​It is quite possible that this article could be relevant to some of the younger readers of InnovaSpace who may themselves be visiting the Moon two decades from now. NASA's Artemis programme aims to return humans to the lunar surface and, through increasingly ambitious missions, establish an enduring human presence on and around the Moon.
Establishing a permanent lunar base will be difficult. A major logistical problem is that almost everything must either be brought from Earth or eventually produced on site. Extreme environmental hazards include the absence of an atmosphere, leaving a lunar base exposed to solar and cosmic radiation and micrometeoroid impacts. Gravity would be just one-sixth that of Earth. Radiation, dust and extreme temperature variations would all affect human health. Temperatures on the Moon can range from around 121°C to -246°C.
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The Lunar Surroundings
Long-term exposure to low gravity, radiation, isolation and confinement raises both medical and psychological concerns. Over time, these factors may affect bone and muscle health, vision, immune function and mood. Long-term isolation on the Moon could also affect cognition, sleep and interpersonal relationships. Anxiety, depression, irritability, reduced attention and burnout resulting from confinement and separation from normal social life could occur.
In practice, healthcare on the Moon would be dependent on habitat, power, food, transport and maintenance. The lunar environment may disrupt circadian rhythms because of unusual light cycles, limited natural cues and operational stress. This can worsen sleep quality and increase fatigue, reducing concentration and judgement. Over time, these effects can affect both performance and emotional resilience.
Emergency care would involve stabilising, monitoring and treating the patient. Evacuation to Earth could be significantly delayed or, depending on mission circumstances, may not always be immediately possible. In addition to first aid and initial management, care on the Moon would therefore include procedures and treatments normally carried out by a physician or surgeon on Earth. Increased medical self-care would be the rule.
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Physiological Changes Beyond Earth
​Human bones lose roughly 1 to 1.5% of mineral density every month during extended exposure to microgravity, particularly in weight-bearing bones. Muscles also atrophy without the constant loading experienced on Earth, while cardiovascular deconditioning occurs as the body adapts to an environment where it no longer has to work against Earth's gravity.
Bone loss also increases the amount of calcium excreted in the urine, which may contribute to the formation of renal stones. Preventive measures, including regular resistance exercise, adequate hydration and appropriate nutrition, will therefore be particularly important for people spending prolonged periods away from Earth.
Although these changes are well documented in microgravity, the long-term effects of living in the Moon's one-sixth gravity are not yet known. Similar effects on the musculoskeletal and cardiovascular systems are anticipated, making exercise and other countermeasures an essential part of future lunar healthcare.
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The Invisible Threat of Cosmic Radiation
​Earth's magnetic field and atmosphere provide protection from much of the radiation encountered in space, but travellers beyond low Earth orbit face increased exposure to galactic cosmic rays (GCRs) and solar particle events (SPEs). High-energy particles can pass through the human body, damaging cells and DNA and potentially increasing the long-term risk of cancer and other health effects.
Unlike crews aboard the International Space Station, future lunar inhabitants will spend prolonged periods beyond the protection provided by Earth's magnetic field. Radiation exposure will therefore be one of the major health challenges associated with living and working on the Moon. Protecting crews will require careful monitoring of radiation exposure, effective habitat shielding and procedures for responding to periods of increased solar activity.
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Clinical Problems
​A crew member may develop dehydration, constipation, urinary stones, infection, trauma, dental pain or an allergic reaction. These are routine problems on Earth. On the Moon, they can become operational crises. A simple injury could compromise an entire mission if the crew lacks adequate triage tools, medication or surgical capability.
Lunar healthcare will therefore need to be preventive, protocol-driven and largely self-managed. A doctor may not always be available within the crew, and evacuation to Earth may be delayed or, in some circumstances, impossible. The main medical challenges are likely to include cardiovascular deconditioning, bone and muscle loss, neurovestibular problems, sleep and circadian disruption, radiation injury, immune dysregulation, renal stones, trauma and psychological stress.
Lunar healthcare must shift from “doctor-centred” to “crew-centred” care, with a strong emphasis on prevention, triage, point-of-care testing and self-treatment protocols. Care before, during and after spaceflight should be organised as a structured continuum, rather than as an emergency-only service.
The question is not whether astronauts will fall ill or be injured. They will. The question is how a crew will diagnose, treat, monitor and recover when Earth is far away and time is not on their side.
The Moon could therefore become an important testbed for the future of healthcare, not only for subsequent missions deeper into space, but also for isolated and resource-limited settings on Earth.

