EXPLORING SPACE MEDICINE
- Sienna Eve Benton
- Sep 6
- 11 min read
The Future of Space Physicians with Dr. Saadia M. Pekkanen
As humanity moves closer to a sustained presence in space, the conversation around medicine beyond Earth is shifting from hypothetical to urgent. With private companies accelerating plans for commercial space stations and intergovernmental collaborations evolving under new geopolitical realities, one central question arises: how will healthcare work in space when patients and doctors come from different corners of the globe?
This question, once reserved for science fiction, is becoming a focus of serious academic and policy discussion. At the intersection of international law, diplomacy, and clinical science, the emerging field of space medicine is confronting challenges that are not just technical, but fundamentally cross-cultural and intergovernmental.
In this exclusive interview with Dr. Saadia M. Pekkanen, Ph.D. a leading expert in space law and diplomacy at the University of Washington, we explored the foundational challenges of establishing a medical framework for space and how healthcare professionals and policy makings can work together.
The urgency of this issue has become more apparent in recent months, as two astronauts, NASA astronauts Sunita Williams and Barry Wilmore, experienced propulsion issues with Boeing’s Starliner spacecraft, which lead to their extended stay at the International Space Station. Their return to Earth was delayed by over nine months.
At the same time, space is becoming more accessible to civilians. As of April 2025, companies like Blue Origin, Virgin Galactic, Space X and others have flown approximately 60 individuals, including celebrities, into space. These tourists get enjoy the experience of weightlessness and spectacular views above the Kármán line for a short period of time. However, even short-duration space travel is not without risk.
One of the most immediate risks is space motion sickness, which can occur almost instantly as the vestibular system (the inner ear balance mechanism) reacts to microgravity. Another risk involves cardiovascular stress. The high g-forces during launch (up to 3-4 times Earth gravity) and reentry can stress the heart, especially in individuals with underlying cardiac issues. A passenger with an undiagnosed heart condition could experience arrhythmia, angina, or even a cardiac event, even in this short window. There’s also the possibility of anxiety or panic attacks triggered by the intensity of the experience. Finally, the change in cabin pressure, though regulated, can be a concern for passengers with certain respiratory conditions, like asthma or chronic obstructive pulmonary disease (COPD), and for individuals with sinus or ear issues, which may be aggravated during ascent or descent.
In addition to astronauts facing extended missions in space and the growing trend of celebrity space visits, the Orbital Assembly Corporation, a California-based startup, has announced plans to open the world’s first space hotel, Pioneer Station. This facility is designed to accommodate up to 28 guests and aims to provide a luxurious, gravity-enabled environment for space tourists. Pioneer Station is part of a larger vision that includes Voyager Station, a more expansive complex with capacity for 400 guests. Both stations are intended to operate as hybrid space business parks, offering office spaces, research facilities, and accommodations for tourists.
The article quotes “ABOVE is partnering with former NASA astronaut Mae Jemison’s organization “100-year Starship” and UC-Irvine to further the study of artificial gravity on human physiology. Researchers are finding that the Zero-G conditions experienced during long-term stays in space may cause serious medical conditions.”
As space exploration and tourism continue despite public calls to prioritize healthcare and wellbeing on Earth first, it becomes urgently clear that the discussion for a new kind of physician is becoming more immanent: the space physician. This role doesn’t yet exist in full, but that is exactly what makes this moment historic. The time to begin training space physicians is now.
Standard Unit of Care
Spacecraft rely heavily on continuous contact with Earth for guidance and support. If communications were cut off, Dr. Pekkanen notes, “You can’t just call an ambulance from Earth.” In such cases, the crew would need to depend on onboard protocols until help could be restored or a rescue mission launched.
To achieve this, it is essential to bridge traditionally siloed fields, such as aerospace engineering, medicine, and policy, to foster collaborative discussions around a new framework for space medicine. Developing specialized training programs and curricula for space physicians is no longer optional but a pressing necessity.
One of Dr. Pekkanen’s major takeaways from the interview was the need to create a global standard of care that can serve as an internationally recognized protocol for medical treatment in space that would account for the diversity of medical training, cultural practices, and national healthcare regulations.
Dr. Pekkanen suggests that “We need a shared medical language in space.” Just as the metric system has created consistency in science, math, and engineering, a need for standardized protocol for diagnosis, treatment, and emergency response for all space travelers, regardless of nationality or training is vital.
For example, imagine a Japanese space tourist falling ill while on a commercial orbital station. If two doctors, one from the United States and the other from Italy, are called to treat the patient, their approaches to diagnosis and emergency intervention might differ dramatically due to variations in training, preferred pharmaceutical regimens, surgical techniques, or even ethical norms around consent and intervention. In such high-stakes, time-sensitive environments, these discrepancies could delay or complicate care, putting lives at risk. A standardized unit of care would help streamline decision-making and reduce the likelihood of medical conflict or confusion in space.
