phase, the virus enters the nervous system, where it infects the nerves that are along the spine, the dorsal root ganglia. And it stays there forever. And our immune system then quiets things down. We get better when immune to the virus quite well during young adulthood.

And this immunity is important to keep the virus from popping back out. So in any situation where immunity dwindles, either from medical reasons, health reasons or age, the virus says, "Ah, here's my chance." And it comes roaring back from the nerves out to the skin. And that can be mainly on the chest, the back and the face.

A third of shingles cases are on the face, and then that's the eyes, the ears, the mouth -- very sensitive areas, but it is the same virus. And you can't actually catch shingles. It comes from inside of us, So you can't catch it from another person who has shingles. If you've had chickenpox or been vaccinated against it, the only way you can get shingles is from the viruses already inside you.

Host Amber Smith: So if you, as a child, you never had chickenpox, then you shouldn't have a risk for shingles?

Jennifer Moffat, PhD: That's right. There is a risk, though, if you've never had chickenpox and never had a vaccine for it, and you've never encountered this virus, the older you are, if you do get it, the more dangerous it is. So chickenpox in kids used to put 10,000 kids a year in the hospital and killed even 100 kids a year, on average. That's all different now in the age of the vaccine, but adults who got it were very seriously ill, and more adults died than kids. So it's a good idea to get immunity to it with a vaccine as a child or get infected, which happens in a lot of countries.

Host Amber Smith: So a person who was vaccinated against chickenpox, should they also get a shingles vaccine when they reach the age for that?

Jennifer Moffat, PhD: Yeah. The chickenpox vaccine was one of the things I worked on 30 years ago, and it was approved in 1995. So the children who got it then are approaching 28, 29 years old.

They're not really old enough to worry about shingles, but when they are 50, they will definitely be eligible for the Shingrix vaccine or any new vaccine.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Dr. Jennifer Moffat. She's an associate professor of microbiology and immunology at Upstate, and she specializes in the study of the Varicella zoster virus, which causes chickenpox and shingles.

So why are there more cases appearing in people under 50 with shingles, people that are even in their 20s, 30s, 40s that are getting shingles? What is the current hypothesis for why that's happening?

Jennifer Moffat, PhD: Yeah, that is a great question, Amber, and we aren't sure, so we still have more questions than answers on this one, but what we know is, everywhere around the world, the cases and the incidence, we call it, the rate or the number of cases per population, is rising for shingles.

We don't know why, and it's not necessarily linked to just an aging population. That's one idea: "Oh, we're just all getting a bit older, so there's more shingles." Well, yes, we get more shingles when we're old, but that doesn't account for what we're seeing, which is people younger -- 20s, 30s, 40s and 50s -- are now getting shingles more often.

And what could that be about? A lot of thoughts. OK, so we know that if the immune system is weakened, the virus can pop out, so that might be something going on. Maybe overall, our immune systems aren't in great shape, but that can't explain all of this.

Maybe we're taking more medications like steroids or immunosuppressant drugs that raises the risk. Maybe people are less healthy, right? We have epidemics of other diseases. Maybe it's linked to that. But we've tried to rule all of these things out, and what we're left with is still scratching our heads and thinking, "What on earth is causing this? Is it just doctors diagnose it better now? We have better medical care, people go to the doctor more?" Those could all be parts of it.

But what we're leaning toward is almost a global change in our human/virus balance, and it could be something very subtle like air pollution or sunlight or temperature. We don't know. We're hopeful to solve it, but we can't say today why we see more virus.

Host Amber Smith: How is the disease different in a young person compared with someone over 50?

Jennifer Moffat, PhD: Luckily, young people have less serious outbreaks of shingles. When they get it, it's a lot less concerning. It doesn't last as long, it doesn't create such a large rash, and it will often heal just fine on its own.

However, that's not the case the older we are. The risks we're worried about are the virus comes out of nerves, and when it does that, it can really irritate the nerves, and it can then cause nerve damage and pain, long-lasting pain, from those nerves called postherpetic neuralgia, or PHN, devastating, painful, can last for years or more. And young people just rarely experience that lingering pain. So that's the major difference, the seriousness of it.

Host Amber Smith: Well, let's talk about what can be done to protect people from chickenpox and shingles. Are pediatricians still vaccinating children against chickenpox?

Is that still a recommended vaccine?