Care Without a Hospital
​The central challenge of lunar healthcare is the absence of a hospital. There will be no emergency department, intensive care unit or immediate access to tertiary care. Care protocols will therefore need to be simplified, tools must be multipurpose, and medical training broader than usual.
Astronauts may need to act as doctor, nurse, pharmacist and paramedic for one another. Artificial intelligence could assist with triage, anomaly detection, medication tracking and pattern recognition from sensor data. Portable ultrasound, compact blood analysers and wearable monitors may allow lunar inhabitants to assess hydration, inflammation, cardiovascular status and injury. Such technologies will become increasingly important as crews operate more independently from medical expertise on Earth.

​Organ-on-chip platforms and other bioengineering tools could also help researchers understand how human tissues respond to the lunar environment, potentially improving our understanding of the biological effects of radiation and altered gravity.
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Challenges in Providing Healthcare on the Moon
​Performing surgery in one-sixth gravity would present major challenges. Blood and other body fluids would behave differently from on Earth, creating difficulties in controlling bleeding, maintaining a clear surgical field and preventing contamination of the habitat. Surgical techniques and equipment may therefore need to be adapted specifically for reduced-gravity environments.
Large diagnostic systems such as today's CT and MRI scanners would also be impractical for early lunar habitats because of their mass, volume and power requirements. Smaller, multipurpose diagnostic technologies will be needed instead.
Lunar medical care will face several additional challenges. These include:

• limited mass and volume available for medical equipment and supplies;
• fewer opportunities to replenish medical supplies;
• concerns about the long-term stability and shelf life of medications and laboratory reagents;
• limited opportunities for rapid medical evacuation to Earth;
• the need for considerable medical training and regular skills practice by non-medical crew members; and
• continued Earth-based medical consultation whenever communication and circumstances permit.

As lunar missions become longer and crews spend increasing periods away from Earth, healthcare systems will need to balance the benefits of terrestrial medical support with a progressively greater capacity for autonomous care.
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​The importance of access to medical facilities on Earth was highlighted in January 2026, when NASA brought its four-member SpaceX Crew-11 mission home earlier than originally planned because of a medical concern involving one of the astronauts. NASA astronaut Mike Fincke later revealed that he had experienced a medical event aboard the ISS that required immediate attention from his crewmates and guidance from NASA flight surgeons.
His condition stabilised, but NASA decided that an early return was the safest course, allowing access to advanced medical imaging that was not available aboard the space station. Crew-11 returned safely to Earth on 15 January 2026, after 167 days in space. The precise nature of Fincke's medical condition has remained private.
The episode provides a timely reminder of one of the fundamental challenges facing future lunar healthcare: medical facilities and expertise that are readily available on Earth may simply not be available when they are needed on the Moon.
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A New Medical Frontier
​Healthcare on the Moon is not about building a miniature version of Earth's hospital. It is about designing a new system for a new world. That system must be preventive rather than reactive, distributed rather than centralised, and intelligent rather than dependent on immediate human expertise. It must anticipate illness, not merely respond to it.
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Epilogue
​NASA's Artemis programme is returning human explorers and scientists to the Moon, with increasingly ambitious missions intended to support a longer-term human presence. The goals include scientific exploration, the development of lunar capabilities and preparation for future human missions to Mars.
Current approaches to medical care in space may not meet the needs of future lunar residents. New technologies, new approaches to healthcare and novel training will be required. Familiarity with both space medicine and aerospace engineering will be essential.
The future is always ahead of schedule.
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What is Space Oncology?
​Space oncology (SO) is a rapidly emerging field that investigates how microgravity (MG) and cosmic radiation influence cancer progression and treatment. Space-based environments are being studied to accelerate tumour modelling and drug discovery, making space a unique laboratory for cancer biology.
Space oncology has already generated important conceptual and technological spin-offs, ranging from three-dimensional cell culture systems and protein crystal studies for cancer drug development to advances in radiation biology, tissue-response research and biomarker discovery.​

