Space Exploration
This week I am talking to Colonel (retired) (Dr.) Walter “Sparky” Matthews, MD, MPH, Clinical Professor in the Honors Program and Honors College Pre-Medical Advisor at Baylor college and recently retired as the Surgeon General of the United States Space Force (USSF), and Command Surgeon for US Space Command (USSPACECOM) (@US_SpaceCom). Sparky as he is known, is an aerospace medicine specialist and a command surgeon for the United States Space Command. He is board certified in aerospace medicine, public health and general preventive medicine and is rated as a chief flight surgeon and the first surgeon general of the US Space Force.
Strategically Dreaming
Sparky, as he is known, is a highly accomplished physician who honed in on Aerospace medicine early on in his career serving in the Air Force through multiple assignments including Commander of Task Force Medical-Afghanistan and the Craig Joint Theater Hospital (455 EMDG) at Bagram Airfield, Afghanistan prior to being called to duty with Air Force Space command right around the time President Donald Trump directed the Pentagon to create a “space force” as a new, sixth military branch to oversee missions and operations in the space domain. As Sparky describes it that created an “explosion of energy” bringing incredible resources and individuals into the program that was intent on
“Strategically Dreaming“
With the range of launch capabilities the return space is assured and “much closer than anyone might think”.
We discuss some of the history of the space program that originally found the fittest and healthiest individuals and then made them perfect before launching them into space, which was similar to the early days of aviation. But like aviation increasing numbers of people participating the way in which we approach the health and wellness must advance to capabilities that are available in orbit, in transit to other planets and moons and a distance locations. As he highlights, the risks increase as we put more people into space
“an impossible event, given an infinite amount of time becomes inevitable”
You will be excited to hear we are going back to the moon, and from there, on to Mars and based on the progress you might see humans walking on Mars in your lifetime.
We discuss medicine in long duration orbit, how we do medical evacuation to Earth orbit, strategic patient movement between planetary orbits starting with the moon – a planetary or space “scoop and run” as it were and and how how we do medical and surgical resuscitation on the surface of other planets. We discuss the incredible advances in technology that have already taken place and are login to have to come to make space exploration possible, including the 3-D printing of organs, instruments, blood and drugs and some of the specific challenges around gravity (the lack of) and differences in pressure and the effects on oxygenation and what that means for any trauma and healing.
Will remote robotics be part of the solutions and might we see autonomous robots in the future? Listen in to hear where we are with these innovations and what the pathway might be to space medicine – you could be one of those people if you want to be, and even if you can’t the level of excitement and potential for all the associated discoveries and advances will be launching us into a real world Star Trek life.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. Walter Matthews. He goes by Sparky. He’s a retired colonel from the Air Force and also the first Surgeon General of the US space force. And he is currently serving as a clinical professor in honors, and the Honors College for pre medical advisors at Baylor University. Sparky, thanks for joining me today.
Sparky Matthews
And, Nick, it’s great to be here. Thank you so much for this opportunity.
Nick van Terheyden
So this is really a dream come true. For me, I’ve got to be honest, you you have an illustrious career, huge, extensive bio of experience that is just so contextual, to what we’re going to explore, which is, you know, the advances in space space medicine and how we get there. Before we do, I think it’s worth just covering off a little bit of your background. And please keep it brief because we haven’t got the whole show. But tell us how you got here. And you know, any specific inflection points that were really important from your your time in the past?
Sparky Matthews
Well, sure. So I am an aerospace medicine specialist. That’s, that’s my discipline of study within medicine. And I had a traditional undergraduate pre med education. I had a mentor that steered me towards the Air Force did a scholarship to go through the through medical school on the Air Force’s dime, and ended up loving it and stayed for 28 years, decided when I was in medical school, that nothing really was to my liking as far as my rotations. And so I became a flight surgeon, an aerospace medicine Doc, decided I enjoyed that so much. I did a residency in aerospace medicine, and then got out and in, you know, took care of pilots in their families, and flew many different airframes in the airforce and eventually got into space medicine when I was assigned to the Air Force Space Command. And that that is truly where we are headed for the future. And unfortunately, my time in the Air Force came to an end. But I’m continuing to try to inspire pre med students here at Baylor University to pick up that mantle and head into space.