Jennifer Moffat, PhD: It is recommended. It is recommended by the CDC (Advisory) Committee on Immunization Practices, and it's also mandated by the state of New York. So the 1-year-old children will get their first dose, and then again, usually right around the start of school, between age 4 and 6. This has been fantastic to prevent outbreaks of chickenpox in the schools and day care.

So what we don't see anymore is this normal springtime wave of chickenpox. That is not happening. The whole epidemiology (occurrence) of this infection has changed due to vaccination.

Host Amber Smith: If there is someone who got through childhood without being vaccinated, is it too late to get the vaccine as an adult?

Jennifer Moffat, PhD: No, it's not. We screen all of our incoming staff at Upstate Hospital. At University Hospital, if you get a job here, you will be screened for your immunity to chickenpox. And every year we find adults who are not immune, and they get the vaccine in our employee health (department). And that is a good idea to protect them. The patients who have shingles could infect them and give them chickenpox.

Host Amber Smith: Well, what are the vaccination rates for shingles for people over age 50? I think that that's when they're recommended, 50 and up, right?

Jennifer Moffat, PhD: Yeah. The vaccine that's used in America right now is called Shingrix, and it is highly effective, 95% effective, at preventing shingles. Well, that's too bad because only 30% or so of people who are eligible have even gotten it. So that's not enough. We could do better.

And people are sick and tired of vaccines, right? Like, "Enough already. I've had all those shots." But Shingrix is one that you probably don't want to put off because once you turn 50, you're eligible, and it's a two-dose vaccine. It does hurt. People say the arm is real sore, but it's worth it because shingles is so much worse, and the lingering pain is no joke. And the virus, when it reactivates in their eyes, can be blinding, and that's terrible.

Host Amber Smith: So maybe just because lack of awareness, maybe people aren't aware about this. Any ideas why it's so low?

Jennifer Moffat, PhD: It's discussed in some friend groups. It comes up. I answer a lot of questions from my friends about it. But I don't think it's promoted well, and then I think people just put it off and avoid it. I can't tell you how many people say, "Oh, I knew I should have gotten my vaccine, and now I've got shingles." It will come up and sneak right up on you because after age 50, your chance of getting shingles goes up and up every year, and by the time you're 80, it's about 50-50 that you've had it already. That's a lot of cases. So, best get it when you're 50 or early 50s; your immune system is still pretty robust. You're going to make a great immune response. That vaccine will work even better. So don't put it off.

Host Amber Smith: And is that a one-time vaccine at age 50?

You don't have to repeat it later?

Jennifer Moffat, PhD: You do. It's a two-dose regimen, but you don't have to repeat it. It's one dose, and then you need the second dose two months to six months later.

Host Amber Smith: And then you're good for life.

Jennifer Moffat, PhD: Yes. Then you're very good. It's like a booster. So the Shingrix vaccine is interesting in that it's the only approved vaccine right now that's designed as a booster for people who are already immune, who already had chickenpox or the Varicella vaccine.

So the Shingrix is designed as a booster, so you really just need that one boost right in your 50s.

Host Amber Smith: Now if we're seeing this show up in people in their 20s and 30s and 40s, is there any thought to vaccinate these people at younger than 50?

Jennifer Moffat, PhD: Well, it comes up; we talk about this in the field all the time, and we're thinking, "Why don't we give people a booster at 30 and get them through to 50?"

And that just hasn't been studied. There hasn't been a clinical trial to study that question. But now that Shingrix is approved, some doctors are recommending to their patients, they're saying, "Hey, you have a particularly high risk for shingles. Let's give you the vaccine." And those are people with underlying health conditions that raise their risk of shingles. And if they have a really smart doctor, they will recommend that they get it as a younger person. But that isn't routine right now. But that could change, and it just requires more research.

Host Amber Smith: Well, let me make sure I understand. If a person becomes infected with shingles, they can't spread shingles to somebody else, or could they spread it to someone who's unvaccinated?

Jennifer Moffat, PhD: Well, if you think that through, a person who's unvaccinated and is exposed to someone with shingles either will get chickenpox from them because it's their first time getting the disease, or they won't get anything because they're immune.

So a person with shingles is contagious. The virus is being shed from their breath and from their rash, but they can't give anybody else shingles.

They just can't, because that virus came from inside of their nervous system. But they can definitely infect: Young kids who are under a year old could get chickenpox, and anyone whose immunity was weakened could be infected and get a type of chickenpox. So really, shingles isn't spreadable.