Effects of Microgravity on Cancer Cells
Reviews of both real-space and simulated microgravity experiments have demonstrated important effects on cell adhesion, migration, proliferation, gene expression and the formation of multicellular spheroids. Microgravity alters cytoskeletal organisation and promotes spheroid formation, creating more physiologically relevant tumour models that may accelerate drug discovery while reducing reliance on animal models.
The effects of microgravity on cancer cells, cancer stem cells and drug response may also help shape future therapeutic strategies. Microgravity enables the production of more uniform protein crystals, lower-viscosity biologics and more stable pharmaceutical formulations.
Microgravity also influences the formation of nanoparticles that deliver chemotherapy directly to tumours while enabling controlled drug release. It alters cancer cell morphology, membrane behaviour and gene expression, thereby influencing how cells take up therapeutic agents. When gravity is removed or substantially reduced, cells experience profound changes in fluid dynamics, mechanical loading and cell-to-cell interactions. For cancer cells, these changes are far from trivial. They also facilitate the production of drug crystals and biologic formulations that are difficult to manufacture under normal terrestrial conditions.

Graf et al. discussed in detail the effects of microgravity on multiple omics disciplines in their paper Omics Studies of Tumor Cells under Microgravity Conditions, summarising transcriptomic, proteomic, metabolomic and epigenetic findings across multiple tumour types exposed to both real and simulated microgravity.
Similarly, Grimm et al., in their paper Recent Studies of the Effects of Microgravity on Cancer Cells and the Development of 3D Multicellular Cancer Spheroids, demonstrated how microgravity alters cell adhesion, proliferation, survival, cytoskeletal organisation, extracellular matrix interactions and spheroid formation, with important implications for drug discovery and the reduction of animal experimentation.
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When I was seven or eight years old, looking at videos of the cosmos would move me to tears. Growing up in Batticaloa, a city in the Eastern Province of Sri Lanka, the concepts of astronomy and space exploration were almost entirely foreign. Like many Asian households, the traditional path of becoming a doctor was the one most spoken about and encouraged by teachers and society.
Yet, an unexplainable pull toward the stars grew inside me. Back then, I didn't even know the word “astronaut”—I just told people I wanted to be a “scientist” because that was the only word available to me in my hometown.
A turning point came when my grandfather bought me my first computer. While other kids were playing games, my search history was filled with the ambient sounds of planetary atmospheres. By the 7th and 8th grades, I was completely hooked. Without the AI tools we have today, and with nothing but a basic Google search bar, I began hunting for NASA student competitions and online astronomy programs entirely on my own.

The Struggles of an Isolated Dream
My home is what I fondly call a “small, lovely birdhouse.” It is just me, my mom, and my dad. We don't live around extended family, and the bond we share is incredibly deep. My mother is the strongest woman I have ever known; she does everything for me. Her love is so fierce that even now, during my university years, she cries every single time I have to leave home, even if it is just for a single day.
Because they love me so deeply, my parents were initially terrified of my interest in space. In the capital city of Colombo, parents might have access to physical guidance, planetariums, and space camps for their children. But in Batticaloa, I was entirely alone.

Editorial Introduction
At InnovaSpace, we explore how advances in space medicine can improve health both in space and on Earth. Research has shown that microgravity can influence the behaviour of cancer cells, making cancer an important area of investigation for both space exploration and terrestrial medicine.
With that in mind, we are honoured to share this deeply personal article by our friend and colleague Dr Krishnan Ganapathy, originally published in The Hindu. His reflections, written from the unique perspective of both surgeon and patient, remind us that behind every diagnosis is a human story. We thank him for allowing us to reproduce his article and send him our very best wishes for his continued treatment and recovery.