Nick van Terheyden
It really feels like some of what we’ve watched on, you know, Hollywood’s serving of science fiction is getting closer and closer to the point that, you know, I can feel it. I don’t know about others. So that sort of inflection from aerospace to the space force. That was a new group, you were the first, you know, to serve in there. How did that come about? Were you applying for it? Did it just, you know, what was the story behind that?
Sparky Matthews
Well, that’s a great question. So I spent a year in Afghanistan in command of the Bogum Craig joint theater hospital. And coming out of that assignment, the people that decided what I wanted to do, decided that the Air Force Space Command, command surgeon job was a great place for me to go. And so got there. And you know, that was before the space force existed. And just about so as I was driving into town to Colorado Springs to take over that assignment. I heard President Trump give his speech on the radio, about the space force. And I realized, baby, it’s a new, it’s a new story. Now, this is this is really going places. And so
Nick van Terheyden
it’s interesting, you talk about the the powers that be but they obviously read your mind correctly, because I know this is an area of passion for you. Is that just coincidence? Or is there some real science going on here?
Sparky Matthews
Well, you know, Nick, it’s interesting that you asked that because my, my entire career seem to follow the line of making the most of where I was, and finding the finding the greatness and whatever opportunity I was given. And so I always enjoyed space. I thought that was a really interesting, you know, interesting way to practice medicine, preparing astronauts to go to space. But when I got to Air Force, Space Command, and then we started talking about spaceforce, I realized that we’re not just talking about preparing astronauts to go to space. We’re talking about the practice of medicine in space, and what a spectacular frontier that is for us to breach and we’re there and I’m eager to tell you about that if you’re interested.
Nick van Terheyden
Oh, absolutely. You can’t believe how excited about this. That would have been my career. The option so you get to Spaceballs. This is a new new group, obviously not something that was entirely new. But the formation of that. This must have been exciting. Tell us a little bit about some of the experiences some of the things that were going on at the time. And, you know, a little bit of insight as to where you see opportunity and the challenges,
Sparky Matthews
certainly. So when when spaceforce first started in December of 2019, that’s when the President signed it into existence. It was it was like, the, it was the greatest explosion of energy in an organization that I’ve ever witnessed. Wow, suddenly, we had, you know, so many more people coming in. And we were starting to strategically dream. You know, you talk about strategic planning, but we were strategically dreaming, thinking about what can we do? what’s possible in the future, you know, as we work with NASA, SpaceX, the United Launch associates, blue origins, Jeff Bezos, his group, you know, we really have the opportunity to do amazing things. And, you know, honestly, our goal at this point, the entire US space program, whether it’s military, civilian or commercial, is Mars, is to go to Mars is to put human feet on the surface of Mars. And I think that most of your listeners may not realize just how close we are to doing that. But the problem is, is, you know, if we’re talking about going to the space station, you know, you can if somebody gets sick or injured there, we can bring them back, you know, and take care of them like that. And do we can do a lot of things on orbit as well. You go to the moon, you know, you have to your two or three days flight, you know, from the moon back to Earth orbit, if you go to Mars, that’s nine months, one way trip. And so we it’s not enough to prepare our astronauts to go to Mars, we have to to be able to provide care for them while they’re there. And so that’s, that’s really where we are heading in the immediate and the mid and distant future, as far as medicine in space.