Host Amber Smith: Does it complicate if a person has another, say, neurologic disorder?

Does contracting shingles complicate that existing disease?

Jennifer Moffat, PhD: I don't know of particular examples of that, but I do know that shingles infections can cause neurological problems. It can infect the brain and cause encephalitis, which can be fatal and needs treatment immediately. It can cause weakness, paralysis, especially facial paralysis, hearing loss, it can attack the retina, cause blindness, cause sensory problems with taste and smell. It really does attack the nervous system, and that's one reason to get that Shingrix vaccine, is nobody wants a facial paralysis and blindness.

Host Amber Smith: Do you have any personal experience with shingles?

Jennifer Moffat, PhD: Well, regrettably, yes. It's ironic, isn't it, that I work on this virus, and I've actually had it twice.

As a young woman, I had a tooth infection, and the infection under my filling triggered shingles on the left side of my face, and it was so mysterious. I didn't know what was wrong at first, but eventually it was very clear that I had shingles from the tip of my nose into my ear, and that was very uncomfortable. I suffered a lot.

So it did heal, and everything seemed fine. And then again, during the COVID epidemic, I got my first COVID vaccine and then the second, and then I got shingles right after that. And it turns out, they found out now that there's a higher risk of shingles right after getting other vaccines.

So I got it again in that same place on my face, and it went into my ear and caused ear pain for a couple of years. So it was definitely worse the second time. I felt like a dummy. You know, (chuckles) here I am, I should have had my Shingrix shot, but, of course, I hadn't, and then I regretted that a lot.

Host Amber Smith: Well, the Shingrix, that wasn't available until when?

Jennifer Moffat, PhD: 2018.

Host Amber Smith: When you were in your 30s, it probably didn't exist, right?

Jennifer Moffat, PhD: It did not exist. No. But later, I was overdue for my Shingrix vaccine and regretted putting it off.

Host Amber Smith: Well, good advice then. Thank you.

Getting back to the virus itself, I'm curious about what is still being studied about it, and what more is left to learn?

Jennifer Moffat, PhD: Oh, well, (chuckles) I have a very busy laboratory here at Upstate, and my emphasis is on discovering and testing new antiviral drugs to treat shingles. Despite the vaccine, we still have a million cases a year of shingles, and people are desperate for treatment, something that you could either take a pill or spread on an ointment, but something to speed healing, reduce the risk of pain, heal the rash, all of those things.

So I have a lot of work to do with, companies and labs around the world who send me their compounds to test them, to see if we can stop some shingles right on the skin.

Host Amber Smith: Very interesting. Well, Dr. Moffat, thank you so much for making time to tell us about your work.

Jennifer Moffat, PhD: Oh, it's been my pleasure, Amber. I just think there's a lot of new discoveries still left to be done.

Host Amber Smith: My guest has been Dr. Jennifer Moffat from the department of microbiology and immunology at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Preparing civilians for safe space travel -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

As the space industry grows in the coming decades, average Americans will have career opportunities in outer space. So how do we protect the health and safety of average civilians who may work and or live in space?

Today I am talking about countermeasures against space hazards with Dr. Michael Marge. He has a faculty appointment at Upstate in physical medicine and rehabilitation, and he's associated with the International Association for the Advancement of Space Safety.

Welcome to "HealthLink on Air," Dr. Marge.

Michael Marge, EdD: Thank you very much.

Host Amber Smith: Now we should clarify first, you're a doctor of education, is that right?

Michael Marge, EdD: Yes.

Host Amber Smith: So, have you always been interested in space? How did you get involved in this field?

Michael Marge, EdD: Well, it's interesting. My education at Harvard was really, they taught me how to think, not what to think. And as a result, I've gone through a number of professional modifications in my life, starting with a focus on child psychology. Then I went into speech pathology. Then I went into public health. And I began to focus on the health and quality of life of people with disabilities and began to work for not only the Centers for Disease Control, but the National Institutes of Health (NIH), at the Department of Health and Human Services.

And that led me eventually to my work in space. Because I was approached in 2016 while I was at NIH by a colleague of mine at NASA (National Aeronautics and Space Administration) who headed up all of the health research being done on preparing astronauts for the journey to Mars. And he needed more research background and research resources to answer the challenging questions about maintaining the health and performance of astronauts in that long journey to Mars, which would be almost a year and a half: six months up, a year on Mars, and maybe six months back. That's two years. And to make a long story short, I asked Francis Collins, the director of NIH, if I have his permission to consult with the 27 institutes at NIH to see if they're interested in collaborative research with NASA.