This concept of a “standard unit of care” is central to the educational and policy initiatives Pekkanen is helping lead through the annual Space Diplomacy Symposium (SDS) and the Strategy, Policy, and Diplomacy Research (SPDR) program, both hosted at the University of Washington. These platforms aim to dismantle professional and disciplinary silos, bringing together experts in law, engineering, medicine, and international relations to collaboratively address real-world problems arising from human activity in space.
Space Medical Corps “The Space Physician”
Pekkanen and her colleagues propose the launch of a Space Medicine program, potentially introduced as a summer boot camp under the SPDR initiative. Long-term, this boot camp could serve as the foundational phase of a formal Space Medical Corps, offering medical students several weeks of rigorous training specifically tailored to space-related health scenarios. While the promise of civilian space tourism grows, so do the unique risks to human health in microgravity. Astronauts and now tourists, face a wide range potential medical emergencies.
“What are the dots that need to go to place to get physicians to do a residency or rotation as future space physicians? What curriculum needs to get in place? SPDR can help break down those discussions by breaking down those silos and discuss which courses from space policy/law, space health, and aerospace are needed?”
To move this vision forward, one of the most immediate steps is to identify is anazling the from decades of the near total of 700 individuals from 47 countries who have journeyed into space. This includes professional astronauts and the increasing number of civilian space tourists. Researchers must establish a comprehensive profile of in-flight medical risks from minor issues like space motion sickness to life-threatening emergencies such as cardiac events or blood clots. This data will be essential in designing not only the SPDR Medical Space Crops curriculum but also the emergency protocols and diagnostic tools that space physicians will rely on in future missions. As more private individuals travel beyond Earth, it is no longer theoretical an emergency can happen, it’s a matter of preparation.
Likely Medical Scenarios in Space
Dr. Pekkanen addresses, “How do you perform CPR in microgravity?”
Performing CPR without gravity is a serious logistical challenge, requiring new specialized techniques and proper restraints. In the absence of a trained physician or emergency equipment, a cardiac emergency in space could quickly become fatal, highlighting the urgent need for more advanced onboard medical protocols and trained space physicians.
Furthermore, what happens if a space tourist spending a week in orbit begins to choke while eating? Microgravity affects swallowing. Food and saliva don’t naturally move down the throat due to gravity, so astronauts must already chew carefully and eat in small bites. On Earth, the Heimlich maneuver relies on gravity and a firm stance to deliver quick, upward abdominal thrusts. In space, without gravity or solid footing, performing it requires adaptation.
One of the most frightening medical emergencies that could occur in space is a sudden cardiac event, such as a heart attack. While rare among carefully screened astronauts, the risk becomes more pronounced as civilian space tourism expands to include older individuals or those with less rigorous health assessments. In microgravity, the heart doesn’t work as hard to pump blood, which over time can lead to deconditioning of the cardiac muscle.
Another medical concern in space is the redistribution of bodily fluids caused by microgravity. In the absence of gravity, fluids such as blood and water shift away from the lower extremities and move toward the head. This can result in blurred vision or, in more serious cases, lead to structural changes in the eyes, a condition known as Spaceflight-Associated Neuro-ocular Syndrome (SANS). Additionally, this fluid shift can slow circulation, heightening the risk of developing blood clots. If one of these clots dislodges and travels to the lungs, it can cause a pulmonary embolism, a potentially fatal blockage that severely restricts breathing. The danger is compounded by the limited availability of diagnostic tools like ultrasound aboard spacecraft. In the event of a technical malfunction that prolongs the mission, these risks become significantly more acute, underscoring how vulnerable even routine bodily systems can become during extended time in space.
Currently, space agencies like NASA or ESA subject professional astronauts to years of physical training, psychological evaluations, and detailed health assessments before clearing them for spaceflight. These protocols include cardiovascular stress tests, neurocognitive assessments, bone density scans, and extensive screenings for chronic illnesses. In contrast, commercial spaceflight operators have begun developing their own, often less stringent, medical clearance guidelines for private passengers. While companies like Blue Origin, SpaceX, and Virgin Galactic include some health disclosures and waiver requirements, the variability and lack of standardization between providers is a point of discussion for the SPDR program.
To mitigate these risks, experts like Pekkanen would encourage for the training of “space physicians” who could become part of the civilian spaceflight prescreening process. These professionals would serve as medical examiners specifically trained in the physical requirements of spaceflight. Screenings would need to be more than routine checkups, as they would need to account for specific risks including how microgravity may impact someone with a history of strokes, immune disorders, or visual impairments. For example, a person with borderline heart function might be stable on Earth, but in space, where the heart weakens rapidly in microgravity, they could face life-threatening complications. Likewise, someone with a history of thrombosis could be at elevated risk of a deadly pulmonary embolism in flight.
