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HUMAN SPACEFLIGHT ETHICS AND OBLIGATIONS: 

OPTIONS FOR MONITORING, DIAGNOSING, 

AND TREATING FORMER ASTRONAUTS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON SPACE 

COMMITTEE ON SCIENCE, SPACE, AND 

TECHNOLOGY 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

SECOND SESSION 

June 15, 2016 

Serial No. 114–83 

Printed for the use of the Committee on Science, Space, and Technology 

( 

Available via the World Wide Web: http://science.house.gov 
(II) 

COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY 

HON. LAMAR S. SMITH, Texas, Chair 

FRANK D. LUCAS, Oklahoma 

F. JAMES SENSENBRENNER, JR., 

Wisconsin 

DANA ROHRABACHER, California 

RANDY NEUGEBAUER, Texas 

MICHAEL T. MCCAUL, Texas 

MO BROOKS, Alabama 

RANDY HULTGREN, Illinois 

BILL POSEY, Florida 

THOMAS MASSIE, Kentucky 

JIM BRIDENSTINE, Oklahoma 

RANDY K. WEBER, Texas 

JOHN R. MOOLENAAR, Michigan 

STEPHEN KNIGHT, California 

BRIAN BABIN, Texas 

BRUCE WESTERMAN, Arkansas 

BARBARA COMSTOCK, Virginia 

GARY PALMER, Alabama 

BARRY LOUDERMILK, Georgia 

RALPH LEE ABRAHAM, Louisiana 

DRAIN LAHOOD, Illinois 

WARREN DAVIDSON, Ohio 

EDDIE BERNICE JOHNSON, Texas 

ZOE LOFGREN, California 

DANIEL LIPINSKI, Illinois 

DONNA F. EDWARDS, Maryland 

SUZANNE BONAMICI, Oregon 

ERIC SWALWELL, California 

ALAN GRAYSON, Florida 

AMI BERA, California 

ELIZABETH H. ESTY, Connecticut 

MARC A. VEASEY, Texas 

KATHERINE M. CLARK, Massachusetts 

DONALD S. BEYER, JR., Virginia 

ED PERLMUTTER, Colorado 

PAUL TONKO, New York 

MARK TAKANO, California 

BILL FOSTER, Illinois 

SUBCOMMITTEE ON SPACE

HON. BRIAN BABIN, Texas, Chair 

DANA ROHRABACHER, California 

FRANK D. LUCAS, Oklahoma 

MICHAEL T. MCCAUL, Texas 

MO BROOKS, Alabama 

BILL POSEY, Florida 

JIM BRIDENSTINE, Oklahoma 

STEVE KNIGHT, California 

WARREN DAVIDSON, Ohio 

LAMAR S. SMITH, Texas 

DONNA F. EDWARDS, Maryland 

AMI BERA, California 

ZOE LOFGREN, California 

ED PERLMUTTER, Colorado 

MARC A. VEASEY, Texas 

DONALD S. BEYER, JR., Virginia 

EDDIE BERNICE JOHNSON, Texas 
(III) 

C O N T E N T S 

June 15, 2016 

Page 

Witness List ............................................................................................................. 2 

Hearing Charter ...................................................................................................... 3 

Opening Statements 

Statement by Representative Brian Babin, Chairman, Subcommittee on 

Space, Committee on Science, Space, and Technology, U.S. House of Representatives ........................................................................................................... 4 

Written Statement ............................................................................................ 6 

Statement by Representative Donna F. Edwards, Ranking Minority Member, 

Subcommittee on Space, Committee on Science, Space, and Technology, 

U.S. House of Representatives ............................................................................ 8 

Written Statement ............................................................................................ 10 

Statement by Representative Lamar S. Smith, Chairman, Committee on 

Science, Space, and Technology, U.S. House of Representatives ..................... 12 

Written Statement ............................................................................................ 14 

Statement by Representative Eddie Bernice Johnson, Ranking Member, Committee on Science, Space, and Technology, U.S. House of Representatives .... 16 

Written Statement ............................................................................................ 17 

Witnesses: 

Dr. Richard Williams, Chief Health and Medical Officer, NASA 

Oral Statement ................................................................................................. 19 

Written Statement ............................................................................................ 22 

Captain Chris Cassidy, United States Navy (USN); Chief, Astronaut Office, 

NASA 

Oral Statement ................................................................................................. 28 

Written Statement ............................................................................................ 30 

Captain Scott Kelly (USN, Ret.), Former Astronaut, NASA 

Oral Statement ................................................................................................. 35 

Written Statement ............................................................................................ 37 

Captain Michael Lopez–Alegria (USN, Ret), President, Association of Space 

Explorers-USA; Former Astronaut, NASA 

Oral Statement ................................................................................................. 41 

Written Statement ............................................................................................ 44 

Dr. Jeffrey Kahn, Professor of Bioethics and Public Policy, Johns Hopkins 

Berman Institute of Bioethics; Chairman, Committee on the Ethics Principles and Guidelines for Health Standards for Long Duration and Exploration Spaceflights, Board on Health Sciences Policy, National Academies 

of Sciences 

Oral Statement ................................................................................................. 54 

Written Statement ............................................................................................ 57 

Discussion ................................................................................................................. 62 

Appendix I: Answers to Post-Hearing Questions 

Dr. Richard Williams, Chief Health and Medical Officer, NASA ........................ 78 

Captain Chris Cassidy, United States Navy (USN); Chief, Astronaut Office, 

NASA ..................................................................................................................... 100 
Page

IV 

Captain Scott Kelly (USN, Ret.), Former Astronaut, NASA ................................ 109 

Dr. Jeffrey Kahn, Professor of Bioethics and Public Policy, Johns Hopkins 

Berman Institute of Bioethics; Chairman, Committee on the Ethics Principles and Guidelines for Health Standards for Long Duration and Exploration Spaceflights, Board on Health Sciences Policy, National Academies 

of Sciences ............................................................................................................. 114 
(1) 

HUMAN SPACEFLIGHT ETHICS 

AND OBLIGATIONS: 

OPTIONS FOR MONITORING, DIAGNOSING, 

AND TREATING FORMER ASTRONAUTS 

WEDNESDAY, JUNE 15, 2016 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON SPACE

COMMITTEE ON SCIENCE, SPACE, AND TECHNOLOGY, 

Washington, D.C. 

The Subcommittee met, pursuant to call, at 2:43 p.m., in Room 

2318 of the Rayburn House Office Building, Hon. Brian Babin 

[Chairman of the Subcommittee] presiding. 
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Chairman BABIN. The Subcommittee on Space will now come to 

order. 

Without objection, the Chair is authorized to declare recesses of 

the Subcommittee at any time. 

Good morning. Welcome to today’s hearing titled ‘‘Human 

Spaceflight Ethics and Obligations: Options for Monitoring, Diagnosing, and Treating Former Astronauts.’’ 

I recognize myself for five minutes and an opening statement. 

As a Nation, we have obligations to those we put in harm’s way. 

As a Congress, we have a responsibility to provide for the treatment of conditions caused by federal service. As a legislator that 

represents the Johnson Space Center and the Astronaut Corps, I 

have a duty to care for my constituents. 

Since the 1960s, the United States of America has asked its 

bravest to travel in space in service to their country. The government recognizes its obligation to care for those it puts in harm’s 

way in other instances. For example, we provide for the care of our 

veterans and our federal employees when their injuries are caused 

by their federal service. 

NASA currently provides treatment for active NASA Astronauts, 

and management and former astronauts are eligible for treatment 

of injuries sustained in their service through existing programs at 

the Department of Labor and the Department of Veterans Affairs. 

Over the last 15 years, several reports have highlighted the potential hazards of human spaceflight and the ethical obligations 

that we have as a Nation, and the additional steps that we might 

take and need to take to address gaps in meeting those obligations. 

From the dynamic launch environment to the unforgiving vacuum of space, to the energetic reentry to Earth, human spaceflight 

has always placed astronauts in challenging environments. Even 

training for spaceflight carries significant risks. 

Up until recently, however, space travel was measured in days. 

Mercury, Gemini, Apollo, and the Space Shuttle program placed astronauts in space for relatively short periods of time. Now, with the 

completion of the International Space Station, our astronauts now 

spend months in space. The risks and potential impacts on our astronauts’ health are not always seen immediately. 

Captain Scott Kelly recently returned from the ISS after spending 340 days in space on one mission. This put his cumulative time 

in space at 520 days. Extended missions like his are teaching us 

a lot about the long-term effects of human spaceflight. 

Weightlessness leads to osteoporosis and loss in bone density. 

Long-duration space missions also seem to impact vision, as 60 percent of ISS astronauts reported worsening eyesight. Furthermore, 

radiation exposure increases the likelihood of cancer. These are just 

some of the conditions we know about. Staying in space longer and 

pushing farther into deep space will likely present additional risks. 

And while NASA attempts to mitigate these risks with protocols 

and countermeasures such as exercise, drug treatments, and spacecraft shielding, there will probably always be a cost to our astronauts that they bear for traveling in space. 

This raises several fundamental questions. For instance, is the 

request for additional authority simply about treating former astronauts, or is it also about NASA getting better data on human 
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spaceflight? Are these two issues related? Are there classes of astronauts such as payload specialists who were not government employees that aren’t covered by existing authorities? How should 

NASA administer treatment? Should they do it in-house or simply 

reimburse patients for this treatment? If NASA decided to diagnose 

conditions in-house, does this pose a potential conflict of interest 

when NASA is financially obligated to compensate former astronauts for conditions caused by their federal service? How would additional authority affect existing rights and benefits under current 

statutes? How would creating a new program at NASA impact the 

causation standard set forth by the Departments of Labor and Veterans Affairs? In other words, will a new authority make it easier 

or harder for astronauts to receive treatment and compensation? 

In order to address these questions, Congress included a provision in the 2005 NASA Authorization Act that asked for a plan on 

how to best provide for former astronaut care. Similarly, the most 

recent Authorization Act that received unanimous support in the 

House and awaits consideration by the Senate contained a provision asking for a cost estimate for expanding treatment. 

I think everyone here wants to make sure that we are doing 

right by our astronauts. They put themselves in harm’s way to advance our knowledge of the universe and by bringing great pride 

to our Nation. 

I’m also very proud to say that I represent a great number of 

these astronauts who call Houston their home. As a health care 

professional myself and as their representative, you could say it’s 

my duty emphatically to make sure these folks are taken care of 

properly. 

But this isn’t simply about addressing a moral and ethical obligation. There is also a great benefit that we receive from providing 

this care. The long-term health information gained by providing 

treatment to former astronauts will give us a greater understanding of radiation exposure, vision impairment, bone loss, and 

many other ailments. This in turn will assist us to develop better 

monitoring and treatment protocols here on Earth for everyone, not 

just astronauts. 

I thank today’s witnesses for joining us as we discuss these very, 

very significant and important issues, and I look forward to hearing your testimony and your answers to our questions. 

[The prepared statement of Chairman Babin follows:] 
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Chairman BABIN. I now recognize the Ranking Member, the gentlewoman from Maryland, for an opening statement. 