Nick van Terheyden
So I take take, you know, Earth orbit? Let’s call that the easiest. And I don’t know, I know, it’s not what are some of the challenges that you’ve faced, we’ve seen, I know, we’ve certainly had some medical experience with all of the flights that have gone. Tell us a little bit about last in the medicine in, in orbit in zero gravity,
Sparky Matthews
certainly. And so when we, when we send astronauts to orbit, our astronauts are selected to be nearly physically perfect specimens. You know, if they have, and we tune them up to maximum performance before we send them on orbit, because if they have a medical issue there, not only does that, you know, that cause problems with the mission, but their entire crew has to come back, because we don’t just switch out one astronauts. And so that’s really what we’ve done throughout the entire 60 years of the space program is ensuring that we have extremely healthy astronauts to go. But that’s kind of the way aviation started as well, you know, you with aviation, when it was born in the early 1900s, you didn’t have a lot of people flying in the air. And so you could afford to be very selective about Who did that? Well, space travel will eventually be the same as air travel is today. And so more and more people will go to space. And so when you think about that, I had a professor once that said, an impossible event, given an infinite amount of time becomes inevitable. And so you know, if we put enough people in space on orbit, for enough time, we’re eventually going to have a life threatening emergency or, you know, illness or injury. Now, we’ve had some some medical issues in space in the past, I’m not at liberty to talk about the details. But you know, that’s eventually going to happen. And if we have a preventable death in space, then the American public will take Mars out of our grasp. And so we have to an end, but, you know, in addition to the fact that we certainly have to be, you know, protect our folks that are going to the maximum extent that we can. And so as we look to the moon, as we look to long duration orbit, as we look to Mars, you know, we have to look at this the same way we do a military deployment, I’m a military officer, and so, you know, that’s why I think, and we never sinned, individuals in the combat without bringing medical support with them. Okay, so we’re gonna have to do that in space as well. And so you know, the really there’s three lines of efforts strategic lines of effort that we’re looking at, as far as what we have to do to be able to go to Mars, because that is the goal. If we can go to Mars, we can go an infinite distance away from the earth. So the three things we have to do is we have to figure out how we do medical evacuation to Earth orbit. The second thing we need to figure out is how we do strategic patient movement between planetary orbits starting with the moon. And the third thing is, we have to find this is the exciting one, we have to figure out how we do medical and surgical resuscitation on the surface of other planets. And that’s, that’s where most of our, our dramatic technological advances are going to have to come. So I can talk about one or all of those, if you’d like.
Nick van Terheyden
Yeah, so I’m going to focus on the latter, because I think that’s where, you know, much of the innovation, and not to oversimplify it for folks listening, but I would say, certainly, the first two were more about, you know, scoop and run. Right. You know, get them back as quickly as possible. You know, if you understand orbital mechanics, you understand how challenging that is, right? So, it’s a little bit more than scoop and run, but you know, in the context of this, so let’s jump forward, because you’ve already said it’s a lot closer than people think I’m, I’m with you, you can see this acceleration, amazing innovation, start with some of the basic challenges around this. I mean, do we have doctors in orbit that, you know, that’s never seen? How do we do this?
Sparky Matthews
Well, we we’ve we don’t have a mission specific role for a physician in space. So we’ve been so we we’ve had astronauts that were physicians, but they didn’t go to serve as a physician. And in certainly, we didn’t have trauma surgeons or nurses, critical care specialists, which is what we’re going to need as we go further. And so, so we’ll, we’ll set aside the moon for a second. But But think about the fact that whatever we do on Mars, we will practice by doing it first on the moon. Okay, so let’s jump forward to Mars because Mars is, is so far away, that we have to provide the care to an injured or ill astronauts, they’re on Mars, you know, we can’t just bring them back and fix them here. Okay. So the challenges that we that we face are primarily the getting stuff to Mars. So getting medical equipment to Mars. In the early days of the Apollo program, one of the astronauts went to one of the flight engineers, and said, Hey, I’d like to take some things with me when I go, you know, to the moon, how, you know, what’s the weight restriction. And he said, Well, you know, whatever you want to take with you go out in the front yard and throw it up in the air. And if it comes back down, it’s too heavy. It’s so we really are restricted in the payload weight that we can take with us. And so anything that we can we can produce on sight on Mars is something we have to do. And so, you know, certainly if we think about a typical surgical