Until standardized international medical protocols are in place, space tourism should include not only physical fitness thresholds, but also psychological and cognitive assessments. Furthermore, they emphasize the need for mandatory on-site medical staff for all flights, not just for emergency response, but also for pre-launch risk mitigation and post-flight care. As the line between space exploration and tourism continues to blur, incorporating medical screening into the civilian launch process is not just wise, it’s critical to ensuring safety and building public trust in the future of space travel.
Space Medicine 101
So what could potential curriculum in the SPDR Medical Corps Summer Boot Camp look like? Some proposals may entail:
Space Fitness and Microgravity Conditioning
Designed to combat the rapid muscle atrophy and bone density loss experienced in space, this course would train future physicians in creating and supervising resistance and aerobic exercise regimens adapted to microgravity. Students would learn to prescribe workouts to tourists that maintain cardiovascular health and reduce injury risk.
Space Physiology and Pathophysiology
In this class students would examine how the human body responds to microgravity, radiation exposure, fluid distribution, and long-duration isolation.
Space Nutrition and Functional Food Systems
Maintaining proper nutrition in orbit is essential for preventing muscle loss, supporting immune function, and minimizing clotting risks. This course would explore the science of space diets, dietary supplementation in microgravity, and the cultivation of edible plants using limited onboard resources, including how to preserve and repurpose food waste like fruit seeds for future growth on the space hotel.
Space Emergency Medicine and Critical Care
Since you can’t "call an ambulance" in space, this course would focus on immediate life-saving interventions using limited tools and personnel such as CPR in microgravity, managing cardiac arrest and arrhythmias during flight, and responding to decompression sickness.
Diagnostic Imaging and Point-of-Care Tools in Microgravity
Given the lack of full hospitals in space, physicians will need to become proficient in portable diagnostics like ultrasound or handheld imaging devices or effective communication with Earth based specialties for remote diagnostic symptoms.
Aerospace Pharmacology and Radiation Countermeasures
Medication absorption and effects differ in space due to microgravity and altered physiology. This course would help students understand how to manage motion sickness, insomnia, anxiety, and preparing radioprotective medications in space.
International Medical Ethics and Jurisdiction in Space
Given the multinational context of space travel, students must learn to navigate legal and ethical complexities surrounding medical consent and international jurisdiction and authority as well as standards for triage and care.
Pre-Flight Medical Screening and Risk Stratification
This course would prepare space physicians to screen and approve space tourists and professionals by educating passengers the health risks involved, designing fitness tests for flight and microgravity conditions, prescreening health backgrounds for history of illnesses that would identify if the tourist were physically and mentally qualified, or is a high risk.
Psychological Resilience and Mindfulness in Isolation
In an emergency where prolonged space travel is required due to technical issues with the spacecraft, mental health can quickly become strained, especially in the absence of friends, family, and familiar surroundings. Much like passengers waiting at an airport for a delayed plane to be repaired, space travelers may find themselves in holding, but with far longer wait periods and no option to simply walk out or switch flights. This course would prepare physicians to recognize and treat anxiety, isolation, and emotional fatigue by teaching mindfulness techniques, stress-reduction strategies, and behavioral health protocols specifically adapted for life in space.
Beyond these core courses, the curriculum could also include training in telemedicine and remote triage in space, infection control and microbiome management in confined habitats, medical crisis simulation and crew coordination, life sciences lab and resources in orbit, space medicine research and data collection, and more. These additional subjects would help prepare space physicians to face the unique and complex demands of healthcare beyond Earth while utilizing every individual as an opportunity for more research and data to pave the way for space exploration and tourism.
Final Thoughts
As space becomes a new frontier not only for exploration but for commercial travel and tourism, the demands on medicine are no longer speculative, they are immediate. The risks are real, the data is limited, and the pace of innovation is accelerating. If we are to send people beyond Earth, astronauts, celebrities, tourists, and researchers alike, then we must also send doctors equipped to care for them.
As debates continue over whether investment in space should come after solving Earth’s problems, one thing is clear: if humanity is going to pursue this future regardless, then it must do so responsibly. That means laying the groundwork now for safety, training, and international collaboration—because in space, even one mistake can mean the difference between survival and disaster.
As the future of space medicine takes shape, we want to hear from the next generation of pioneers. Whether you're a medical student, or a professor, or simply space-curious, your voice matters. Scan the code below to share your thoughts. Would you apply to be a part of a Space Medical Corps Summer Boot Camp? Your input could help shape the very first curriculum designed to train physicians for the final frontier.
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