Ms. EDWARDS. Good afternoon, and thank you, Mr. Chairman. I 

want to extend a welcome to our distinguished panel this afternoon, and thank you as well for your patience. 

Human space flight is inherently risky. That’s why NASA exercises diligence and caution during all phases of a space mission, including training, vehicle flight testing, launch, mission operations, 

and landing. 

In addition to mission risks, astronauts bear significant personal 

risks, particularly as they relate to their health. Health risks during long-duration flights include both short-term health consequences as well as potential long-term health conditions that 

may arise months and sometimes years after an astronaut’s service. 

This is a problem. Because of the small number of U.S. astronauts who have flown in space, and the corresponding small data 

set currently available on astronaut exposure during long-duration 

flights, characterizing those risks is a major challenge for NASA. 

However, if we are to go to Mars, as I have strongly advocated, 

mitigating these health risks is critical. But we also need to ensure 

that the risks NASA’s astronauts take are recognized and addressed by the American people. 

While active astronauts receive comprehensive health care, 

former astronauts do not. This needs to change. We need to ensure 

that care is provided for all of our NASA astronauts, not just those 

who are on active status. Providing ongoing medical care for active 

and former astronauts will give NASA the needed insight to enable 

earlier detection and treatment of any potential medical problems 

that could result from human spaceflight. It will also provide 

NASA with the data that are necessary to help mitigate against 

health risks related to future human space exploration. 

This is also a recommendation of a 2014 National Academies report, which concluded that lifetime healthcare for astronauts is our 

ethical responsibility. The report’s principle of fidelity recognizes 

that ‘‘Given the risks that astronauts accept in participating in 

hazardous missions, NASA should respect the mutuality of obligations and ensure health care and protection for astronauts not only 

during the mission but after return, including provision of lifetime 

care for astronauts.’’ 

NASA responded to the National Academies report by proposing 

a legislative change that would give NASA the authority to provide 

medical monitoring, diagnosis and treatment for psychological and 

medical conditions that are deemed by NASA to be associated with 

human spaceflight. 

It’s worth noting that, as the Chairman indicated, the bipartisan 

NASA Authorization Act of 2015, H.R. 810, that was passed by the 

House in February 2015, directs NASA to provide a formal response to the National Academies report. This response, as directed 

in the legislation, must include the budgetary resources required 

for implementation of the report’s recommendations, as well as any 

options that might be considered as part of the response. Had that 

bill been enacted, it is likely that our discussion today would have 

been much better informed. 
9 

That said, Mr. Chairman, it’s clear to me that ensuring comprehensive care of our astronauts before, during, and after their active service is a high priority. NASA’s legislative proposal provides 

one option for addressing this issue, and I hope that we can explore 

other options as well. 

However, the impact each option would have on existing authorities warrants careful consideration. For example, should Congress 

direct NASA to provide astronauts with lifetime healthcare in return for their service to the nation? Under this scenario, how would 

existing astronaut healthcare support systems be affected, including those provided by the Veterans Administration for former military astronauts? Or should Congress pattern astronaut care after 

NASA’s legislative proposal by directing NASA to provide enhanced 

medical screening that would facilitate claims made by former astronauts for occupational health conditions under the FECA and 

VA processes and provide proactive diagnosis and treatment, if 

needed, while those FECA and VA processes are underway? In either scenario, how would such authority be implemented? 

In addition, we need to clarify on how NASA intends to establish 

the causality link between human spaceflight and any identified 

psychological and medical conditions astronauts may develop. The 

bottom line here is that we need to do the right thing. 

And so Mr. Chairman, if the Committee intends to address the 

issues contained in NASA’s proposal, I would hope that we could 

craft legislation on a bipartisan basis, and I look forward to working with you. 

Thank you, and with that, I yield the balance of my time. 

[The prepared statement of Ms. Edwards follows:] 
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Chairman BABIN. Thank you very much, Ms. Edwards. 

I now recognize the Chairman of our full Committee, Mr. Smith 

from Texas. 

Chairman SMITH. Thank you, Mr. Chairman, and welcome to our 

all of our witnesses today including three astronauts. I often say 

publicly, and I’ll say again now, that I consider astronauts to be 

our modern heroes for many, many reasons, and certainly appreciate their presence here today. 

Mr. Chairman, I also believe this is probably the first hearing we 

have had dedicated entirely to the subject of astronauts’ health in 

space, and so it’s most timely, and as you and the Ranking Member 

both mentioned, it might lead to legislation that can be helpful to 

them in the future. 

Since NASA selected the first group of astronauts in 1959, more 

than 300 of America’s finest have ventured into the cosmos as explorers. Each one of these astronauts represented the compelling 

urge of humankind to explore and to discover and the lure of curiosity that leads us to try to go where no one has gone before. From 

Neil Armstrong’s first step on the Moon to Captain Kelly’s one-year 

voyage on the International Space Station, their peaceful exploration of outer space continues to inspire our nation and the world. 

In an age when spaceflight has come to seem almost routine, it 

is easy to overlook how dangerous it is and how little we know 

about the long-term health effects of spaceflight. 

For almost 20 years, astronauts have lived on the International 

Space Station. One of their primary missions has been to learn 

about the physiological and psychological effects of long-duration 

human spaceflight. Captain Kelly’s one-year mission was in pursuit 

of a scientific understanding of how the human body responds to 

extended space flight. 

But even with our 20 years of experience on the ISS, we are only 

just beginning to understand the effects of long-duration missions. 

Our lack of knowledge becomes especially evident as NASA prepares for its journey to Mars. 

Only 24 individuals have journeyed beyond low-earth orbit. All 

of these astronauts flew during the Apollo era and never for more 

than a handful of days. Using our current propulsion technology, 

a successful mission to Mars will require astronauts to survive a 

roundtrip spaceflight of no less than several hundred days, and unlike our near-Earth environment, the trip to Mars will offer no natural protection from galactic cosmic rays and solar radiation. 

Today, through its Lifetime Surveillance of Astronaut Health 

program, NASA screens and monitors astronauts for occupational 

related injury or disease. This program contributes to our scientific 

knowledge of long-term health effects and assists participating astronauts in monitoring for spaceflight related illnesses and disease. 

But this program does not provide for diagnosis or treatment of 

those no longer serving, nor for management and retired astronauts because NASA is not explicitly authorized to provide such 

services. These astronauts can receive treatment from the Department of Labor or the Veterans Administration now, but this may 

not be the best process for the former astronauts or NASA’s developing knowledge base. 
13 

We as a nation have a responsibility to ensure that our astronauts, both active and retired, are provided with appropriate monitoring, diagnosis, and treatment of spaceflight-related injuries and 

disease. This is also the recommendation of the National Academy 

of Sciences in its review of NASA’s study of astronaut health. 

For our nation, the question should not be whether we should 

provide these services to our astronauts, but rather how to do it in 

a way that best addresses the current and future needs of our 

space explorers in America’s quest for discovery of new frontiers. 

Thank you Mr. Chairman, and I’ll yield back. 

[The prepared statement of Chairman Smith follows:] 
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Chairman BABIN. Thank you, Mr. Chairman. I appreciate you. 

I now recognize the Ranking Member of the full Committee for 

a statement, Ms. Johnson from Texas. 

Ms. JOHNSON. Thank you very much, and good afternoon. Let me 

welcome our distinguished witnesses. 

Mr. Chairman, I’d like to thank you for holding this hearing on 

‘‘Human Spaceflight Ethics and Obligations: Options for Monitoring, Diagnosing, and Treating Former Astronauts.’’ 

Our NASA astronauts are American heroes, and they are some 

of the most accomplished, highly trained, and courageous individuals who serve our nation in the pursuit of furthering our exploration of outer space. 

Astronauts and our human space program also inspire the next 

generation, with many of our youngest Americans dreaming of one 

day following in their footsteps and exploring outer space. And I 

might add that no child falls asleep when there’s an astronaut 

speaking in high schools. 

It is no surprise that our astronauts are held in very, very high 

regard. They accept considerable risks in doing their jobs and serving our nation. And over the decades that we have been sending 

humans into outer space, more than a dozen NASA astronauts 

have paid the ultimate price as part of this service. 

That’s why I’m pleased that we are examining the responsibility 

we have to care for our astronauts, even after they have left active 

status including looking at the risk of cancer, musculoskeletal conditions, and ocular disorders are just a few of the known health 

concerns related to human spaceflight. But there is still much that 

we are learning and need to learn about the potential effects of 

space on the human body and on human health. 

Congress has acted to ensure that others we have put in harm’s 

way, such as those who have served in our military, receive lifetime healthcare. It is time we do the same for NASA astronauts. 

The practicalities of how we authorize the provision of such 

health care is very important, and I look forward to hearing from 

our witnesses on key questions and issues that Congress needs to 

consider before we legislate in this area. 

I thank you, Mr. Chairman, and yield back. 

[The prepared statement of Ms. Johnson follows:] 
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Chairman BABIN. Yes, ma’am. Thank you. 

Now I’d like to introduce our panel of distinguished witnesses. 

Our first witness today is Dr. Richard Williams, Chief Health 

and Medical Officer for NASA. In this role, Dr. Williams is responsible for the oversight of all health and medical activities at NASA 

including the medical aspects of all national and international 

NASA missions involving humans. He has extensive experience in 

the clinical practice of general surgery, aerospace medicine, and occupational medicine as well as in administrative medical management. During his 27-year Air Force career, Dr. Williams served in 

a wide variety of settings as a clinical practitioner and medical 

leader including service in the contingency deployments. Dr. Williams holds an M.D. degree from the Virginia Commonwealth University and completed residencies in general surgery at Wright 

State University and an aerospace medicine and occupational medicine at the United States Air Force School of Aerospace Medicine 

at Brooks Air Force Base in Texas. Thank you for being here. 

Second witness today Captain Chris Cassidy, a United States 

Navy SEAL and the 16th Chief of the Astronaut Office at NASA. 

As NASA’s Chief Astronaut, he is responsible for flight assignments, mission preparation, and on-orbit support of U.S. crews as 

well as organizing astronaut office support for future launch vehicles. Captain Cassidy was selected as an astronaut by NASA in 

2004, and he’s a veteran of two space flights, STS–127 and Expedition 35. During STS–127, Cassidy served as a Mission Specialist 

and was the 500th person in history to fly into space. Captain Cassidy has been deployed twice to the Mediterranean and twice to Afghanistan. He is the recipient of the Bronze Star with a Combat 

V and Presidential Unit Citation for leading a nine-day operation 

at the Zawar Kili Cave on the Afghanistan-Pakistani border. Captain Cassidy received a bachelor of science in mathematics from the 

U.S. Naval Academy and a master of science in ocean engineering 

from Massachusetts Institute of Technology. Thank for being here. 

I’m the proud father of a Navy SEAL myself. 

Our third witness today is Captain Scott Kelly, a retired U.S. 