And I did contact all of them, and 22 out of 27 were interested in working with NASA. And so we set up a NIH-NASA Collaborative Research Interest Group. And then that group has continued to collaborate with NASA on their specific problems with regard to the health of their astronauts. And that's how I got interested in it.

I studied the problems that NASA had to, rather wanted to address, such as problems related to space radiation, which they hadn't solved, and problems that dealt with microgravity, the loss of gravity in space. And in that process, I was then hired by NASA to be a consultant and to advance this research as it related to people with chronic health problems and people with disabilities.

Host Amber Smith: Well, let me ask you though, because you, it sounds like you started out looking at astronauts, but astronauts are different from civilians. Is that right?

Michael Marge, EdD: Correct.

Host Amber Smith: Can you please explain?

Michael Marge, EdD: Yes. And to make a long story short with regard to that issue,while I was at NASA, I asked them to expand their health research program to include the population of civilians who have notable chronic health problems and also have disabilities. Because the space industry in America, the US space industry, the commercial space industry, SpaceX, Virgin Galactic, Blue Origin, Axiom Space and so forth, Sierra Space, they all have been asking for the involvement of average civilians into space. They want space to become accessible to everybody.

And so my challenge was: "Do you folks know anything about sending a person with Parkinson's disease, or cerebral palsy, or migraine headaches or diabetes into space? I mean, you're sending healthy astronauts, who have no health problems whatsoever, and they're highly educated, they've had over 1,000 hours of jet space flight and so forth, and then you're going to send an average civilian with atrial fibrillations into space. I said, "Do you realize what you're talking about?" Well, NASA immediately said this is not their cup of tea. They said we will not expand our program. We'll stay focused on astronauts because we are known as the agency in government for space exploration. We are not disinterested in average civilians because we know that in the future, in the coming decades, thousands will be traveling in space, living in space and working in space. So we anticipate the population of average civilians to go into space almost at the same rate as we experienced with commercial airlines. There'll be thousands, maybe millions, working and living in space.

Host Amber Smith: How soon?

Michael Marge, EdD: Well, members of the space industry are building what they call orbital platforms. These are like malls that will be up in space, maybe 300 to 400 miles above the earth, in orbit -- like the International Space Station is in orbit at 230 miles above the earth. These will be higher. And, they'll have shopping centers, hotels, you can look at the moon over the weekend, on a tourist visit. They'll have research laboratories with the actual researchers doing research in the area of pharmaceuticals, as well as in discoveries that deal with medicine.

They found, for example, cancer cells do not live in space. They die in space. They can't cluster because of microgravity. They found that the DNA of the cells actually change. So they feel they've opened a whole new area of cancer research that will have great implications for terrestrials, people here on earth.

So we anticipate new drugs, new manufacturing, new research being done in space, a lot of advantages. However, the human who goes into space is still heavily challenged by all of the hazards that they face as they go into space. Space is very dangerous.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Michael Marge about how regular people can safely live or work in outer space.

NASA has had a human research program since 2004, looking at the space hazards in biomedical risks. Can you give some examples of what they've found so far?

Michael Marge, EdD: Yes. In preparation for a workshop we held, with the assistance of the National Space Council of the White House back in 2020, and also with the help of the space industry --we had all of the key space industries working with us through their association called the Commercial Space Flight Federation. They wanted to look at how can we prepare average civilians for space. So I did a complete, as much as one can do, a review of all the (medical and scientific) literature that dealt with the findings from NASA over its years of investigating the health and the impact of space on their astronauts. And what we found was that there are many, frankly, unreported adverse health outcomes.

And we discovered the reason that NASA did not report it was because their population is so small that individuals will begin to identify, against the HIPAA (Health Insurance Portability and Accountability Act privacy) regulations, who got that problem. We found that some of the individuals developed blood clots, edema, brain edema, blindness in one eye. I mean, microgravity is quite a dangerous place to work and live in, and without countermeasures, it's going to be very difficult to survive.

One of the major problems that NASA addressed was that immediate bone loss occurs after you're in microgravity for a short period of time. In some cases it was weeks. In some cases it was months. And the bone loss could lead to dangerous situations where the bone is so weak that it fractures, and it also affects muscle loss. So NASA has been working feverishly to combat that with exercise and medications, while their astronauts are in space.