How it all began
March 2,7.30 a.m. I had initiated the act of micturition (urination), possibly for the100,000time in the past 75 years. Ten seconds had passed. I saw 2 ml of diluted ‘coke’ in the urine stream. In that split second I realised that this was a breakdown of blood products, a condition known as haematuria. I recollected surgery classes taken 55 years ago, where the lecturer said – “When an elderly person passes blood there are only 3 diagnoses - a) malignancy b) malignancy c) malignancy.”
​In 1970, there was no ultrasound; cystoscopy was not routinely available. We were taught that if malignancy was not picked up, it meant investigations were insufficient and were told to keep investigating. Trained in that era, the thrill of making an early clinical diagnosis took over. I did not dwell on dire implications, should I be right, nor did I make any prayers that I should be wrong. Cool, calm, composed and totally asymptomatic, I did a literature search. Every article, and every chapter concluded that “malignancy had to be excluded”. Two days later I saw diluted ‘coke’ in my urine again. Within 48 hours, I got myself investigated.

Diagnosis confirmed
An outpatient cystoscopy was scheduled. Within 15 seconds I saw on the screen an obviously malignant tumour. Three minutes later, on my way to the consultant’s room, I told my wife with pride: “See I was absolutely right. Hi-grade malignancy confirmed”. Fifty-eight years of managing thousands of serious and critical head injuries, bleeding in the brain and brain tumours had probably resulted in my nonchalance. Or maybe reality had not dawned yet, and I was fooling myself.
The uro-oncologist outlined different management options. I was to be on the dais ata major international conference the following week. My brain interjected: “Time you learn to let go– look, the cancer cells are multiplying every second, get operated on immediately; management depends entirely on the detailed biopsy.”

Immediate response
A normal reaction on being told that one has a hi-grade cancer could vary from shock, disbelief, fear, denial, anxiety, distress, anger, sadness, rage, guilt, frustration and withdrawal. “A bolt from the blue”, “the ground fell away” or “my world collapsed” iswhat is expected – particularly in an individual with outstanding physical and mental health. In my case I was reconfirming a self-diagnosis. My occupation, education, socioeconomic background, access to current knowledge and access to state-of-the-art resources resulted in a different response – within 10 minutes, I started the paper work, fixed a date and time of surgery, and informed my family.
But then, I am also human. Every now and then I broke down with my lacrimal glands going into overdrive unashamedly. I gave vent to my anger and frustration. My spouse of 51 years stood firm as the rock of Gibraltar. When I threw away the high protein nutritious food painstakingly prepared with love and affection she only smiled – knowing that it was the malignant cells responding, not her husband. I recollected a quote widely attributed to Dr. Henry Maudsley that appears in Boyd’s textbook of Pathology -- “The sorrow which has no vent in tears, may make other organs weep.”

What the Numbers Actually Say
This is not a distant hypothetical. NASA's Exploration Medical Capability (ExMC) element of the Human Research Program has been modeling the probability of medical events during long-duration and exploration missions for years. Their probabilistic risk assessment framework, which draws on ISS medical event records, Shuttle mission data, and analog environment studies, consistently points toward the statistical near-certainty of significant medical events during a Mars mission of the expected duration. Traumatic injury has been explicitly identified by NASA as the highest medical concern for mission success. Every extravehicular activity, every spacecraft maintenance procedure, every moment of work in a pressurized suit accumulates risk. Over a three-year mission, that cumulative exposure translates directly into probability.

Cardiovascular diseases remain one of the leading causes of mortality worldwide, demanding diagnostic and therapeutic strategies that are not only accurate but also personalised. As healthcare shifts toward precision medicine, aptamer-based technologies are emerging as powerful tools with the potential to revolutionise how cardiac diseases are detected, monitored, and treated.

​Aptamers, short single-stranded DNA or RNA molecules, are engineered to bind specific targets such as proteins, cells, or biomarkers with high affinity and selectivity. Often described as synthetic alternatives to antibodies, aptamers offer several advantages, including low immunogenicity, high stability, cost-effective synthesis, and ease of chemical modification. These features make them particularly suitable for integration into next-generation diagnostic and therapeutic platforms.