Naval Officer and former NASA Astronaut, who is fresh off his oneyear mission in space. Welcome home, Captain Kelly. I’ve had the 

distinct pleasure and honor of meeting and visiting with Captain 

Kelly on several occasions before and after his historic mission. In 

1996, Captain Kelly was selected by NASA. He has logged more 

than 520 days in space on four space flights and served as Space 

Shuttle Pilot on STS–103 in 1999 and was the Mission Commander 

on STS–118 in 2007. Captain Kelly also served as a Flight Engineering for ISS Expedition 25, and as the Commander of ISS Expedition 26. In March of 2015, Captain Kelly launched for a one-year 

mission to the ISS serving as a Flight Engineer for Increments 43 

and 44 and Commander for Increments 45 and 56. Captain Kelly 

returned to Earth on March 2nd, 2016, after his historic 340-day 

mission aboard the ISS. Captain Kelly received a bachelor of 

science degree in electrical engineering from the State University 

of New York Maritime College and a master of science degree in 

aviation systems from the University of Tennessee in Knoxville. 

Thanks for being here, Captain Kelly. 
19 

Our fourth witness today is Captain Michael Lopez-Alegria, 

President of the Association of Space Explorers-USA, a retired U.S. 

Naval Officer, and former NASA Astronaut. Captain Lopez-Alegria 

has over 35 years of aviation and space experience with the U.S. 

Navy and NASA and a variety of roles including Naval Aviator, 

Engineering Test Pilot, and Program Manager, NASA Astronaut, 

and International Space Station Commander. He is a four-time astronaut, having flown on Space Shuttle Missions STS–73, STS–92, 

and STS–113, and serving as Commander of ISS Expedition 14, flying to and from the ISS aboard Soyuz-IMA-9. He holds NASA 

records for the most extravehicular activities, or spacewalks, or 

EVAs, 10 EVAs and cumulative EVA time of 67 hours and 40 minutes. Captain Lopez-Alegria received a bachelor of science in systems engineering from the U.S. Naval Academy and master of 

science in aeronautical engineering from the U.S. Naval Postgraduate School. He is also a graduate of Harvard University’s 

Kennedy School of Government Program for Senior Executives and 

National and International Security. Thank you for being here 

today, Captain. 

Our final witness today Dr. Jeffrey Kahn, Professor of Bioethics 

and Public Policy at Johns Hopkins Berman Institute of Bioethics, 

and Chairman of the Committee on Ethics, Principles and Guidelines for Health Standards for Long Duration and Exploration 

Spaceflights for the Board on Health Sciences Policy at the National Academies of Sciences. His research interests include the 

ethics of research, ethics in public health, and ethics in emerging 

biomedical technologies. Dr. Kahn speaks widely both in the 

United States and abroad and has published four books and over 

125 articles in bioethics and medical literature. Dr. Kahn received 

his B.A. from the University of California-Los Angeles, Ph.D. from 

Georgetown University, and MPH from Johns Hopkins Bloomberg 

School of Public Health. 

The Committee also invited a representative from the Department of Labor to discuss how the Department of Labor currently 

provides for treatment of federal employees under the Federal Employee Claims Act, or FECA. The Committee sent Secretary Perez 

or anyone in the agency that he would like to designate an invitation to appear. Unfortunately, the Department of Labor could not 

find anyone to appear, which is very surprising since there are 

17,000 employees at the Department of Labor. 

Furthermore, we only asked them to comment on what they already do. Executive Branch officials have a responsibility to Congress and to the taxpayers of the United States to provide testimony and inform the legislative process. I am disappointed that a 

federal agency was unable to assist Congress, failing to fulfill this 

fundamental responsibility. It is no wonder that NASA wants to 

handle these issues themselves. 

I would now like to recognize Dr. Williams for five minutes to 

present his testimony. 

TESTIMONY OF DR. RICHARD WILLIAMS, 

CHIEF HEALTH AND MEDICAL OFFICER, NASA 

Dr. WILLIAMS. Mr. Chairman and Members of the Committee, 

thank you for this opportunity to appear before you today to dis-
20 

cuss the critical issue of astronaut healthcare. This is an issue that 

has consumed me in my role as Chief Health and Medical Officer 

for NASA, and I am very grateful that the Committee is using its 

limited time and resources to focus on this critical agency priority. 

Astronauts are exposed to unique hazards that no one else on 

Earth has experienced. Microgravity and space radiation are just 

two of the exposures that are only found when we venture into 

space. Some conditions such as reduced muscle mass caused by exposure to microgravity are somewhat foreseeable while others are 

complete surprises. Certainly, the visual problems and increased 

risk of cataracts astronauts experience was not expected or predicted. 

For active astronauts, NASA currently provides medical care and 

treatment. We also use data from the treatment of active astronauts to figure out ways to minimize negative impacts to astronaut 

health. 

Some of the things we do include monitoring for radiation exposure, using exercise to combat microgravity effects, and continued 

health monitoring. While these efforts can’t entirely mitigate exposure to space, they are valuable. 

However, when it comes to former astronauts, the situation is 

different. We invite astronauts to participate in our voluntary Lifetime Surveillance of Astronaut Health program. This includes a 

limited health status evaluation on an annual basis at the Johnson 

Space Center Flight Medical Clinic. 

However, if there are questions or concerns from this evaluation, 

NASA can only encourage astronauts to follow up with their personal healthcare providers. This presents a number of problems. 

NASA cannot do all the tests it believes need to be done to effectively monitor former astronauts as some of these tests would be 

considered personal healthcare. If personal physicians do tests and 

evaluations, we often do not have access to the data unless the astronaut aggressively pursues getting this data to us. And 

healthcare providers often don’t understand the need for some of 

the targeted tests that we require for occupational health surveillance and would not routinely order them. 

For example, some astronauts should probably be receiving yearly MRI scans of the area around their eyes. MRI scans are not normally used as preventive screening; they are usually ordered in response to illness or injury. 

I need to emphasize how small this population is. There are only 

280 living astronauts that have flown in space—280. That isn’t 

even enough to take a good consumer product survey, let alone try 

to predict what effects human spaceflight might have on the 

human body 10, 20 or 30 years down the road. An average doctor 

or nurse practitioner no matter how skilled they are has no exposure to or understanding of these issues. 

With only 280 people to collect data from, we need to get as 

much data as possible from every one of them. With only 60 percent of our former astronauts participating in the current surveillance program, expanding our authority to provide for extensive 

testing would be a great incentive to increase this number. We believe 80 percent or more would participate if our authority to provide testing and monitoring was expanded. 
21 

Being able to gather data on astronauts’ medical conditions and 

understand the health impact of spaceflight exposures over time is 

essential to provide crew health and safety during long-term journeys beyond low-Earth orbit. If we’re serious about going anywhere 

beyond low-Earth orbit, we’ll need to understand these risks. 

Ethically, we will make sure all decisions astronauts make about 

their healthcare and personal information are completely voluntary. This brings me to an issue that may even be more important than our need for data, and that is our ethical obligation to 

our astronauts. When the United States government puts individuals in harm’s way, our government has an obligation to care for 

them. Our military personnel are provided the care they need for 

the hazards and dangers they have faced in service to our country. 

The Institute of Medicine has in multiple studies pointed out that 

NASA has an ethical obligation to the astronauts who have dared 

exposures no other human beings in history has faced. 

To meet the health needs of our astronauts and to live up to our 

ethical obligations, I urge Congress to act to ensure we can safeguard the well-being of our former and future astronauts. 

Mr. Chairman, I would be glad to answer any question you or 

any other member might have. 

[The prepared statement of Dr. Williams follows:] 
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Chairman BABIN. Thank you, Dr. Williams. 

I now recognize Captain Cassidy for five minutes to present his 

testimony. 

TESTIMONY OF CAPTAIN CHRIS CASSIDY, 

UNITED STATES NAVY (USN); 

CHIEF, ASTRONAUT OFFICE, NASA 

Captain CASSIDY. Mr. Chairman and Members of the Committee, 

I sincerely appreciate the chance to appear before you today. Thank 

you very much. 

As the Chief Astronaut for NASA, this issue is not only critically 

important to the agency but also of great importance to myself, 

both professionally and personally. In my role as the Chief, I serve 

in the most senior leadership position for active astronauts. I am 

the principal adviser Administrator Bolden through NASA leadership and the chain of command on all aspects of astronaut operations. This covers a wide variety of tasks from astronaut training, 

operations, and safety to advising on spacecraft design and even 

finding astronauts to speak in order to inspire our nation’s students and the public and to keep those high school students from 

falling asleep. 

We take healthcare very, very seriously. Other than our crew, 

the most precious resource on the International Space Station is 

time. We have an international mix of six crew members on the 

Space Station, and each of them has only 16 hours of awake time 

per day. Every minute of this period is treated as a critical resource similar to that of air, water or food. This time is used to accomplish the hundreds of scientific experiments to execute the 

many tasks required to keep the ISS functioning yet we still schedule two hours of exercise every single day. This is done simply because it’s the best way we have found to counteract the effects of 

microgravity exposure. Without a doubt, there are many other 

tasks that could be accomplished with those two hours. However, 

absolutely nothing is more important than keeping our astronauts 

as healthy as we possibly can. 

Our knowledge of the kinds of health changes associated with 

the exposure to space has increased as more astronauts fly on the 

Space Station. Conditions have surfaced after long-duration 

spaceflight that were not apparent in short-term space exposure. 

For example, muscle atrophy and the associated bone loss have 

been experienced on longer-duration flights that were not a concern 

on shorter missions. 

There are other major risks to long-term exposure to space. 

There is far more radiation in space without the protection of 

Earth’s magnetic field. There is also experimental evidence that radiation encountered in space as compared to gamma or X-rays commonly encountered on Earth is more effective at causing the type 

of biological damage that ultimately leads to cancer. This means 

that astronauts need to be more closely monitored for cancer for 

the rest of their lives versus someone who has not flown in space. 

Right now, NASA only has limited authority to provide medical 

monitoring for former astronauts. Our current program, the Lifetime Surveillance of Astronaut Health, does basic health screening 

but can’t provide for the advanced monitoring and testing that is 
29 

needed. Expanding the tests and conditions NASA can proactively 

monitor would greatly assist in establishing the evidence base that 

we need. It would also increase the numbers of astronauts who participate. With only about 280 living people who have flown in 

space, and about 60 percent of those former astronauts participating in a limited health evaluation, every additional astronaut 

who can be part of this population is vital. 

The other reason for doing this extensive monitoring is to catch 

medical conditions in the early stages before they become more serious. Proactive monitoring gives us a much better chance of treating diseases in the early stages with a greater likelihood for a positive outcome. 

The lack of advanced monitoring worries me for another reason. 

We are involved in helping to evaluate our new generation of 

spacecraft, and the lack of data hampers us in our efforts to go beyond low-Earth orbit. How do we design vehicles to protect against 

the long-term effects of microgravity and radiation exposure if we 

still aren’t certain of what those effects entirely are? 