capability, we’re going to have to take the anesthesia machine, we’re gonna have to take the the surgical bed with us, we’ll have to take the ventilator, you know, the the complex machinery will have to take with us. But can do we need to take a pharmacy? Do we need to take a blood bank? Do we need to take supplies like gauze and surgical instruments and things like that? All of those challenges, all of those materials will likely be produced by 3d printing on Mars. And so if so we did some research team up at the Uniformed Services University of the health science, it’s a Military Medical School here has already printed red blood cells on a 3d bioprinter. And the FDA is currently evaluating those to see if they actually function as red blood cells. But this, you know, this is the first step in it. We’re in a frontier that is almost unimaginable, it’s, it’s almost at the level of Star Trek, where we type in what we want, and the printer makes it okay. And so imagine if we could print organs that there’s experimentation going on on the space station right now printing kidneys, imagine if we could print surgical instruments. If we could print replacement parts for the machinery that we take up to Mars. If we could simply print blood products, then our need for a blood bank or storage of massive amounts of blood products would be a thing of the past. Now people have ask why are we spending all this time and effort and money in space exploration? Imagine if that innovation that we use for space could be brought to the earth, and blood banks of the thing of the past, and blood borne infections and Rh and compatibility, you know, graft versus host reactions from the immune system are gone, because we can print the blood cells without antigens. So, I mean, that’s just massive potential, if we could print the molecular structure of medications that we need. And so you don’t have to take a pharmacy. If we can print gauze, if we can print, you know, anything that we need. Essentially, all you have to do is have the pressure vessel, you know, where you where you have the or you have your equipment that you bring with you, and then you make everything else. It’s spectacular. possibilities with that.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist and today I’m talking to Dr. Walter Matthews, he goes by Sparky. He’s a clinical professor in honors and the Honors College pre med advisor at Baylor University, and also the first Surgeon General of the US space force, we’re talking about the essentially I want to call it the colonization of space. Right. I mean, that’s, that’s not unreasonable. You know, the step away into the remote distance, you know, and the challenges of that time, your inability to sort of bring services and what you need to bring, you know, 3d printing as a basics, technology, we’ve seen that you’ve covered some of those, we’ve seen it with drugs, organs. What about the challenges of air quality or lack of air, the decrease pressure, and also the reduction in Gravity? We’ve seen the impact on the body, you know, a lot of great studies, you know, the work from NASA and others? How are we going to cope with that? Because that seems like a problem. That’s, it’s going to persist, right?
Sparky Matthews
Certainly. So the gravitational field of Mars is roughly 1/3. Earth’s gravity, I believe that’s correct. And so you bring up an interesting point that when we have seen when we have astronauts that go to orbit, and they’re in microgravity, so virtually no gravity, they go through bone demineralization, because they, they lose the sound, and they lose some of their cardiovascular reflexes, they have some muscle wasting, because they’re not using postural muscles. Well, so we haven’t spent an extended amount of time in a lower gravity environment, such as the moon or Mars. And so we’re going to be learning some of this as we go. But if if the if the human is required to to use musculature to stand, then that activates the postural muscles in such a way that we believe that most of that bone in demineralization will not be an issue, when we get to, you know, too long duration. You know, being on other planets, essentially, our bigger concern with that is how the body reacts when it’s trying to heal. So you have increased caloric requirements, you have, you know, massive oxygen requirements that go along with the calories for injuries and surgical, you know, surgical injuries to heal. And so, you know, wherever we go, you know, if we go to the moon, we have to take oxygen with us in some form. When we go to Mars, one of the things that we’re training people wonder, why are we looking for water on Mars? Why are we trying to find that ice? Well, that’s where oxygen is going to come from. And there is a NASA just landed a Mars Rover, and I can’t remember the name of the rover. But one of the experiments on that rover is converting atmospheric carbon dioxide on in the Mars environment, to oxygen to breathe oxygen. If we’re able to do that, with this rover, we have one of our what probably our biggest problem is solved. Because if we have oxygen, then we can concentrate that oxygen to almost any pressure we desire. So pressure brings up another issue that that we have to have a pressure vessel to 14 psi roughly the same that we have here on Earth, because lower the lower pressure causes a lower oxygen pressure, which decreases oxygenation of tissues, which then will cause inhibition of healing.
