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Dr Kevin Fong


Kevin Fong is a Wellcome Trust Public Engagement Fellow, co-director of the Centre for Aviation Space and Extreme Environment Medicine, expert on space medicine, anaesthetist, physiology lecturer, author and television and radio presenter.  His programmes have included ‘Space Shuttle: The Final Mission’ for the BBC and ‘Extreme A&E’ for Channel 4.  His first book, ‘Extremes’, was released in 2013.

I do worry a little bit that we may end up getting to the point where we make a mistake that we can’t beat.

On getting interested in science

So I think that the first thing that grabbed me as a kid was the big idea.  And the big idea was stars and planets and spacemen.  My parents were, you know, neither of them had been to university, but the thing that grabbed them in the early 70s, when I was little, was the stories of space exploration.  These were ideas that were big enough for people who basically were non-technical, non-professional people to sit around a dinner table with their kids and say ‘This is amazing’.  And so that came first, definitely.  And that’s what got me into science.  You know, watching the last missions of the Apollo era: 1975, the Apollo-Soyuz mission where the Russians and the Americans docked in space.  That’s probably the first thing I remember.  The medicine came much later actually.

On science in the 20th century

The 20th century to me looks pretty fast.  We came such a long way in such a short space of time.  And my favourite quote from that is, I think it’s Edgar Mitchell, or one of the Apollo astronauts, who said – this is a great example – he said, ‘When I was five, the Barnstormer came to my farm and I thought it was the greatest thing I’d ever seen.  When my son was five, I walked on the moon, and he didn’t think it was a big deal’.  And that’s how fast we move.  And you look at medicine, you look at the things that we do, you know, you walk out on the road now, you get hit by a truck, there’s a pretty good chance that some vehicle with rotating wings will drop out of the sky, a couple of people with fireproof jumpsuits will get out, scoop you inside and you’ve got an outside chance of surviving what is at any point in history prior to that point unsurvivable.  And so, you can be circumspect about what progress truly is. 

But in medicine, you look at the start of the 20th century, you know, worldwide – well, in the UK – our life expectancy still languishes close to the fourth decade of life.  You come ten short decades from that and you more than double that expectation.  More than that.  You’ve taken on the thing that you’ve been at war with since the beginning of the human species – which is that war against microorganisms – with antibiotics and vaccinations and public health, and you’ve made life, ah, life has reached a point where it’s never been longer lived and never been safer.  And so, for me at least, in my field in medicine – and in exploration – we’ve come such a long way and it’s, yeah, we can have a philosophical debate about whether or not that’s progress, but from a doctor’s point of view, it’s progress.

The other aspect I think you need to look at when you’re considering the 20th century and the speed of advance is exploration.  Take us back a hundred years, almost exactly a hundred years to Scott’s expedition, the Terra Nova Expedition of 1912.  Back then, our ships of discovery are ships made of wood, driven by sailcloth, probing the pack-ice in the Antarctic , or the ‘supposed continent of Antarctica’ as it was labelled on maps at the time.   There is white space all over the globe of places that no human foot has ever trodden because they’re just too physically extreme.  The South Pole, our highest mountain peaks, the oceans – never been there.  And yet we take all of that on, we take all of that on in the first half of the 20th century.  We take the ground on, and then we go into the endless skies.  And then well before the second half has expired, we’re into space and we’ve been to another world.

If we were to sit here in 1912, if this was 1912 and we were having this conversation, and I said to you, ‘Do you know, before this century is out, men will walk on the moon, people will routinely sit around – students will be able to apply to go to Antarctica as a postdoctoral project, people will straight-facedly talk about going to Mars, funded by a private company’, you’d think I was bonkers.  But all of that has happened.

On the continued progress of scientific discovery

The question about whether or not one can be optimistic about the future is a tricky one.  When you read my book, when you look at the stories of the 20th century, what stuck out in my head was how, you know, I think a colleague of mine who’s a medical historian described it as the sort of ‘cock-up’ theory of history, where we go through as a species making these cock-ups, mitigating their consequences, learning from that mistake and moving forward.  And you look at some of the things that happened: the birth of cardiac surgery, which really comes out from the cardiac injuries suffered by soldiers in both World War I and World War II, it needs both of those wars really to bring it quickly to the point at which we feel we can operate on hearts.   The birth of plastic surgery through the experience of the World War II pilots who fought in the Battle of Britain and later the bomber crews, you know, us trying to mitigate the consequences of the horrific injuries we subjected these human beings to.  And you keep going forwards.  So what struck me was how good we are, when faced with challenge, at mitigating the consequences of some failure or some disaster.