I work with our Astronaut Corps on a daily basis. This isn’t just 

an abstract issue for me. I know these men and women and their 

families. Their dedication, enthusiasm, bravery and diligence while 

they voluntarily accept the risks and dangers of spaceflight, that 

should not be an excuse to not be thorough with their health. We 

need to do everything in our power to understand and minimize 

the hazards they face in order to further protect future generations 

of Americans who will one day live off of our planet. 

Mr. Chairman, I would be happy answer your questions, and I 

look forward to them. Thank you. 

[The prepared statement of Captain Cassidy follows:] 
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Chairman BABIN. Thank you, Captain Cassidy. I really appreciate that. 

I now recognize Captain Kelly for five minutes to present his testimony. 

TESTIMONY OF CAPTAIN SCOTT KELLY 

(USN, RET.), 

FORMER ASTRONAUT, NASA 

Captain KELLY. And Mr. Chairman, I have a short video, if you 

don’t mind, an introduction video. 

[Video playback] 

Mr. Chairman and Members of the Subcommittee, thank you for 

the opportunity to appear before you today to discuss the importance of understanding the medical impacts of human spaceflight 

on astronauts and the proposed legislation on astronaut health. 

This issue is of critical importance to me and to our nation’s future 

space exploration initiatives. 

I recently returned with my colleague, Russian Cosmonaut Mikhail Kornienko, from nearly a year in space aboard the Isa, which 

serves as our best asset for understanding how human physiology 

behaves in a microgravity environment. Until at least 2024, the 

Space Station will continue to provide a platform for research on 

astronaut health and many other scientific investigations. 

The major objective of this Year in Space mission was to expand 

the experience and knowledge base required to safely send humans 

deeper into our solar system. A Mars mission is no easy feat and 

could require astronauts to be in space for three years or more. 

During this mission, we conducted more than 400 experiments in 

the fields of biology, material sciences, chemistry, and physics. 

Many of these experiments focus on how the human body responds 

to weightlessness and other effects of long-duration spaceflight. 

One of these experiments, which was dubbed the Twins Study, 

gave researchers the unique opportunity to study my physiology 

while I was in space compared to my twin brother, retired Astronauts and Navy Captain Mark Kelly, who was on Earth. Data acquired from this Year in Space Mission will help NASA make determinations that will directly affect decisions regarding crew safety in the years to come in areas from the design of future spacecraft to medical and psychological risk mitigation. Although I’ve 

been home for 100 days, much of the data is still being analyzed 

by researchers from around the world. 

You know, much attention is paid to the risks astronauts face 

while launching aboard rockets or returning to Earth in a giant 

fireball. Much less attention is given to the other risks we face, 

which are much more insidious but potentially just as fatal. The 

environment astronauts are exposed to while in space is unlike 

anything we experience here on Earth. Specifically, we’re exposed 

to high levels of radiation and carbon dioxide, and a microgravity 

environment which causes loss of bone and muscle, vision impairment, and effects on our immune system, to name just a few. These 

are very real issues that need to be solved before the human race 

is able to reach destinations beyond the Earth and the Moon. 

When I returned after 340 days, I was surprised how differently 

I felt compared to my long-duration mission of 159 days. My mus-
36 

cles more quickly stiffened, and because my skin hadn’t touched 

anything for nearly a year, it was extremely sensitive and became 

inflamed. I developed a hive-like rash on every surface of my skin 

that came in contact with ordinary surfaces on Earth during normal activities like sitting or lying in bed. My legs were swollen due 

to the fluid shift imposed upon my body by gravity. I even had flulike symptoms that appeared to have been a result from my extended time in space. 

Exposure to the space environment has permanent effects we 

simply do not fully understand. The Lifetime Surveillance of Astronaut Health program NASA has in place to study astronaut longterm health is too limited to provide the data needed to ensure the 

safety of our space explorers. If we are to go beyond low-Earth 

orbit, NASA needs the ability to proactively and aggressively monitor, diagnose and treat astronauts who serve our country in the 

name of science and exploration. Expanding healthcare coverage 

for our U.S. Astronaut Corps will enable NASA to more effectively 

and efficiently support it and collect the data necessary to push out 

further into our solar system. 

Furthermore, continued investigation of space-related ailments 

and mitigation steps will help in treating similar ailments on Earth 

such as osteoporosis, muscle wasting diseases, high blood pressure, 

glaucoma, and certain brain disease, to name just a few. There are 

already FDA-approved treatment modalities which are a result of 

space-based research. 

Although Mars and other long-term NASA objectives seem to be 

many years ahead of us, laying a secure foundation for astronaut 

health is imperative to the continuance of our nation’s ability to explore. Healthcare for our astronauts is critically important. Our astronauts are exposed to numerous health risk factors while in 

space, and while we are aware of some of the impacts, we just need 

more data from astronauts in space and on the ground to better 

understand these negative effects of this harsh environment. 

The proposed legislation on astronauts health will not only help 

us learn more about the impacts of human spaceflight but also will 

serve to protect the health of those who push the boundaries in the 

name of exploration on behalf of our nation. We are on the cusp 

of a new Space Age, one in which greater numbers of Americans 

will travel to space and go further than ever before. 

I was honored to play a small role in paving the way for those 

future pioneers but want to make it clear, this Year in Space mission was not my achievement; it was the achievement of thousands 

of dedicated professionals that believe, like I do, that the benefit 

of human spaceflight is vital to the continued success and development of our nation and our species. 

Mr. Chairman, I’d be happy to respond to any questions you or 

other members of the Subcommittee may have. Thank you. 

[The prepared statement of Captain Kelly follows:] 
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Chairman BABIN. Thank you, Captain Kelly. We really appreciate your testimony. 

And now I recognize Captain Lopez-Alegria for five minutes. 

TESTIMONY OF CAPTAIN MICHAEL LOPEZ–ALEGRIA (USN, 

RET), 

PRESIDENT, ASSOCIATION OF SPACE EXPLORERS-USA; 

FORMER ASTRONAUT, NASA 

Captain LOPEZ-ALEGRIA. That’s all right. Thanks, Chairman 

Babin, Ranking Member Edwards, and Chairman Smith, and 

Ranking Member Johnson and all the Members of the Subcommittee. Thanks for organizing this hearing and for asking me 

to give you some comments on the proposed legislative language as 

the President of the USA Chapter of the Association of Space Explorers. 

ASE is an international nonprofit professional and educational 

organization that has only one prerequisite for membership: having 

made at least one orbit of the Earth in space. Our vision is a world 

where living, working and exploring in space will be as familiar to 

humanity as life on our home planet. 

We count among our members over 400 current and former astronauts and cosmonauts from 37 nations and are organized into 

four regional chapters: Russia, Europe, Asia, and ASE–USA, by far 

the largest with 214 living members. 

There’s a standing joke at the NASA Johnson Space Center in 

Houston that if you ask five astronauts for their opinion on an 

issue, you’ll get at least six answers. Nonetheless, the response I 

received from the membership of ASE–USA was absolute unanimity in support of the change that would allow NASA to provide 

enhanced monitoring, diagnosis, and treatment of the effects of 

health hazards that are associated with having flown in space. 

I heard from former astronauts who left the agency from several 

months to several decades ago, and many of the stories were strikingly similar. My written statement mentions some of the known 

health hazards that are unique to the spaceflight environment, and 

members of the ASE–USA convincingly confirmed that that list is 

real with many personal accounts of musculoskeletal, vision, bone 

density, and most grimly, cancer-related medical issues. 

In some case, their maladies were flagged during annual exams 

that are offered by NASA as part of the Lifetime Surveillance of 

Astronaut Health but in all cases, further diagnosis and any treatment is at the expense of the astronaut. There is ample precedent 

for targeted surveillance and treatment for occupationally related 

medical conditions both within the government, for instance, 

healthcare for veterans as well as screening for DOE and DOD nuclear workers as well as by non-government employers for their 

workers in mines, foundries, and in civilian nuclear power industry. 

But as compelling as some of my former colleagues’ medical situations are, the most persuasive argument for this type of legislation is that understanding the human physiological response to 

spaceflight is imperative to inform future policies and procedures 

for managing health risks in space. 
42 

In the absence of methodical medical surveillance and care for 

those exposed to these health risks, we are irretrievably losing an 

invaluable source of data and severely hampering our plans to extend human exploration beyond low-Earth orbit. 

The current and former astronaut cadre is the only study population that can facilitate our understanding of past and future 

space-related health risks. It is unforgivable to not monitor their 

health and collect and analyze the relevant associated data. 

I’m a participant in a previously mentioned LSAH. Each year I 

travel to Houston and receive a medical check that includes collecting my vital signs, blood and urine samples, exams of my vision, hearing, and lung function, an EKG, and a brief physical 

exam by a flight surgeon. Every few years, it is recommended that 

I undergo a colonoscopy to look for polyps or tumors that may have 

appeared as a result of my exposure to ionizing radiation while on 

orbit. The procedure is completely voluntary, and if I do choose to 

have it done, the results are not a priori shared with NASA. This 

is just one example of the lack of monitoring that negatively affects 

our understanding of the epidemiology of spaceflight. 

Another valuable test that might be performed is high-powered 

MRI of my eyes to look for anatomical changes. Like about 60 percent of long-duration astronauts, I suffer from microgravity ocular 

syndrome, sometimes called vision impairment and intracranial 

pressure. VIIP is emerging as one of the most significant and least 

understood health risks for human exploration beyond low-Earth 

orbit. It seems absurd that we do not actively study those who have 

suffered from it. 

During my seven months aboard the ISS, my bone mineral density decreased by over ten percent. While the density itself recovered after a couple of years, we don’t fully understand if the structure of the bone and therefore its resistance to fracture has returned. A test like QCT, quantitative computed tomography, cannot only measure bone mineral density but also assess the geometry of the bone and the stress-strain index, a much better measure 

of fracture resistance. This test is also not performed as part of 

LSAH. 

What I found perhaps most startling in responses from the ASE– 

USA membership was how many reported that they have dropped 

out of the LSAH program. A relatively routine physical that lacks 

targeted surveillance of known space-related health hazards, let 

alone any kind of in-depth diagnosis or provision of treatment, is 

simply not compelling enough for many former astronauts who 

might live far from Houston to take time from work and family to 

make the trip. This means that not only is NASA deprived of any 

data related to spaceflight-specific health risks, even the routine 

surveillance that is part of today’s LSAH is often being done by 

local medical providers and the associated information is lost to 

NASA. 

There is a moral and ethical obligation on the part of any employer to exercise due diligence to study all occupational hazards 

that its employees encounter in the workplace to understand the 

short- and long-term health effects of those dangers to use all reasonable methods to prevent these risks from negatively impacting 

the well-being of its current and future workers and to provide care 
43 

for former employees who suffer health issues as a result of their 

service. 

There are a number of significant human health risks associated 

with flying in space. Many of these perils are unique to the 

spaceflight environment and most evade our full understanding. 

It’s clear that we must do our utmost to mitigate these risks for 

the cadre of current and future American astronauts by assiduously monitoring the health and, where applicable, treatment of 

their predecessors. This information is absolutely imperative for 

the design of missions, vehicles, and countermeasures for the 

human exploration of space beyond low-Earth orbit. 