Nick van Terheyden
Yeah, so perseverance is there or in a you know, it’s stacked full of technology? lasers banging iPhone, you know, watch helicopters? Yeah, that’s right. They had a drone include that, you know, just incredible. I it’s so I You know, some extraordinary challenges, you know, obviously, you’ve got people there. What do you think the scope is for some automation to sort of deliver some of this, we get the, you know, delivery of tools and capabilities, but what about actually delivering the care if necessary?
Sparky Matthews
So that’s a really interesting question. One of the frequent questions my students ask, is, why do we need to send a surgeon to Mars? Can’t we use the da Vinci robot? Can we use robotic surgery, somebody here on Earth doing those procedures. So the problem is the distance and the communication lag. So anyone that is observed surgery, and certainly anyone that has had a scalpel in their hand, knows that that you know, even a half second delay between what you intend to do and what actually happens, can can cost of life. And so, you know, we may eventually get to the point where we can do that kind of automation. But to this kind of goes back to the difference between, you know, aircraft that don’t have pilots, so remotely piloted aircraft, and aircraft, where you have a pilot with their button seat, okay, there’s no fighter pilot in the world, that’s going to tell you that they can, you know, effectively complete, you know, air to air combat with another aircraft, sitting in a semi tractor trailer, you know, behind the screen, we’ve got to be there. And I believe that that’s how we’ll start with medical care on Mars. And this is kind of a reverse, I think we’ll start with people. And then as our technology advances, we will eventually regress back to progress, we’ll move to robotic surgery, or robotic procedures, right? There’s not a whole lot that we can do totally, robotically, right now in medicine robot. So robotic surgery can take the can take the shake the micro shakes out of a surgeon’s hand, but they can’t replace the hand.
Nick van Terheyden
So unfortunately, we’re running out of time, and I want to be sure to get a couple of sort of key questions in. One is, you know, if people want to get into this, and you know, focus on this, some thoughts about that you’ve obviously managed to architect a pathway into it. But the other one is a straightforward yes or no faster than light drive or not.
Sparky Matthews
I believe eventually. Okay. Yeah. Only because humans refuse to be told no.
Nick van Terheyden
I’m with you, because I’m a Trekkie. So I now what about folks, you know, as excited as me, but you know, maybe earlier in their career, how do you get to this, um, what should you be thinking about and doing so that you can be contributing and learning because I think you know, that the knock on effect into our world is just going to be immense as it was from NASA and Apollo. And
Sparky Matthews
so, so the path to get to being a physician in space, and that’s, that’s what I know, is it’s a standard pathway, all the way to the end of medical school. And then at the end of medical school, doing a residency in aerospace medicine, you can do that in any of the branches of the military. But we also have civilian programs. And there’s a great civilian program at Wright State University in Ohio. But there’s a space specific program or space focus program at the University of Texas Medical branch down in Galveston, and they actually work in the bio astronautics clinic at NASA at Johnson Space Center. So that discipline is how you get into space medicine. And once you get into the discipline, it’s a matter of, you know, if you want to go the civilian route, talking to NASA, SpaceX, I know is starting to develop a space medicine function within their organization. And certainly, within the military, you can right now physicians can’t join the space force, but we can join the Air Force which supports space force in providing medical support.
Nick van Terheyden
Exciting stuff, so if if it were to come up if somebody walked in and said, Sparky, we’d like you to go to space tomorrow would you go?
Sparky Matthews
I would. But only after asking my wife Monica, which means I wouldn’t she she’s been without me on deployment for too many months, too many years in my career, so
Nick van Terheyden
right. Well, I you know, at this point in my career, it just seems everything is getting faster, quicker. We’re getting the all of this exciting technology. You know, I can’t thank you enough for spending a little bit of time with me. Very excited about the potential and all of the things that we’ve learned and are going to learn in the future. So thanks for coming on the show.
Sparky Matthews
Thank you, Nick. It’s been a true pleasure.
