TEAM LRN Review of NASA’s Longitudinal Study of Astronaut Health David E. Longnecker Frederick J. Manning Melvin H.Worth, Jr., Editors THE NATIONATELA AMC LRANDEMIES PRESS REVIEW OF NASA’S Longitudinal Study AstronaOuFt Health David E.Longnecker, Frederick J.Manning, and Melvin H.Worth, Jr., Editors Committee on the Longitudinal Study of Astronaut Health Board on Health Sciences Policy THE NATIONAL ACADEMIES PRESS Washington, D.C. TEAM LRN www.nap.edu THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract/Grant No. NASW-03031 between the National Academy of Sciences and the National Aeronautics and Space Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the Institute of Medicine Committee on the Longitudinal Survey of Astronaut Health and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 0-309-09148-9 (Book) International Standard Book Number 0-309-53016-4 (PDF) Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334- 3313 (in the Washington metropolitan area); http://www.nap.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. TEAM LRN TEAM LRN The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org TEAM LRN COMMITTEE ON THE LONGITUDINAL STUDY OF ASTRONAUT HEALTH DAVID E. LONGNECKER (Chair), Senior Vice President and Corporate Chief Medical Officer and Robert D. Dripps Professor of Anesthesia, University of Pennsylvania Health System, Philadelphia, Pennsylvania ALFRED F. CONNORS, JR., Charles H. Rammelkamp Professor of Medicine, Case Western Reserve University, and Chair, Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio ROY L. DEHART, Director, Vanderbilt Center for Occupational and Environmental Medicine, Nashville, Tennessee R. J. MICHAEL FRY, Retired Head of Cancer Section, Oak Ridge National Laboratory, Indianapolis, Indiana DANIEL R. MASYS, Director of Biomedical Informatics and Professor of Medicine, University of California, San Diego VAN C. MOW, Stanley Dicker Professor of Biomedical Engineering and Orthopaedic Bioengineering, and Chair, Department of Biomedical Engineering, Columbia University, New York, New York TOM S. NEUMAN, Professor of Clinical Medicine and Associate Director, Emergency Medical Services, San Diego Medical Center, University of California, San Diego THOMAS F. OLTMANNS, Edgar James Swift Professor of Arts and Sciences, Department of Psychology, Washington University, St. Louis, Missouri RUSSELL B. RAYMAN, Executive Director, Aerospace Medical Association, Arlington, Virginia WALTER ROBINSON, Associate Professor of Pediatrics and Medical Ethics, Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts ELAINE RON, Senior Investigator, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Rockville, Maryland CAROL SCOTT-CONNER, Chair, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa M. RHEA SEDDON, Assistant Chief Medical Officer, Vanderbilt Medical Group, Vanderbilt University Medical Center, Nashville, Tennessee DEBORAH ZUCKER, Assistant Professor of Medicine, Tufts University and Clinical Investigator, Division of Clinical Care Research, New England Medical Center, Boston, Massachusetts Study Staff FREDERICK J. MANNING, Study Director NATASHA S. DICKSON, Senior Project Assistant BENJAMIN HAMLIN, Research Assistant v TEAM LRN vi STAFF Institute of Medicine Staff ANDREW POPE, Director, Board on Health Sciences Policy MELVIN H. WORTH, JR., Scholar-in-Residence TROY PRINCE, Administrative Assistant, Board on Health Sciences Policy CARLOS GABRIEL, Financial Associate TEAM LRN INDEPENDENT REPORT REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: John R. Ball, American Society for Clinical Pathology John Boice, International Epidemiology Institute F. Andrew Gaffney, Vanderbilt University Thomas A. Louis, Johns Hopkins University Jay H. Lubin, National Institutes of Health Jonathan D. Moreno, University of Virginia Deborah J. Wear-Finkle, Maine Cognitive Therapy Center Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by ROBERT M. EPSTEIN, Harold Carron Professor of Anesthesiology Emeritus at the University of Virginia, appointed by the Institute of Medicine, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. vii TEAM LRN TEAM LRN