Thank you again for this opportunity, and I look forward to answering questions from the Subcommittee. 

[The prepared statement of Captain Lopez-Alegria follows:] 
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Chairman BABIN. Thank you, Dr. Lopez-Alegria. 

And now I recognize Dr. Kahn for five minutes. 

TESTIMONY OF DR. JEFFREY KAHN, 

PROFESSOR OF BIOETHICS AND PUBLIC POLICY, 

JOHNS HOPKINS BERMAN INSTITUTE OF BIOETHICS; 

CHAIRMAN, COMMITTEE ON THE 

ETHICS PRINCIPLES AND GUIDELINES 

FOR HEALTH STANDARDS FOR LONG DURATION 

AND EXPLORATION SPACEFLIGHTS, 

BOARD ON HEALTH SCIENCES POLICY, 

NATIONAL ACADEMIES OF SCIENCES 

Mr. KAHN. Thank you. Chairman Babin, Ranking Member 

Edwards, Committee Chairman Smith, and Ranking Member Johnson, thank you for the opportunity to present testimony on this 

timely and vitally important subject today. I am a Professor of Bioethics and Public Policy at the Johns Hopkins University Berman 

Institute of Bioethics in Baltimore, and I should say after the introduction of my fellow witnesses, a rank underachiever. 

I appear before you today in my capacity as Chair of the Institute of Medicine—now the National Academy of Medicine—Committee on Ethics Principles and Guidelines for Health Standards 

for Long Duration and Exploration Spaceflights, which issued its 

report in April 2014, as Representative Edwards has already noted. 

In addition, I should note that I’m currently Chair of the Board 

on Health Sciences Policy for the Health and Medicine Division of 

the National Academies, and a member of the Division’s standing 

Committee on Aerospace Medicine and Medicine of Extreme Environments. 

In those contexts, I will describe recommendations contained in 

the report of the committee I mentioned related to protecting and 

sustaining astronaut health. 

First, I want to say that my committee’s report in 2014 was not 

the first to identify the ethical obligations to protect astronaut 

health, as has been noted by others. As outlined in the 2001 IOM 

report titled Safe Passage, and as noted in the my committee’s report as well, the new challenges that will be faced in long-duration 

and exploration spaceflight necessitate a new look at the ethics 

principles for these missions, and I quote now from Safe Passage: 

‘‘Current ethical standards for clinical research and practice with 

astronauts were developed in an era of short space missions when 

repeat missions were the norm and a return to Earth within days 

was possible. In future missions beyond Earth orbit, however, a diverse group of astronauts will travel to unexplored destinations for 

prolonged periods of time. Contact with Earth will be delayed, and 

a rapid return will be impossible. Long-duration missions beyond 

Earth orbit, space colony habitation, or interplanetary travel will 

create special circumstances for which ethical standards developed 

for terrestrial medical care and research may be inadequate for astronauts. These ethical standards may require reevaluation.’’ That 

again is from 2001. 

My committee in 2014 noted that NASA, as an employer, a federal agency responsible for innovation and exploration, a research 
55 

sponsor, and an international partner, has moral obligations to formally recognize and act on responsibilities that logically flow from 

the ethics principles outlined in our report if long-duration and exploration spaceflights are to be ethically acceptable. Among the six 

principles we identified, two are particularly relevant for discussion 

in the context of health care for former astronauts. Those principles 

are (1) fairness, and (2) as already noted by Representative 

Edwards, fidelity. Let me quote from the report. ‘‘Fairness is the 

principle that requires that equals be treated equally, that burdens 

and benefits be distributed fairly, and that fair processes be created and followed. NASA’s decision making surrounding missions 

should explicitly address fairness, including the distribution of the 

risks and benefits of the mission, crew selection, and protections for 

astronauts after missions.’’ 

An important ethical challenge of exposing humans to the risks 

of long-duration and exploration spaceflight is that the burden of 

the health risks associated with these missions falls to a limited 

number of astronauts and their families as well while the benefits 

of the proposed missions accrue primarily to future astronauts and 

to society more broadly. 

In addition to being a concern of appropriate risk-benefit balance 

about going at all, the appropriate risk-benefit distribution must 

also be considered. Asking individuals to accept great risk, either 

in likelihood or magnitude of the harm to be caused, can be partially balanced by making a commitment to provide long-term 

health care and health monitoring. 

The second principle we identified is fidelity, and again I quote 

from the report. ‘‘Fidelity is the principle that recognizes that individual sacrifices made for the benefit of society may give rise to societal duties in return. Given the risks that astronauts accept in 

participating in hazardous missions, NASA should respect the mutuality of obligations and ensure health care and protection for astronauts not only during the mission but after they return, including provision of lifetime health care for astronauts.’’ 

Those who consent to incur long-term health risks for society’s 

benefit are entitled to fidelity, reflected in society’s commitment to 

minimize any harms that emerge, whenever they emerge. The committee noted that this concept of fidelity or reciprocity resonates 

with the basic, widely shared understanding that it is unjust to 

allow some people alone to bear burdens which, in all fairness and 

justice, should be borne by the public as a whole. As a practical 

matter, the public cannot physically share the risks that astronauts 

will bear. It can, however, share the costs and burdens of ongoing 

risk mitigation efforts. 

An astronaut’s consent becomes binding and irrevocable at the 

moment the mission launches. Astronauts are free to withdraw 

their agreement to participate prior to launch of course, but from 

the launch moment forward, it becomes nearly impossible to turn 

back, and astronauts likely will encounter uncertain and 

unquantifiable risk exposures and endure potential harms to 

health that will persist after the mission. The irrevocability of participation in spaceflight creates an ethical imperative to define 

long-term duties owed to the participating astronaut. 
56 

In this context, the principles identified by our committee report 

support the minimization of risk of harm, the treatment of injuries 

or health conditions during the flight, and the ongoing monitoring 

and provision of health care after the flight. This binding duty to 

provide ongoing surveillance, monitoring, and health care during 

the lifetime of the astronaut is part of the continuum of risk management that begins with engineering and design efforts to minimize risk and continues through the flight and post flight. Our 

committee concluded that the ethics responsibilities that result 

from sanctioning high-risk activities include continuous learning 

and engagement in health-related activities that protect astronaut 

health, support ongoing evaluation of health standards, improve 

mission safety, and reduce risks for current and future astronauts. 

Employers that knowingly expose employees to risks have an 

ethical responsibility to provide protection to the extent possible 

and to address the harms that occur when protections fail or turns 

out to be inadequate. Robust research and health monitoring or 

surveillance programs that fully inform all who are involved, including astronauts and their families, are required. 

Furthermore, the committee maintained that the nation, through 

NASA, has the ethical duties to protect and sustain astronaut 

health based on the ethics principles of fairness and fidelity. Providing lifetime health care to astronauts respects the commitment 

that our astronauts have made and the risks they have taken on 

society’s behalf. 

Thank you. 

[The prepared statement of Mr. Kahn follows:] 
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Chairman BABIN. Thank you, Dr. Kahn. All fascinating testimony. I thank every one of you witnesses for your testimony, and 

now I recognize myself for five minutes for questions. 

The first one I’d like to direct to Dr. Williams. How would additional authority affect existing rights and benefits under current 

statutes? And would creating a new program at NASA impact the 

standards that are set forth by the Departments of Labor and Veterans Affairs for compensation and treatment? In other words, will 

a new authority make it easier or harder for astronauts to receive 

the treatment and compensation that they are due? 

Dr. WILLIAMS. Thank you for the question, sir. I don’t think that 

there’ll be a major impact to existing infrastructure. As a matter 

of fact, we envision using an existing claims infrastructure working 

very closely with our partners in the Department of Labor, and 

we’re developing the same relationships with the Department of 

Veterans Affairs to approach this as a facilitated claims process, 

providing the expertise and space medicine and disease-specific experts as well as the evidence base that we’ve accrued so far to help 

determine the likelihood of association with occupational exposure 

as disease develops in our former and retired astronauts. 

With regard to your question about whether I think this will 

make it easier to advance the plausibility of association, I think it 

likely will, sir. I think endorsement by the Congress in recognition 

that these unusual exposures can cause disease in our astronauts, 

I think that will send a powerful message and will enable us to be 

more successful in taking care of them. 

Chairman BABIN. Absolutely. Thank you very much, Doctor. 

The next question I’d like to direct to our three distinguished astronauts. If NASA is given authority to provide additional treatment for astronauts beyond existing programs at the Department 

of Labor and Department of Veterans Affairs, should NASA provide 

that treatment in-house at NASA or reimburse patients for privatesector treatment? Captain Cassidy, how about you first? 

Captain CASSIDY. Mr. Chairman, that’s an excellent question. I 

think that there’s some degree of care that can be handled in-house 

at the Johnson Space Center but I also think that there should be 

some flexibility in order to take care of the former astronauts who 

potentially in their older age have a hard time getting back to 

Johnson Space Center, or because of their condition can’t make 

that trip. 

Chairman BABIN. Right. Okay. 

Captain Kelly? 

Captain KELLY. Sir, I don’t really have anything to add other 

than what Chris said, but I think, you know, the emphasis on some 

of these guys, as we age and traveling back and forth to Houston 

could be problematic. 

Chairman BABIN. Sure. Thank you. 

And Captain Lopez-Alegria? 

Captain LOPEZ-ALEGRIA. Yes, Mr. Chairman, pretty similar. I 

think clearly there are some things that the clinic at Johnson 

Space Center could not do from a medical perspective. We couldn’t, 

you know, treat somebody with chemotherapy, for instance, at JSC, 

but I think to the extent possible, we should try to keep it in-house 

just to facilitate the transfer of the data, which are very important 
63 

to the discussion, but agree with my colleagues about that being 

impractical in some cases. I think that we should endeavor to make 

it happen when possible but realize that that won’t always be the 

case. 

Chairman BABIN. Sure, and then just to follow up, if NASA does 

decide to diagnose and treat conditions in-house, does this pose a 

potential conflict of interest when NASA is financially obligated to 

compensate former astronauts for conditions caused by their federal service? If one of you three would like to take a stab at that? 

Captain CASSIDY. Well, let me start by saying—and Scott will 

back me up on this—as military aviators, we have an adversarial 

relationship with our flight surgeons generally. I was expecting 

that to be the case at NASA and could not have been more wrong 

about that. The relationship that we enjoy is very unique, and 

there’s no doubt in my mind that our best interests are at heart 

when they give us treatment. So I would have a great level of confidence that the people with whom we all have personal relationships would be very disposed to help us to the extent possible, and 

I don’t see there being a conflict of interest. I think that it if you’re 

saying the conflict of interest would mean they would be reluctant, 

I don’t see that as a likelihood. 

Chairman BABIN. Right. Anybody else? Pretty much in agreement? 

It’s an interesting comment you make, because I was an Air 

Force dentist, and occasionally we had to put DNIF on somebody’s 

records, and they were not happy: duty not to include flying. 

Let’s see. I think I’m out of time so I will yield back, and we will 

call on the next one, the Ranking Member from Maryland, Ms. 