So I was very positive by that, because every epoch, it seemed, whatever the challenge was, someone or something or some organisation brought science, technology, medicine to it, society to it, and beat it.  But there was a bit of uneasiness because, the first thing was that war is fairly prominent in my book.  You know, I think I mention World War I, World War II, Korea and Vietnam in it, and that’s not because I think war is any great thing.  It’s because I think, you know, war is the ultimate cock-up.  You know, if a society has gone to war, it has cocked-up.  Whether it was necessary or not, surely?  And so, the mitigation for that, you know, the things that you use to mitigate the consequences of that tend to lead to great innovation.  But, you know, you have to understand that, in the first instance, you’ve done something pretty horribly wrong.

And I think the pattern for me through the 20th century was, you know, we’re making bigger and bigger mistakes that require greater and greater feats of mitigation and innovation to mitigate.  I do worry a little bit that we may end up getting to the point where we make a mistake that we can’t beat.  So that’s my creeping concern about the whole thing.

On a proposed mission to Mars

I remember picking up the newspaper not so long ago, with this proposed mission to Mars that was on the books for ‘let’s try to get there by 2018’.  You know, so less than five years from now.  And if NASA had said that – NASA, the most accomplished, successful international space agency in the history of international space agencies – said we’re going to get there by 2018, I would just think it was ridiculous, couldn’t be done.  And if it was someone in the pub saying it to me, I’d laugh them out of the pub.  And so I just dismissed it. 

But when I started looking closer into the detail of it, this is Dennis Tito, so himself a former employee of the jet propulsion laboratory, NASA’s jet propulsion laboratory in Pasadena.  He’s got a team around him which includes genuine rocket scientists, a former NASA flight surgeon, and you start to think these aren’t just Dan Dare enthusiasts, these are people with serious pedigree in rocket science.  So why, why are they proposing this mission?  And then you look at the detail, and you realise, actually there’s this really, really uncomfortable realisation that it is actually on the edge of possibility. 

Now, on the edge of possibility – that’s not to say it’s safe, and not to say it’s comfortable.  This mission would see two people in something that looks, I don’t know, it’s the size of a small caravan, with rudimentary comfort at best, with everything stripped down to the bare minimum in terms of their life support.  So the last drop of water, the last sheet of toilet paper, is accounted for in their accounting.  No showers.  This idea that you’re going to be able to wash yourself with a flannel and some water for this 500 day mission.  So just in terms of being locked up in a capsule with someone you may or may not get along with for 500 days, that’s bad enough.   That’s before you take into account going on this epic journey that’s going to see them cross a void of space that will be hundreds of millions of miles in distance. 

And you need to remember that in the history of our species, only twelve people have walked on the face of the moon, and that that object is 250,000 miles away.  You know, that is not much of a distance, the sort of distance that you could get a car – a new car – to drive before the engine fell out of the bottom, if you didn’t service it.  You know, it’s not very far.  And these guys are scaling that up by two, three orders of magnitude. 

The problem with that journey is that it takes a long time, so you have to pack enough food and life support for that.  But you’re also exposed to the worst ravages of space.  And this includes radiation.  This includes the inexorable wasting of the body that happens when you’re weightless for all that time.  And of course, hard vacuum.  So, you know, you’re going to sit in this tin can, you’re going to sit in this tin can, flying along at, I don’t know, 25,000 miles an hour, with death about that far away from you the whole time, eating rubbish food, possibly having arguments with the person sitting next to you. 

And it’s do-able, but only just.  And the chances that they don’t return  are significant.  High.  I mean, I don’t know, 5, 10, 15, 20 percent – that sort of thing, I would imagine.  So, you know, it’s do-able, but do-able in the way that people heroically explored the globe in times past, with huge risk, at huge expense, with the prize of being first, but the great possibility that you’ll never return at all.

On the risks of going to Mars

It’s interesting to think about the risks associated with spaceflight.  So when I first went to NASA and I was working there as a doctor, you come from this building which is a hospital, whereby your role is part of the reason why this building exists, is to look after people, and you’re used to having, you know, an important role there.   You go through the gates at NASA, and no one really cares.  It was really odd.  No one really cares that you’re a doctor.  And I couldn’t quite work that out at first, until I realised that actually the big thing, the risk, is not medical, it’s not psychological, it’s actually hoping that all the nuts and bolts work when you push the ‘go’ button. 