Now for a healthy individual,bone loss can be combated fairly well, not completely, but fairly well if you live in microgravity for more than, say, 30 days or up to, say, three months. But for a person who may already have a chronic bone loss, such as in Paget's disease or someone with cerebral palsy, or someone with spinal cord injury, multiple sclerosis, you're going to send them into space with advanced bone loss and then have that exacerbated by further bone loss in space? We know nothing about the impact of space on that population, yet the industry wants to send everyone into space, which to me becomes a serious, a very serious problem.

Host Amber Smith: How big of a threat is space radiation?

Michael Marge, EdD: It's a very big threat. We pretty well took care of the hazards of solar radiation from our sun. They have water bags inside the spaceship. They're able to put in zinc lining, and the spacesuits now, uh, can pretty well handle solar radiation. But the biggest danger is galactic cosmic radiation, the radiation from the stars. Once you leave the earth's atmosphere and you get into space, say 100 miles or 200 miles above the earth, you'll face galactic cosmic radiation. Very dangerous. Ionizing, penetrates everything. And NASA does not have an adequate countermeasure for that yet.

They're still planning to send people to the moon next year. And I've asked them to please hold off until they've found a countermeasure for a galactic cosmic radiation. And their current approach is to say, "Well, we will handle that by the amount of exposure when they leave the spaceship, once they land on the moon." I say, but that's not adequate, how much time can they spend outside the spaceship? And they say, "Well, we're working on that now. We don't know if it's two hours or three hours." But if the astronaut who's going to the lunar projects called at the Artemis project -- and they're going to the South Pole, where they feel there's water. Now that's the first stop -- if they intend to get out to explore, how much exposure can they have? This is radiation from the stars surrounding, within our universe, surrounding our solar system.

Host Amber Smith: So the spacesuits protect from the sun?

Michael Marge, EdD: Yeah.

Host Amber Smith: But not from other, from the galactic or cosmic....?

Michael Marge, EdD: No. No. And the spacesuit does not protect, also, from flying debris, which is going at thousands of miles per hour, like a bullet. And if it penetrates any of the space suits, a person can live in space for 11 seconds. Their lungs explode if they're not protected. So if they leave the space ship, the space suit is essential in terms of their survival.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stay tuned for more about civilian space travel.

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith. My guest is Dr. Michael Marge. He's explaining what's important to consider before civilians head into outer space for work or tourism.

Michael Marge, EdD: Do we know of astronauts that have suffered radiation damage? Well, when you say, "Do we know of," I don't know who they are. But, we have found NASA reports that it affects the cardiac muscle. It affects other organs of the body. One of the Kelly twins (retired astronaut Scott Kelly) who was up there for more than one year, he said he's going to die of cancer, because he was exposed to space radiation, all types, both types, galactic as well as solar, for over one year. He said he expects to die from cancer due to radiation.

Host Amber Smith: Hmm.

Michael Marge, EdD: But we don't have any exact measure now of effects, except the studies that have been done in analog situations. NASA has said, "Why do you want to do the research on civilians? Why don't you simply extrapolate the data that we have acquired all these years to the U.S. population?" I said, "Well, first of all, there're two problems. One is your 'n's' (numbers) are very small. When you report on, say, radiation affecting a cardiac muscle, you're speaking about an 'n' of one or two. If you're going to apply it to the U.S. population, you've got to have much larger numbers in order to handle this appropriately. And the other thing is, the populations are quite different. The two populations are quite different. NASA's, their selection criteria is very exacting. They've got to have a master's degree. They've got to have, their astronauts have to have no underlying health problems that they can perceive at first. They can't be blind or deaf. They can't wear glasses. They can't have any heart conditions. They have to be completely healthy. Their performance is, they're physically fit.

Many Americans are not physically fit. They're smoking, and they're drinking, and they don't exercise. They're not in good shape. And also, NASA spends four to five years training their astronauts, at a cost of $5 million per astronaut. And the other thing that's very different is, they're medically supervised and monitored every single week. They get regular physicals, and they found, for example, one of the astronauts -- they finally reported this, which was really surprising because NASA, as I said, does not report on their astronaut's health because of people being able to violate the HIPAA (privacy) Act -- one of their astronauts had completed three trips to the International Space Station, and he's ready to go on his fourth trip and develop atrial fibrillation. So NASA said, what are we going to do about this? We invested $5 million in this individual.So they sought the best cardiac surgeon in America to do an ablation surgery on this astronaut and eliminated the, at least at that point in time, his atrial fibrillation. And he went on his fourth trip to ISS.