Edwards. 

Ms. EDWARDS. Thank you, Mr. Chairman, and thank you again 

to the witnesses. Your testimony was really—was very thorough. 

One of the questions that I had as we came up, and particularly 

for Captain Lopez-Alegria, if you could tell me whether the care is 

provided in-house or out-of-house in terms of the surveillance data 

that are gathered, and Dr. Williams, please contribute as well, it 

seems to me that you all are already close to or you already have 

a tool that could—a screening tool that could easily be used more 

broadly, whether that’s at Johnson or at some private care facility, 

and the question is whether we can authorize both the mechanism 

for surveillance but also separately the provision of health care, in 

which case you would be able to capture more than the 60 percent, 

I think, of the Astronaut Corps, retired and active, who are currently participating. Would that be right? 

Captain LOPEZ-ALEGRIA. Well, I think your last point would absolutely be right, that you would have far more participation than 

we have. I don’t know enough about what the current limits of the 

authority on the screening that are in place right now, but I do 

know that some of the tests that I mentioned in my oral testimony, 

which could be done, which hare very specifically targeted to hazards that are known to be caused by flying in space, are not being 

done, and I think that if that authority does not exist, which I assume it doesn’t, who would be doing them, then they should be. 

Ms. EDWARDS. Dr. Williams? 
64 

Dr. WILLIAMS. Yes, ma’am. We—our current authority to provide 

that ongoing health monitoring to former and retired astronauts is 

limited. Our ability to spend appropriated funds in providing that 

diagnosis and much more so in providing treatment in that group, 

we don’t feel like we have the authority to do that. So although we 

have the basic framework in place, which is the Lifetime Surveillance of Astronaut Health, we believe that that framework can be 

greatly enhanced and greatly expanded and become much more 

comprehensive with specific authority to provide diagnosis and 

treatment. 

Similarly, we think that our ability to engage and treat serious 

illness that arises in the Astronaut Corps will be greatly facilitated 

by the—for the lack of a better word, I’d say the facilitated claims 

process we envision with our partnerships with the Department of 

Veteran Affairs and the Department of Labor. 

Ms. EDWARDS. So, I mean, I want to get to this, because I think 

there’s a separate question. If we give the authority that then allows for the provision of health care, we could do that either 

through those who are covered by VA, those who are covered under 

the FECA, or other kinds of private health care. The question then 

becomes, can we develop a tool that encompasses all of the kind of 

surveillance that you would need both to provide current health 

care but also to look down the line in terms of providing prevention 

or looking forward to the future Astronaut Corps, and you’re saying 

that we would need—you would require a separate legislative authority in order to be able to do that? 

Dr. WILLIAMS. Yes, ma’am. I think based on the very small number of cadre of the astronauts and the very unique exposures and 

the need for targeted surveillance and broad preventive surveillance in this group targeted toward those exposures that we know 

more about than anyone else on the planet, I think that NASA having that care—we do have within our agency a comprehensive 

healthcare delivery system that is aimed at the active Astronaut 

Corps, and leveraging our abilities along those lines on behalf of 

the retired and former astronauts including helping coordinate 

their care wherever they live I think would go a great way toward 

making sure that we take care of them and recovering as much 

data as possible to establish our evidence base. 

Ms. EDWARDS. And Captain Cassidy, I take it that you believe 

that we—that Congress has to provide a broader legislative authority to provide those services? 

Captain CASSIDY. Yes, ma’am. I think that it’s—my experience 

base is with the active astronauts, and like my two colleagues here, 

I don’t have a whole lot of experience with what it’s like as a 

former astronaut to go through that. I’ve talked to both of them, 

but where I think we can do—I know we can do a better job at 

pulling this data together, and the execution of how we do that, 

where it happens, what tests are done, and the mechanism for payment I think are things that can be further honed and discussed 

as we move forward and actually get this going, but those are 

things that I think we could collectively get a better story on. 

Ms. EDWARDS. And Dr. Kahn, can you tell me, is there any other 

sector that you can think of where there’s an employer who has an 

employee who engages in risk for the purposes of completing their 
65 

employment where there isn’t a comparative ethical obligation for 

care? 

Mr. KAHN. Thank you, Representative Edwards. It’s a really interesting question. In fact, part of the work of the committee that 

I had the privilege to chair, we tried to find parallel occupational 

examples, and in fact, it’s quite unique is the short answer. And 

so when people leave occupational environment, they tend to have 

either a new job or they become retired and then they’re covered 

by other means. So astronauts are really frankly in a unique category that way. 

Chairman BABIN. Thank you, Ms. Edwards. 

I now call on the gentleman from Alabama, Mr. Brooks. 

Mr. BROOKS. Thank you, Mr. Chairman. 

Captain Kelly, thank you, sir, for being here today and for your 

service to America’s space program. As many are aware, you and 

your twin brother, Mark Kelly, are providing scientists with a 

wealth of information on the effect that human spaceflight has on 

the body. NASA is set to share the results of the study next year. 

Are you in a position where you can give us any previews of what 

they’re finding so far by sharing with us the most surprising or interesting things that you have noticed so far? 

Captain KELLY. Well, I mentioned in my testimony the difference 

between my initial 159-day flight and 340, my symptoms immediately upon return. I have gotten some data back, my bone mass, 

muscle mass data, some of the data on my vision, that for me I was 

kind of surprised that it was relatively flat in comparison to the 

159 days. In other words, being in space for twice as long didn’t 

mean that I lost twice as much bone mass. It was pretty similar. 

So I think some of these we do have, a good understanding to how 

to mitigate the risks to bone and muscle loss so we can stay in 

space longer. 

The data with regards to my brother and the comparison with 

me, a lot of those samples just came back on SpaceX, my biological 

samples, so, you know, like most research, you collect the data, you 

analyze the data, you write the reports, have it peer-reviewed. I 

think that type of genetic data, the effects of the radiation environment, the effects on my immune system, things like that as it compares to my brother are just going to take much longer. 

But I was actually, you know, pleasantly surprised that my bone 

and muscle data was pretty much flat between the two flights, although, you know, how I felt when I got back was much different. 

Mr. BROOKS. And this is a question for each of you, though I’d 

like to start with the astronauts, Captain Cassidy first and working our way around, and then on the two ends of the table, and 

whoever wants to follow them, feel free. 

With current technology, can NASA safely send an astronaut on 

a Mars mission without resulting significant adverse health risk, 

and if not, what should be done to safely protect astronauts on a 

Mars mission? 

Captain CASSIDY. Sir, that’s a fantastic question because that’s 

where I think our nation should go, to Mars, and that’s where our 

vision is, and so how do we do that effectively and safely is a fantastic thing to consider, and clearly, radiation monitoring and protection is critically important there. Do I think that we could do 
66 

that mission safely right now? We could do it as safely as we think 

we can, and there are certain risks that we don’t know, and that’s 

where collecting this data between now and going to Mars will 

keep my future colleagues safer. 

Mr. BROOKS. Captain Kelly? 

Captain KELLY. Yes, sir. You know, my time on the Space Station, I was really inspired that building and operating this vehicle 

was the most difficult thing we have ever done, and I think it’s 

proven that if we decide to do something and we set our mind to 

it and put the resources behind it, we can be successful, whether 

that’s going to Mars or curing cancer if we decide that that’s what 

we’re going to do, and we devote the appropriate resources to do 

it, we can do it. 

Now, there are challenges with going to Mars. Chris mentioned 

radiation, which I completely agree with. I think the physical challenges, that would be the number one concern I would have is protecting the crew members on that long trip away from the protection of Earth. I think there are also, you know, challenges in the 

systems that keep us alive onboard the Space Station. You know, 

these are designed to work for long periods of time in low-Earth 

orbit but having them that can, you know, operate consistently, reliably, get us to Mars and back, is a challenge, but I think it’s 

clearly a challenge that if we decide that’s what we want to do, 

then we can accomplish it. 

Mr. BROOKS. Well, with respect to the number one concern that 

both of you have mentioned, radiation, do we have the technology 

now to protect our astronauts from the radiation of a long-term 

flight to Mars and back or do we need to develop new technology? 

Captain KELLY. You know, I think there’s two ways to approach 

that. One is, you get there really fast so you’re not exposed to the 

radiation environment for as long, and the other one is some means 

of, you know, insulating the crew members from it, and you know, 

I’m not an expert on this, but my understanding is, if you have a 

propulsion system that potentially has a magnetic field as part of 

it, that can act like the magnetic field of the Earth to protect us 

from certain types of radiation, but again, I’m not an expert in this 

area. 

Mr. BROOKS. Captain Lopez-Alegria? 

Captain LOPEZ-ALEGRIA. Thank you, Representative Brooks. You 

know, I think could we do it technically, technologically? Perhaps. 

It would be incredibly expensive the things that you mentioned and 

my colleagues have mentioned about radiation. You could shield. 

That takes mass. That makes the vehicle heavier. That makes the 

vehicle more expensive. The current propulsion technology, we’ve 

heard how long it would take the mission. We’d have to bring our 

food with us. There are so many things that it’s possible to do. I 

think a breakthrough in technology would make a lot of those problems go away or at least become much more easy to solve. 

One thing that I do think is going to happen in almost any case, 

it’s going to be very difficult to have any kind of a reasonable abort 

possibility once you’re on your way, and so this country’s going to 

have to have a different risk acceptance posture, not just for radiation exposure, which is right now three percent above the normal 

population is what we admit for a risk of exposure-induced death, 
67 

that would probably have to change. But also just the notion that 

somebody could have an unforeseen medical problem on the way 

which today we could have the crew member on the ground in a 

matter of hours, it would take potentially months to get them back. 

So we could do it. I think we have to go through some evolutionary processes in the way we think both at NASA and as a country 

for it to happen. 

Mr. BROOKS. Well, my time is expired, but if the Chair would 

permit for Dr. Kahn and Dr. Williams to answer, that’d be great, 

but if not—— 

Chairman BABIN. No, certainly, go ahead, if you have something 

to add to that. 

Mr. BROOKS. Dr. Kahn or Dr. Williams, would either of you like 

to add anything to a Mars mission safety, technological advances 

we might need to ensure health safety. 

Dr. WILLIAMS. I think my colleagues covered it quite well. Physiologically, we believe that we could send people on a Mars-duration mission out and back, you know, all the other safety concerns 

notwithstanding. We believe we could do that. Physiologically, I 

think it’s safe to say that those astronauts would be forever 

changed. In all likelihood, they’d have a greater risk of developing 

a fatal cancer during their lifetime and the associated changes in 

bone and muscle. I mean, they may have a greater fracture risk 

and the cataracts and all the things we’ve talked about. 

One of the great challenges are the unknowns, and there are unknowns and unknown unknowns with regard to the increased duration of spaceflight. So that’s what makes it so imperative for us 

to continue our studies and to continue gathering as much data as 

we possibly can in support of an eventual Mars mission. 

Mr. BROOKS. Dr. Kahn, do you have anything to add? 

