Personalized Medicine and the Icarus Project: Ethical and Moral Issues in Sending Humans into Space
The irresistible urge of humans to expand their current competence in mastering the environment is nowhere more apparent than the attempt to conquer space and colonize other worlds. The promise of an expanded universe for earth’s life forms is irresistible. It is driven by positive and negative forces: among others, devastating climate change (and irreducible disagreements on the measures needed to reverse it), the threat of nuclear conflicts that will make huge segments of the earth uninhabitable, and the possibility of harvesting precious resources on other celestial bodies.
One of the most important issues in screening space travelers for their ability to endure flight and long-term stays in novel environments is that the phenotype might be quite specific for each voyager. Given the complexity of what the pursuit of personalized medicine has already demonstrated, truly informed consent for the individual prospective traveler is obviously impossible: our assessment of precisely what features of an individual’s molecular biology are essential to assess and what reactive measures might be taken to minimize vulnerability is obviously still very much a work in progress.
In selecting humans for travel to and eventually exist for prolonged periods in entirely new environments beyond earth’s atmosphere, we have already extensively exploited the techniques of personalized medicine to characterize the suitability of individuals for such an adventure. In an important review, Schmidt and Goodwin emphasize the uniqueness of individuals and advocate the use of Omic methodologies (genomics, transcriptomics, proteomics, and metabolomics) to more precisely assess individual persons for their competence and/or vulnerability for proposed voyages.1 They summarize the importance of personalized assessment of each individual traveler:
“There are vast molecular networks that interact dynamically to influence astronaut susceptibility to any specific environment or condition to which he or she is exposed. Second, there are a series of mission stressors that impact heavily upon the individual susceptibility of each astronaut. Whether one thrives within the space environment may be heavily dependent upon individual susceptibility, space environmental exposures and whether the countermeasures deployed for an individual astronaut are sufficient to overcome these susceptibilities.”
The NASA Twins Study yielded a comprehensive collection of omics information on the impact of life in space on human function. Scientists compared data from one of the monozygotic twins who spent a year in the International Space Station with those of his brother, who remained on earth. 2,3 Significant differences between the twins in lipid metabolism, telomere and telomerase behavior, cognitive function, microbiomic composition, bone metabolism, and inflammation were documented. Genomic studies revealed more than 200,000 RNA molecules that were differently expressed between the twins. Of interest was that telomere length returned to normal within 2 days of the space-twin’s return to earth. While 93% of his genes returned to normal after landing, 7% did not and may underlie long-term changes in genes related to his immune system, DNA repair, bone formation networks, hypoxia, and hypercapnia.
The notion that life on other planets would produce utopian communities miraculously free of all the evils that beset human interactions on earth is not only undocumented, but given human history, improbable. Equally important, the completely unfounded conviction that longer lives and even immortality would be realized in other environments as Slobodian puts it, “goes unexamined.” 4 As exciting as the accounts of our recent excursion beyond earth’s space seems pursuing human colonization of space might end in unanticipated disaster. Nevertheless, the momentum of the urge to visit and conquer space is irresistible.
Legato, Marianne. (2019). Personalized Medicine and the Icarus Project: Ethical and Moral Issues in Sending Humans into Space. Gender and the Genome. 3. 247028971983840. 10.1177/2470289719838401.
1 Schmidt MA, Goodwin TJ. Personalized medicine in human space flight: using Omics based analyses to develop individualized countermeasures that enhance astronaut safety and performance. Metabolomics. 2013;9(6): 1134-1156.
2 https://www.nasa.gov/twins-study/research. Updated July 30, 2018. Accessed December 16, 2018.
3 McPhee JC, Charles JB. eds. Human health and performance risks of space exploration missions: evidence reviewed by the NASA human research program. Vol 3405. Government Printing Office; 2009.
4 Slobodian RE. Selling space colonization and immortality: a psychosocial, anthropological critique of the rush to colonize Mars. Acta Astronautica. 2015;113(August–September): 89-104.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”