Now, how many Americans face that kind of medical care? Very few. Well, they have $5 million invested in each astronaut, and they're a small number. You're talking about a handful. And the other thing that I have pointed out, which people in my writings and so forth, is that another major difference is that astronauts know that when they go into space, they face serious injury or death. Most Americans, most average civilians, if they were told, "Your lungs will explode if the spacesuit is torn in any way, and you lose all of the oxygen and so forth, and the pressure, your lungs will explode, and you'll die in 11 seconds," they will not want to go into space. So the risk issue, in my judgment, is another major issue.

A colleague of mine who was the medical director for SpaceX, for Elon Musk. Dr. (Anil) Menon is a emergency physician who was working for SpaceX for seven years as the medical director. He left SpaceX about three years ago to become a NASA astronaut, to go on the first trip to the moon. They're going to have a physician for the first time with them on the moon in case someone gets appendicitis or what have you. And so I asked him, I said, "Are you willing to take the risk? You're a doctor." He said, "Yes. I'm a risk taker. I've always been a risk taker. I like to climb mountains and things of that nature. It's part of my character. We all are risk takers. We know the dangers involved."

Now, if a person goes into space who is not a risk taker, they have to be pretty well informed about what the trip may entail, or we must make sure that space travel becomes as safe as possible and as comfortable as possible, where the person goes up there and comes back with the same status in health. If a person has cerebral palsy, and they go and work up in space for say, three weeks or 10 weeks, what have you, for a company, they should come back without having any exacerbation of their neurological problem. That's what I'm working toward.

Host Amber Smith: So whether if they're working or as space tourists, let's talk about some of the potential health problems that civilians could face and the countermeasures that are being considered. You already mentioned microgravity and radiation. What about just isolation and confinement?

Michael Marge, EdD: Yes. That, If a person has had depression, it will exacerbate the depression. The person will become depressed, even in short space travel because immediately when you leave the earth, there's a syndrome called distance from earth syndrome. The farther you leave the earth, and you look back and see this, see our sphere become smaller and smaller, we've learned from even healthy astronauts, there's an anxiety that develops that they'll never be able to return. They've lost contact with this beautiful green verdant, lovely planet that we love, that we live in with trees and so forth. They're going to a sphere, which has nothing on it, but dust and rocks and things of that sort. It's a scary kind of a thing. How can they overcome it? We have not solved that problem yet. Even with other astronauts as a team, we're worried about anxiety and how it may lead to disruption in the travel. The greatest concern astronauts have is that someone goes berserk during a long trip.

Host Amber Smith: I imagine.

What about sleep? Is it easier, or harder to get a good night's sleep in space?

Michael Marge, EdD: It's very difficult. Your sleep deprivation is quite noticeable because you lose your concept of time, and your body clock changes rapidly. So deprivation is a problem. It does lead to not only depression, but loss of performance, acuity and skill. And they're very much worried about that.

You know, the trip to Mars is going to be six months. Well, if they launch from the moon, which they hope to, it'll cut the trip down by maybe a month. So it'll be five months in a little container going into space. And they intend to establish an installation on Mars. And it'll be six months back, or maybe they'll land back on the moon. I'm not sure. They haven't worked all those details out yet.

That's a very hazardous journey. But, you know, after the moon and after Mars, they intend to go to Europa, which is the moon of Jupiter. That's four years, a four-year journey, given our current rockets and the speed of our rockets. They're working desperately to improve the speed from 37,000 miles an hour to double that or triple that so they can cut back the trip to Europa maybe in half. Make it two years.

In some of the discussions I've had at NASA, they talked about having some of the astronauts, of course, in sleep, long periods of sleep, and have the ship operated or monitored by one person. They alternate. They saw the movie "2001: A Space Odyssey" with HAL (a computer that refused to follow directions), and they do not want a computer to run the ship without a human actually in charge.That triggered a great fear among the NASA folks.

Host Amber Smith: I imagine.

You're listening to Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with Dr. Michael Marge about the safety and the hazards of space travel, specifically for regular people.