In the context of cardiac diseases, early detection is critical. Conditions such as myocardial infarction, heart failure, and atherosclerosis rely on timely identification of biomarkers like troponins, C-reactive protein (CRP), and B-type natriuretic peptide (BNP). Aptamer-based biosensors enable highly sensitive and rapid detection of these biomarkers, even at very low concentrations, offering the potential for earlier diagnosis compared with some conventional approaches. When integrated with portable platforms such as paper-based assays or smartphone-assisted devices, these systems can deliver point-of-care diagnostics, reducing the need for centralised laboratory infrastructure. These innovations maybe particularly valuable in remote or resource-constrained environments, including spaceflight medicine, where rapid point-of-care cardiovascular monitoring is essential.

​Beyond diagnostics, aptamers are also gaining attention in targeted therapy. Their ability to specifically bind disease-related molecules allows them to act as drug delivery agents or therapeutic inhibitors. Although not a cardiovascular therapy, Pegaptanib, an RNA-based aptamer approved by the FDA in 2004, demonstrates the therapeutic viability of aptamer technologies and supports exploration of similar cardiovascular applications. For example, aptamers may be designed to block clot formation pathways or target inflammatory mediators involved in cardiovascular disease progression.

Exposure to spaceflight, particularly microgravity, induces profound physiological alterations that compromise neuromusculoskeletal and cardiovascular systems. These changes lead to muscle atrophy, bone demineralization, postural instability, and other functional deficits. Physiotherapy and related countermeasures, including tailored exercise regimens and structured rehabilitation protocols, are central to mitigating these effects during and after space missions.
Spaceflight imposes unique stressors on the human body due to the absence of Earth’s gravitational load, leading to systemic physiological adaptations. While space agencies have developed exercise countermeasures to moderate deconditioning, astronauts still face significant health challenges both during missions and upon return to Earth’s gravity. Physiotherapy plays a critical role in preparing, supporting, and rehabilitating astronaut health through evidence-based interventions.

Neuromusculoskeletal Deconditioning
Prolonged microgravity exposure leads to pronounced muscle atrophy and bone density loss, especially in weight-bearing structures such as lower limbs and the spine. Astronauts can lose significant muscle strength and up to 1–2% of bone mass per month without consistent loading stimuli. These changes parallel muscle atrophy and deconditioning observed in terrestrial patients subjected to prolonged immobilisation.
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Sensorimotor and Postural Control Deficits
Spaceflight results in impairments in postural control and dynamic gait performance due to altered vestibular inputs and neuromuscular coordination. Astronauts show significant decrements in balance and sensorimotor function upon return to Earth, comparable to the effects seen in bed-rest analog studies.
In microgravity and related analog environments, discrepancies may arise between actual body position and perceived orientation.
(A) When sensory inputs are aligned, posture is maintained with accurate perception of body position.
(B) Under conditions of reduced or conflicting sensory input, such as limited visual feedback, a mismatch can occur between actual and perceived orientation. The individual may physically lean in one direction while perceiving a lean in the opposite direction. Despite this discrepancy, stability can still be maintained.
Such orientation illusions are commonly observed on entry into weightlessness and depend on the available sensory information. In the absence of visual input, tactile cues become dominant in determining perceived orientation. Interpretation of foot pressure and support loading may therefore lead to an incorrect perception of body position.

​When we think of human spaceflight, it’s easy to focus on rockets, spacecraft and mission timelines. Less visible, but just as critical, is the quiet disruption of the body’s natural rhythms. On board the International Space Station, astronauts witness multiple sunrises and sunsets every day, challenging circadian systems that have evolved under a single 24-hour light–dark cycle. Sleep, hormonal regulation, cognition and overall wellbeing all depend on rhythm. The below article written by Dr Maria Helena Itaqui Lopes, originally published in the journal Zero Hora and website GZH, explores rhythm from a clinical and musical perspective, and reminds us that the language of the body matters deeply, whether on Earth or in orbit.

​One day, while studying the biography of Herbert von Karajan, the legendary conductor regarded as one of the greatest in the history of conducting and often referred to as the “conductor of conductors”, I was struck by his reflections on rhythm. He stated that “if no one teaches students the basic disciplines of rhythm, things become impossible”. Although this statement, coming from a musician, may at first seem to relate exclusively to music, in reality rhythm goes far beyond this. It encompasses a sense of balance in physical movement, mental processes, learning, self-care, daily activities and vital energy.