Mr. KAHN. I would just add to what Dr. Williams just had to say, 

that the committee that I chaired actually understood that there 

were such great unknowns and unquantifiable risks, and rather 

than try to answer the question that you posed about what technological breakthroughs would be necessary, whether we could do it 

today, we gave them a framework to think about the ethics of exceeding existing standards and how to think about that since, as 

Captain Lopez-Alegria said, there are existing health standards 

and we have to evaluate those standards in light of the mission 

that is being proposed, and that’s what the committee that I 

chaired had to say. 

Mr. BROOKS. Mr. Chairman, thank you for your indulgence. 

Chairman BABIN. Yes, sir. Thank you. 

I’d like to now call on the gentleman from Virginia, Mr. Beyer. 

Mr. BEYER. Thank you, Mr. Chairman. I thank all of you very 

much for being here. 

Dr. Kahn, given the difficulty of establishing causality for medical conditions that may have resulted from human spaceflight one 

of the options would be to have NASA take care of all the medical 

problems that astronauts would have in the years to come. What 

are the pros and cons of such an approach? 

Mr. KAHN. Thank you, Representative Beyer, for that question. 

I think that’s actually a really important question, and I’ll speak 

to it from the ethics perspective because that’s what I know, and 
68 

in fact, the committee that I chaired discussed that, and we came 

to the conclusion that the causality question is impossible to answer, and that we as a country and a society owe astronauts protection and provision of care throughout their lifetimes without 

asking the question about whether—what they might suffer from 

in terms of injury or health needs was a result of their time in 

space or not. 

Mr. BEYER. Thank you, Dr. Kahn. 

I met earlier today with the Fire Chief for the County of Arlington in Virginia and talked specifically about this issue with the 

presumption of heart-lung disease, the presumption that if they got 

heart disease or lung disease later, that it was presumed to be 

from rushing into burning buildings, and he said it actually expanded in Virginia over the law to things to do with the GI tract 

also. So this just extends it to all those who go into space for us. 

Mr. KAHN. And as you heard from others, there’s new information coming out all the time, and so what we don’t know today may 

be something we learn about in the future, and so the committee 

that I chaired really did not find the causation question a compelling one as a matter of limitation of provision of the—of lifetime 

healthcare benefits. 

Mr. BEYER. I am struck today by the two big reasons we have 

at this hearing. On the one hand is the ethical considerations, the 

responsibility to take care of people who are sacrificing for all humankind. On the other hand, there’s the simple practical data reason that we want to learn as much as we can to be able to move 

forward. 

Dr. Williams, what about when Captain Kelly retires and goes to 

work for a private space person, you know, SpaceX or Orbital, how 

does that influence the government’s responsibility to take care of 

him and his space things, the space-related conditions for years to 

come? 

Dr. WILLIAMS. Yes, sir, another great question. I think there’s 

plenty of precedent in the U.S. government that we would consider 

that to have no impact at all on our ethical obligation to take care 

of Captain Kelly and on our desire to gather as much data as we 

can to inform our database and to help us protect crews in the future, so I think there’s no accrual, no effect at all, sir. 

Mr. BEYER. I was very impressed, fascinated by reading, Captain 

Kelly, all the impacts of your 340 days in space, everything from 

the rash to the flu-like symptoms and all the things we don’t know 

yet, the unknown unknowns. 

So Dr. Kahn, from an ethical standpoint, especially after the recent death of Muhammad Ali, I mean, my mother never wanted me 

to box, right? The concussion and what the NFL is trying to deal 

with, concussions right now we see, those are voluntary sports. At 

what point do the ethical considerations become so great that we 

become reluctant to send men and women into space for the long 

voyages? 

Mr. KAHN. At what point would they? Is that the—is that your 

question? 

Mr. BEYER. You know, we send young men and women to go 

fight for us overseas because they’re defending the country and we 

know we’re going to lose some. We don’t ever want to lose anybody 
69 

despite Elon Musk saying the other day, ‘‘We’re going to go to Mars 

and some people are going to die.’’ Do we go into this knowing with 

certainty that some of these health effects, the long-term health effects, are going to be inevitable? 

Mr. KAHN. I think what we want to be sure of, as sure as we 

can be, that we can protect the men and women who go into longduration spaceflight to the greatest extent possible, and that we 

learn along the way, so among the things that hasn’t come out yet 

today is this notion of long duration, so we’re talking hundreds of 

days in transit until there’s some new propulsion system, and so 

we can learn along the way. So data will come back to Earth from 

the experience of astronauts as they fly, and we should use that 

and learn and use that to decide about whether people should 

spend more time in protective cocoons in the—on the way or 

whether there should be some other means by which we should 

modify exposure along the way. So I think it’s a notion of learning 

as we go but we don’t go until we’re sufficiently confident that it’s 

safe enough, and then it’s up to NASA to decide when and if it’s 

safe enough. 

Mr. BEYER. Thank you very much. 

Mr. Chairman, I yield back. 

Chairman BABIN. Yes, sir, thank you, and I’d like to recognize 

the gentleman from Colorado, Mr. Perlmutter. 

Mr. PERLMUTTER. Thank you, Mr. Chairman, and thank you for 

having this hearing. It’s fascinating and it’s important. Gentlemen, 

thank you for your service. 

Dr. Kahn, I want to start with you because I thought your two 

sort of pillars of fidelity and fairness really kind of lay out the 

thinking on this for me. 

You know, if somebody—these three gentlemen next to you are 

explorers and they put themselves at risk to explore in the name 

of the United States, in the name of science, in the name of adventure, in the name of I don’t know what, lots of things, and they now 

have put themselves at risk. So it’s my opinion, based on your two 

principles of fidelity and fairness, that we have a responsibility to 

provide both the medical care that they may need on into the future and the research that they provide us as to their health. 

So did your committee agree with you on this fidelity and fairness? It certainly resonates with me. 

Mr. KAHN. Yes. Sorry if I wasn’t clear, Representative Perlmutter. The—my testimony represents the conclusions of the committee that I chaired, and everything I said actually is a summary 

of what’s in our report, which was issued in 2014, and so that was 

the consensus of those 16 people who have a variety of expertise, 

some like mine but actually two former astronauts were members 

of this committee, along with scientists and physicians and occupational health specialists. 

Mr. PERLMUTTER. The reason I’m sort of thinking about this, and 

Dr. Williams, you can chime in if you choose, you know, in my district we have Rocky Flats, where we built the nuclear triggers for 

our bombs, and we had a lot of workers out there. They’ve developed a number of maladies as a result, some I guess anticipated 

some not anticipated, and we came up with a—we the Congress— 

came up with the Energy Employees Occupational Illness Com-
70 

pensation Program, which has worked in some regards and hasn’t 

worked very well in other regards because, you know, whether it’s 

bone mass or some issue of radiation or something like cataracts, 

completely unexpected, we’ve seen maladies that were never expected. So in your analysis, Dr. Williams or Dr. Kahn, how do we 

be inclusive? Do we just—see, right now, the burden is on the 

worker to say that the illness came from working at Rocky Flats. 

I’d just like to say hey, if you worked at Rocky Flats and you’re 

sick, we’re going to take care of you. If you’re an astronaut and you 

got up there, we’re going to take care of you. But it gets expensive. 

We’ve got to be prepared for potential costs if we build our astronaut base. I mean, what was your committee considering? And Dr. 

Williams, have we estimated what costs we might see in the future? 

Mr. KAHN. So the committee that I chaired did not—was not 

asked and did not try to estimate the cost, so we identified what 

we thought were, as you articulated, the pillars—we called them 

principles of ethics that would support recommendations which included a recommendation for lifetime provision of health care for 

astronauts but we did not go past that into the practical question 

of how much it would cost for how many people or for how many 

years we’re discussing. 

Mr. PERLMUTTER. Dr. Williams? 

Dr. WILLIAMS. Yes, sir. I think when you articulated the sentiment that if we send you in harm’s way as astronauts, we want 

to take care of you, I think that’s what NASA absolutely wants to 

do. 

The practicalities of doing that with this legislation, we can—we 

have to be aware of the problems, hopefully at the earliest stage 

possible in order to remediate them, and that’s the monitoring portion of our—the health monitoring portion of our proposal, which 

is quite detailed and quite targeted and broadly preventive in nature. And then I think with this authority, work very closely— 

under the envision model, work very closely with folks in existing 

claims structures—the DOL and the VA, whoever we need to—to 

lean very forward and be very proactive in—with regard to working—providing evidence and best expert opinion to try to receive favorable consideration of claims and acceptance of diseases as they 

arise. 

Mr. PERLMUTTER. Well, for all of us on this Committee, you 

know, I think I showed you, Captain Kelly, when you were up on 

Space Station, you know, 2033 we can do this. I mean, we really 

want—I don’t know, you know, exactly what the timing is going to 

be. That’ll be for the technicians and the engineers and you astronauts and the scientists to figure it out, but we want to get there, 

but we want you not to put your lives at stake. I mean, there will 

be some level of risk. I know I as a Member of Congress on behalf 

of the 750,000 people that I represent want to make sure that 

when you do put your lives at risk that—and your health for who 

knows how long down the road, we as the United States of America 

help you with your health care. Hopefully there’s no problems, but 

if there are, we help you. 

And so I just thank you for your service, gentlemen. Docs, thank 

you for looking at this. This is important stuff. Thank you. 
71 

Chairman BABIN. Thank you. Thank you very much. Thank you, 

Mr. Perlmutter. 

I think there’s a little time left if we could go back through for 

another round of questioning if the witnesses are agreeable and the 

members. Why don’t we this? Instead of 5 minutes, we’ll have a 2- 

minute question period, okay? And Mr. Perlmutter, we’re going to 

keep you at 30 seconds. 

Okay. I’m going to start out with Dr. Williams. Similar to the 

question that Mr. Perlmutter asked, NASA has indicated that extending existing monitoring of former astronauts would increase 

the cost to NASA from approximately $400,000 a year to around 

$800,000 a year. A recent University of Nebraska Medical Center 

report indicated that providing medical care for all 367 astronauts 

and their families would cost between $2.4 and $6.5 million a year. 

How much money would NASA’s current proposal cost per year? Do 

you know that? 

Dr. WILLIAMS. We think the direct portion, health monitoring 

portion, would be in the neighborhood of doubling our current cost 

to $800,000 a year. Right now, we spend 400 a year for that portion. We believe if we—including remediating providers in the community for testing and imaging and so on and so forth, we think 

that would drive that cost up, and anticipating increased participation rates, we think it would drive it to $800,000. 

With regard to the remediation of illness and injury, the astronauts do display a very strong, healthy worker effect. They pursue 

very healthy lifestyles. They’re committed during their careers and 

after their careers to maintaining good fitness and making good 

lifestyle choices. So when you compare chronic diseases and malignancies and so on and so forth to almost any comparison groups 

at this point, the astronauts compare very favorably. After latent 

period of exposure passes in the next 10 to 20 years, that’s an unknown quantity at that point. 