Getting back to the anxiety. Do medicines for anxiety work in space, or what would they do if someone started freaking out?

Michael Marge, EdD: Well, they're trying to reduce the number of drugs that they take in space. But from what I understand, the astronauts who have reported experiencing anxietywere able to overcome that. I don't know of any reports of humans, I mean civilians, rather, who have had that experience. I looked at the literature, and I couldn't find any reports.

But confinement is an issue. It's identified by NASA as one of the five space hazards.

Host Amber Smith: Has anyone investigated pregnancy in space?

Michael Marge, EdD: No. But they have investigated, well, they report that a woman who was pregnant should not go into space, because of the radiation exposure. And we don't know what microgravity will have.

The females who are selected to go into space now know about the impact of microgravity, and males also, impact of microgravity and space radiation on the reproductive organs. So one astronaut has decided that she willsave her ova (eggs), in the event she loses that capability when she goes to the moon. There'll be a woman going to the moon, and several, maybe, going to Mars. And in that case, knowing what radiation will do to the reproductive organs, they want to be able to save what they can, and that is an issue, yes. They do not recommend women with who are pregnant to go into space.

The space medicine group, when we first looked at this issue of people going into space, had a list of people who should not go into space. People who have had strokes, for example, should not go into space. People who have had other neurological diseases, cardiac problems, and they got battered by groups saying, "You are depriving us of the right to determine our lives." And they were hit left and right. So no one wants to say you should exclude anyone from space. Except they did say recently, women who are pregnant should not go into space.

Host Amber Smith: You mentioned that you got started in this looking at for people with disabilities and whether they could travel in space. What have you found on that?

Michael Marge, EdD: Well, again, if you are familiar with the disability movement in America, people with disabilities do not want to be deprived of making choices. And although I would recommend that they wait until we have countermeasures, there are those who say, "Look, if I want to commit suicide, it's my choice." You know, as I said. But from an ethical point of view, if I'm involved in the situation, I'm going to tell you I'll do everything I can to do no harm. I'm committed to do no harm to you as a professional in allied health. If you want to commit suicide, I can't control that, but I'm not going to be involved in the situation. I wash my hands clear of that.

Some of my colleagues in the disability movement feel that you should not deprive them, even though they don't know the potential outcome of sending a person with amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) into space.

There's an organization called AstroAccess. That organization is taking parabolic flights and sending people with disabilities in those flights. Parabolic flights, the plane goes up about, what, 35,000-40,000 feet and dips down, and then makes about 12 different dips. And in the dips you experience microgravity for seconds, like 30 seconds, 40 seconds. You start floating. That experience is relatively, I would say, benign. I don't think it'll harm anyone. And a whole group of people with disabilities -- blind, deaf, individuals with cerebral palsy -- have had that experience. But now if you're talking about going into this microgravity for, say, three months or four weeks, I have no knowledge what's going to happen to the individual. I would not go into space. I would advise them not to do that. But I guess the issue is personal freedom and personal choice. So we're facing a conundrum here.

Host Amber Smith: Well, you've given us a lot to think about. I really appreciate your time, Dr. Marge.

Michael Marge, EdD: You're welcome.

Host Amber Smith: My guest has been Michael Marge. He holds a faculty appointment in Upstate's department of physical medicine and rehabilitation, and he's associated with the International Association for the Advancement of Space Safety. I'm Amber Smith for Upstate's "HealthLink on Air."

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Here is a loving tribute to memory from Skaneateles poet Pam Freeman.

"Long-Ago June"

Glistening toddlers

Wading pool

Sunstruck splashing

Summer afternoon

Time-lapse wrapped

In a wicker basket

Watermelon pickles

Oyster crackers

Ladybug sandals

Long-ago June

We lost one brother

Couldn't stop the cancer

Grandma thinks the other's

Their dad sometimes

His two girls

Are home from college

Grandma can't place them

But they make her smile

Like a cocoa-butter hug

Long-ago June

Never know why

Some memories last

Old home movies

All-star cast

Faded postcards

Addressed and stamped

Wish you were here

With me in the past

Life's a wheel

Love's the axle

Heartache's the break

Then we roll on

Catch a sudden glimpse

Of a chance remembrance

Polka-dot freckles

We're suddenly back

Click-click-clack

Of the slide carousel

Yes all of us are back

Long-ago June

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," treatment options for sleep apnea.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.