​Our bodies function rhythmically. We need only recall cardiac rhythm, breathing, sleep, digestive function and circadian rhythms, among many others. Of the biological rhythms that regulate bodily function, the circadian rhythm stands out as a central example, as it organises hormonal release in a time-dependent manner. The secretion of cortisol, melatonin, growth hormone and insulin follows patterns that influence metabolism, immune response, cognitive performance and tissue repair. In preventive medicine, recognising these rhythms allows functional variations to be interpreted, the timing of assessments to be guided, and interventions to be individualised.

​Still within the scope of preventive medicine, the starting point for a health review is not defined by age-related calendars nor by the presence of symptoms, but rather by the early recognition of functional changes, taking family history and genetics into account. Beginning an assessment at this stage means respecting an individual’s biological timing, interpreting subtle functional signals and anticipating risks before disease becomes established. In this way, the clinical review becomes a strategy of continuous, personalised care, aimed at preserving autonomy and health over time.

​These notions of the body’s own language interact with our daily activities. Returning to music, we know that a large proportion of Baroque works were written at a tempo of 75 to 80 beats per minute, measured by a metronome (a device used by musicians to regulate tempo by setting beats per minute), which corresponds closely to the average resting heart rate considered normal. It could be said that this synergy is pleasing to most people.

​A medical consultation also has its own rhythm, which is sometimes forgotten or even never learned. A consultation has a beginning, a development, a moment of climax and a conclusion. Expressing empathy either too early or at an inappropriate moment disrupts this balance, and the doctor–patient relationship becomes misaligned. Entering the correct frequency to properly understand a patient is a skill that requires a basic sense of rhythm. An andante tempo (a musical term referring to tempos between 72 and 84 beats per minute) closely resembles our heart rate and therefore feels comfortable to us. In other words, at the start of a consultation or during a visit to a patient in a hospital bed, the encounter should follow a rhythm that conveys safety and support from the doctor. This is a skill that should be better recognised and valued by professionals. From the patient’s perspective, the choice of when to undertake a clinical review should be carefully considered and planned for the new year that is beginning.

​Another, rather striking, story related to rhythm concerns three conductors who died while conducting the third act of Wagner’s opera Tristan and Isolde. The pauses in this passage are intermittent and irregular, creating tension that can affect both mind and body. Karajan, aware of this and seeking to protect himself, would dissipate this intense tension by using breathing movements to distance himself from the musical strain.
In life, as in music, it is essential to find the right rhythm for each challenge, especially when it comes to caring for one’s own health.

When humans eventually set foot on Mars, they’ll face a medical challenge that rarely needs to be thought about on Earth - TIME. A radio signal between Earth and Mars can take 4 to 24 minutes to travel one way. That means if an astronaut sends a question to Mission Control, it could be more than 40 minutes before they receive a reply, which in an emergency situation is far too long to wait.
To close this gap, NASA and Google are working together on something called the Crew Medical Officer Digital Assistant (CMO-DA), an artificial intelligence system for space medicine designed to support astronauts when Earth is too far away to give immediate help. Think of it as a “medical copilot” that will not replace doctors, but instead will help the crew diagnose and manage problems step-by-step using knowledge adapted specifically to space medicine.

Unlike a standard chatbot, the CMO-DA can work with multiple kinds of input. Astronauts might type or speak questions, upload vital signs, or share images from a portable ultrasound. The system then offers possible causes, highlights urgent warning signs, and suggests treatments that match the very limited supplies they have available to them. The big difference from Earth-based systems is that it’s trained with information that reflects spaceflight medical challenges, such as fluid shifts in low gravity, the increased risk of kidney stones, or how certain drugs behave differently in space.
To test its usefulness, NASA and Google have been running the assistant through structured scenarios. These use the same exam style that medical students face, called Objective Structured Clinical Examinations, where candidates are judged on how well they manage a case. The early results look promising, with the AI decision support tool giving safe, reliable advice, and it helps astronauts approach a situation more clearly under stress.