Because the energies required, and this is why we look at this thing with awe, when you ask yourself why do we look at spaceflight as a thing of awe, it’s because of the tremendous energies required.  You sit that thing on a pad, you put a few people in the top of it, it has the explosive capacity of a small nuclear weapon, and you hope that that burns in a controlled fashion for long enough to throw the thing out towards this object hurtling around in the darkness, you know, a couple of hundred million miles away.  So that’s why they don’t really care about doctors, because in the history of human spaceflight, if you look at all the people who’ve died, it’s all malfunctions of engineering.  Either everything works and everyone lives, or it doesn’t and everyone dies.  You don’t have these sort of Hollywood ‘Oh no, he’s had a cardiac arrest, let’s get him into the buggy and get home’.  That doesn’t happen.

Now for missions to Mars, you do begin to get into that ‘Well, what would happen if you had a medical issue or a psychological issue?’  And that’s tricky really.  What do you do?  What do you pack?  What will you prepare for?  What will you accept as being something that can’t be survived that would be survivable here on earth?  So appendicitis, do you just deal with that?  Do you just ride it out and just hope it gets better?  There’s all sorts of things.  You can’t pack the kitchen sink in terms of medical, and certainly not on these missions. 

And then there’s the psychological.  We know that these environments are hard.  If you look at similar environments on Earth, submarine crews are pretty similar in terms of they’re away, they’re locked away in a very hazardous environment for a long time.  The second most common reason, I’m given to understand, the second most common reason to evacuate a training mission aboard a submarine is – second only to someone falling down a ladder and breaking their leg – is a psychological emergency.  You know, this is a reasonably well-selected crew who should be used to this environment.  So the idea that you can lock people up in a tin can and fire them away from earth, fire them out towards a distant object, so far that they won’t be able to maintain a live conversation with anyone on the planet that they’ve just left, so far that all they have for company, real live company, is each other, the idea that you can do that and say ‘They’ll be alright’ is just nonsense. 

I mean, you know, you’ve got to at least cater for the possibility that there’s going to be some pretty catastrophic breakdown: you can’t think about these very long duration missions that will stretch over not over days or weeks but months and years, you can’t really sensibly plan those without considering, without at least considering what happens if there’s a catastrophic breakdown in relationships between the crew, or indeed between the crew as a unit and the people back on Earth.  Because there’s going to be such a huge separation that the round loop communication time, so the time it takes me to say something to them and them to say something to me, is up to 40 minutes.  So you’re not having conversations at that point.  You’re communicating by, you know, pretty slow return text message.  And that utterly alters the dynamic of the relationship between the people on Earth versus the people in the capsule.  And people have talked about that. Certainly the Europeans have done a lot of work about, you know, how the us-and-them mentality might evolve for the people who are on Mars versus the people who are on Earth.  All that’s fascinating, untested.  And it’s great to think about, but we will never know the answer until we send a crew.

On the lunar astronauts

I’ve been thinking a lot recently, actually, about how special were these people who undertook the great historic missions – the twelve people who walked on the moon, their command module pilots, the people who didn’t land on the moon – how unique were they?  How much of a singularity were they, in terms of personalities?  And it’s just difficult to know.  They had to be competitive.  You know, you read Tom Wolfe’s account of that era and he talks about the ziggurat and all of these people wanting to be on the top of this ziggurat, on top of this pyramid of achievement, you know.  But beyond that, was it them, or was it the system?  Because you only see the people up front, but there is this huge, huge organisation, this huge effort, an effort that is resourced in a way that has the resources that you would put to a war , because it is, it’s the Cold War when they go.  And that system, I think, wraps these guys up.  And I think one of the themes for me in the book is that individuals in the 20th century were only able to achieve these truly remarkable things because we wrapped concentric layers of technology and organisation around them and then thrust them forwards into these environments.  

So was there something very special about Armstrong or Aldrin or Collins or any of those people?  Yes, I think they were special people.  Was it uniquely them?  Could nobody else have done it?  I’m not so sure.  I mean, I think it was a product of the time and an organisation and a remarkable feat of technology and engineering and science, which opened and closed in a very small window.

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