But right now, we would anticipate based on historical precedent 

no more than one case, maybe two cases every one or two years of 

significant illness that would be expensive, and by ‘‘expensive,’’ I 

mean that would be in the, you know, $500,000 range for a catastrophic case of cancer or something, and that’s what we believe we 

would be dealing with in the short term, sir. 

Chairman BABIN. And one quick question here for you, Dr. Williams, and Captain Cassidy. The Department of Labor and Department of Veterans Affairs both provide treatment for conditions derived from federal service. Are there classes of astronaut such as 

payload specialists who are not government employees and therefore would not be covered by existing authorities? Do you all know 

the answer to that? 

Captain CASSIDY. Sir, currently at NASA we have active astronauts and management astronauts. Management astronauts are 

folks that still work at NASA but are no longer in the line for a 

space mission, and we used to have in the past payload specialists. 

We no longer have that designation. However, from our perspective, anybody that goes on a space mission on a NASA mission 

should be covered. 

Chairman BABIN. Right. Dr. Williams? 
72 

Dr. WILLIAMS. And sir, for classes of astronauts like payload specialists, we believe that no matter what method that they use to 

enter the agency as a detailee or what method of employment they 

have, that there would be a pathway forward under existing structure to treat them just like we would any astronaut in clearly military or civilian service and pursue helping them. 

Chairman BABIN. Thank you. Thank you very much. 

And I now call on the gentlewoman from Maryland, Ms. 

Edwards. 

Ms. EDWARDS. Thank you very much, Mr. Chairman, and thanks 

for the second round. 

Dr. Williams, I want to go back to the VA system because I understand that about 60 percent of the astronauts that have flown 

in space are military or retired military—we have two here on this 

panel—and as such, any occupational injuries or conditions are currently handled by the VA. Have you actually directly addressed 

with the VA how occupational-related health conditions for former 

military astronauts as a result of spaceflight will be handled if this 

legislative proposal is enacted? 

Dr. WILLIAMS. We have reached out to our contacts in the Veterans Administration and we are initiating discussions with them 

similar to those that we have initiated with the Department of 

Labor, and we would envision in implementation of this legislation 

partnerships going forward on both fronts to build this facilitated 

claims process with NASA playing a key role in determining accepting the diseases. 

Ms. EDWARDS. I mean, it is a little bit problematic, you know, 60 

percent of the astronauts are retired military, and we have—you 

haven’t engaged the VA in this discussion before presenting legislative proposal, but I hope that that happens really soon and that 

you’re able to share that information with us. 

Captain Kelly and Captain Lopez-Alegria, you both are retired 

military. Have you used the existing VA system? 

Captain KELLY. I think it’s important—I think it’s important to 

point out that there are—astronauts come from all different backgrounds. Some of us are retired military. I’m personally, as is Mike, 

covered under Tricare for life as a retired military member. If you 

were a member of the military and you didn’t retire, I believe the 

VA would still cover you. There are members of the Astronaut 

Corps that are civil servants. Some of those civil servants retire 

from federal service, in which case they do have retired civil service 

health care, but then there are other people that may fly for one 

flight or more and then leave federal service without any kind of 

long-term health care benefits until they were potentially eligible 

for Medicare. So there are different categories, and I think this system, this legislation, if enacted, would benefit them and people in 

different ways considering the fact that, you know, we already have 

health care coverage that is pretty good. 

Ms. EDWARDS. And in effect, at least bring the payment within 

one house, if not the care within one house? 

Captain KELLY. Certainly, and I think that the important—the 

other important factor, as previously mentioned, was the fact that 

we can collect all this data whereas if I’m, you know, living in another state and I’m being treated under the Tricare system, NASA 
73 

doesn’t directly benefit from any of that information, and also the 

fact that, you know, those health care providers may not even 

know what they should be looking for in these types of, you know, 

cancer or radiation-based illnesses. 

You know, it’s interesting, Mike and I—I was going to point this 

out, and I don’t think he would mind mentioning it, but we’re going 

to meet with one of our colleagues tonight who lives in the area 

that has recently been diagnosed with stage IV pancreatic cancer, 

and he’s, you know, flown in space on a number of occasions, and 

you know, we never know whether that’s actually directly related 

to his spaceflight but it’s possible that it is. 

Ms. EDWARDS. Thank you very much. I mean, a reminder, it took 

us 30 years after Vietnam to finally recognize the long-term impacts of Agent Orange. 

Chairman BABIN. Yeah, absolutely. 

The next one, Mr. Beyer, the gentleman from Virginia. 

Mr. BEYER. Yes. Thank you, Mr. Chairman. 

And Dr. Williams, I know you’re not a statistician but I understand from reading lots of science magazines that essentially we 

need to get to 10,000 DNA complete disarticulations into the database before we’re really going to be able to figure out what some 

of these DNA connections are. 

You know, we have 250 retired astronauts. Sixty percent are in— 

so 150 are in the LSAH program right now. If we move to 80 percent, that gets us 200. What are the—what’s the implications for 

us of the limited sample size, the limited size of the database? 

Dr. WILLIAMS. It’s something we’ve always struggled with, sir, 

whether we’re actually doing space-based research with a small 

population and trying to, you know, reach conclusions or whether 

we’re trying to do epidemiology on this very small, very uniquely 

exposed group of folks. The only thing—the thing I think that is 

most important to note is that given the group is so small, the data 

from every single one of them is precious and the data from every 

single one of them is important, and anything we can do to maximize participation in our program, both for the surveillance and recovery of healthcare data in the event of injury and illness, is critical. 

Mr. BEYER. A question for any of the three captains but perhaps 

especially for Captain Kelly. We had a Mars hearing here a couple 

weeks ago, and with, you know, the big companies that are developing all the places to get there, and Andy Weir came, who wrote 

The Martian, and at the end he threw out the proposal that we 

should be thinking about using rotational energy to create artificial 

gravity on the way up. So how much of the consequences that you 

all have felt have been radiation related versus gravity-free-related, and I say that because I think for Ed and for me, the highlight of this Committee so far has been when you and Dr. Lindgren 

did your flips at the end of the flight. 

Captain KELLY. Well, you know, I believe all the symptoms that 

we have, the stuff that we can feel when we get back, is a result 

of the microgravity environment versus radiation. I think the radiation effects are, you know, more long term and unknown, you 

know, of someone that does develop a cancer, whether or not that 

was due to the radiation, I don’t think we can ever say for sure be-
74 

cause it may have—you know, we get radiation here on Earth as 

well. It just increases our risk of those type of cancers. 

So as far as, you know, having an artificial gravity to mitigate 

those risks, I think, you know, based on how I felt after being in 

space for a year, if I was going to travel to Europa, for instance, 

and it’s going to take, you know, many, many years to get there, 

I think—and then you have to perform after being in space for multiple years and you had to perform away from Earth, I think that 

type of artificial gravity would be crucial. If we’re going to fly 

around the Moon or fly around Mars, for instance, and it’s going 

to take, you know, three years and you’d be in space for three years 

or if you’re going to land and be on the surface for a few weeks, 

being in space for an extended period of time is going to have a 

negative effect but fortunately you’re coming back to Earth where, 

you know, there’s a big, you know, system to support you. So artificial gravity in that type of mission I think is less critical. 

Mr. BEYER. Great. Thank you very much. 

Mr. Chair, I yield back. 

Chairman BABIN. Yes, sir. Thank you, Mr. Beyer. 

And now for the gentleman from Colorado, Mr. Perlmutter. 

Mr. PERLMUTTER. For my 30 seconds. 

Chairman BABIN. No, we’ll give you two. 

Mr. PERLMUTTER. So this is to all of you. So as things have developed and we’ve heard from Mr. Musk and SpaceX that, you know, 

their intentions to try to get astronauts to Mars in the 2020 time 

frame or sometime, and we know that there’s going to be more 

commercial endeavors in space. So we have a small pool to do research on. Should we consider those astronauts that are on a private capsule? Should they be covered by something like this? And 

I’ll start with the three captains and then go to the ethicist, I 

guess. 

Captain LOPEZ-ALEGRIA. Well, I’ve been in this room a lot wearing my hat as president of a commercial spaceflight federation, so 

your comments about democratization of access to space are near 

and dear to my heart. I think that we would love to have the data 

from those folks that are going to be going, you know, first on suborbital but at some point on orbital flights. I do not think it is the 

responsibility ethically but I will leave that to the ethicist, but it 

seems to me that it would have to be a voluntary program for 

them, but what is clear is that the data that we are gathering in 

LSAH and hopefully with this expanded authority, our flights and 

our careers have been paid for by taxpayer dollars and we owe 

those taxpayers those data to help them make informed decisions 

about spaceflight. 

Captain KELLY. I don’t really have anything to add other than 

what Mike said. I think that makes a lot of sense. 

Captain CASSIDY. And sir, I concur as well. 

Mr. PERLMUTTER. Okay. So to the doctors, do you want to have 

a bigger pool? Do you want them in there, or should we cover 

them? What do you think? 

Mr. KAHN. Well, so I’ll start. I think in terms of coverage that 

if it’s commercial spaceflight, then those companies ought to take 

on that obligation, so I do think there’s an obligation but not on 
75 

the part of the government to protect those people but on the part 

of Elon Musk or whomever. 

In terms of the data, that to me is something that ought to be 

encouraged but I think it’s hard to obligate on the part of individuals. So, you know, I think as our astronaut colleagues here will 

say, there’s very few of them, and every bit of the data that is precious, and with the proper protections, there should be, I think, a 

lot of willingness to participate, but I don’t think you can force people to do that. 

Dr. WILLIAMS. And sir, I think our database and our experience 

base would form the risk assessment database that the commercial 

companies are going to have to use. That’s going to inform their 

risk decisions when it comes to a health standpoint and undertaking some of these longer missions. 

I agree with my colleagues. From a practical perspective, our 

health care infrastructure, and I’m sure our research community 

too would pursue helping them as much as we could by sharing our 

experience and our data as much as we can, and also we would 

seek to facilitate their gathering of data. We have a lot of experience in doing that. And if there were opportunities to leverage 

their data on behalf of future human spaceflight, we would welcome the opportunity to do so. 

Mr. PERLMUTTER. Thank you very much. 

Thanks, Mr. Chairman. I yield back. 

Chairman BABIN. Yes, sir. Thank you, Mr. Perlmutter. 

I want to thank the witnesses. It’s been an extremely edifying 

hearing, and to be honored with the three astronauts and the two 

doctors, thank you all for your many years of service to your country, and really I want to thank you from the bottom of my heart. 

The record will remain open for two weeks for additional written 

comments and written questions from the Members. 

So without any further ado, this hearing is adjourned. 

[Whereupon, at 4:27 p.m., the Subcommittee was adjourned.] 

(77) 

Appendix I 

ANSWERS TO POST-HEARING QUESTIONS
78 

ANSWERS TO POST-HEARING QUESTIONS

Responses by Dr. Richard Williams 
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Responses by Captain Chris Cassidy 
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Responses by Captain Scott Kelly 
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Responses by Captain Michael Lopez-Alegria 
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Responses by Dr. Jeffrey Kahn 
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Æ