This project is part of NASA’s broader plan for Earth-Independent Medical Operations. For deep-space missions, it has long been recognised that crews need a much higher degree of autonomy, since communication with Earth may be delayed or even cut off entirely—for example, when Mars is hidden behind the Sun. A tool like the CMO-DA gives astronauts a way to stabilise and treat a patient without waiting for ground communication.
It’s important to remember that the system is meant as support and not as an authority. Ultimately, the astronauts in-situ remain the decision-makers. The assistant provides structured checklists, reminders, and treatment suggestions. It can also document everything that was done and prepare a clear report so that, once communication is restored, doctors on Earth can follow-up what happened and advise on next steps.

The future will bring new features, with researchers aiming to link the assistant to onboard sensors, wearables, and imaging devices, and to test it in Mars analogue missions on Earth. The goal is a complete medical system—crew, tools, and smart software working together to make medical autonomy on Mars a reality.
This technology, however, isn’t just for astronauts. It could also benefit people in remote communities on Earth, where medical access and connectivity are limited. In that way, a tool built for Mars missions medical support might improve healthcare for millions here at home.
NASA and Google’s project shows how AI in aerospace medicine is shifting from science fiction into practical support for space medicine—with potential benefits reaching well beyond Mars.

Microbes are generally associated with infection, and the usual response to their mere presence is to eradicate them as quickly as possible. For example, the “no-rinse soap” used during space travel mainly consist of antimicrobials, i.e. chemicals that kill microbes, with the aim to remove bacteria on the skin.
It is correct that microbes can cause disease, but it is microbes that created an environment and an atmosphere on Earth that allow plants and animals to exist. Microbes are literally everywhere, and we ourselves depend upon microbes to keep our external facing surfaces healthy and to help with the breakdown of food in our gut and production of substances that our body needs. The microbes form actual communities with thousands of species in and on us, for example the gut, respiratory and skin microbiomes, and these communities collaborate with our immune systems.

​To give an idea of their importance, data suggest that it is the pollution from antimicrobials that is the primary responsible for climate change because their impact is very broad and reduces the microbial diversity and changes the microbial balance. Similarly, studies indicate that antibiotics have long-term impact on our health, and they have been shown to increase the frequency of cancer, diabetes, asthma as well as functional impairments in children’s development, immune function, and cognition. Poor gut health, which usually means an unbalanced and low diversity microbiome, has also been associated with mental health problems including depression and anxiety as our gut microbiome is responsible for producing substances needed for normal brain function.
On the International Space Station skin issues and problems with wound healing have been reported. Microgravity and radiation have generally been assumed to be responsible for this and the fact, that “no-rinse-soap” is a cocktail of antimicrobials, has received practically no attention. Antimicrobials are traditionally used for treating wounds, but the US FDA reported in 2016 and again in 2022 that they are ineffective in treating wounds, and studies have demonstrated that antimicrobials directly impair healing and that a healthy wound microbiome is required for healing to take place. These novel conclusions banning antimicrobials in skin care and wound healing are further supported by the positive findings with a new technology, MPPT (micropore particle technology), which acts by regulating the wound microbiome without killing anything. MPPT has been able to achieve 100% wound closure rates, including in complicated wounds and in people with impaired immune function. This observation shows that approaches that support the collaboration between the microbes and the immune system can be much more effective than the traditional, old blanket-bombing approach of eradicating all microbes, which renders the skin debilitated and less resilient.

These observations are relevant to space travel, in terms of both the environment onboard and clothing, food and methods of ”washing”. Our bodies have evolved on Earth, where microbes were and are present, and our evolution has benefited from this as the microbes assist in protecting our surfaces and in delivering nutrients and critical compounds needed for our health. This dependence persists, even if we decide to leave Earth for shorter or longer periods of time. It is therefore a necessity, particularly for deep space travel, which does not permit us returning to Earth periodically to update our microbiome, to develop environments and procedures onboard that can sustain our microbial requirements.
These considerations are based on an article recently published in Frontiers in Public Health, which focuses on the role of antimicrobials in causing climate change from severely damaging the Earth’s microbiome. The impact of antimicrobials on the Earth microbiome and the microbiome inside a space station are comparable as they are both closed systems. It is consequently important to consider the essentiality of the microbial environment, when planning human life outside the Earth’s environment.