Torn between space and medicine, Kevin Fong took degrees in astrophysics and in medicine at University College London. He studied space medicine at Johnson and Kennedy Space Centers in the US. He co-founded the Centre for Aviation, Space and Extreme Environment Medicine at UCL in 2000. Last year, he won a ÂŁ75,000, five-year fellowship, part of which he plans to use to experience hostile environments and research human physiology. His love affair with space started when he was dragged out of bed, aged 4, to watch TV pictures of the Apollo-Soyuz test programme. The sense of wonder, he says, has stayed with him ever since.
How did it feel being on Esquire’s 2004 list of “most influential men under 40”?
Obviously it’s enormously flattering. When they rang me I assumed that it must have been a massive mistake. It has become a bit of a running joke among my friends.
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The jokes apart, was the publicity welcome?
Yes, of course. The ideas behind extreme-environment medicine are comparatively new – and it’s an area where much of the conventional wisdom about physiology is being overturned when you look closely.
How did you get interested?
In 1999, when I was a newly qualified doctor, I was sent out to the scene of the Admiral Duncan pub bombing in London. The pub is popular with homosexual men and was targeted by a lone bomber for that reason. I saw some very, very badly injured people that day. I remember following these people up on intensive care – people my age who’d had limbs amputated, lost lots of blood and suffered repeated infections. Every day I saw them I was thinking: “Today is the day this guy is going to die.” But of those who made it to the hospital, all bar one survived. It just seems incredible. What was the difference between the guys who lived and the guy who died? Was it just his injuries, or was it that they had something he didn’t?
Where do you start looking for answers?
When you get down to the nuts and bolts, critical care is chiefly about one thing – getting oxygen molecules and putting them into the cellular machinery so that they can be used to make energy. At high altitudes, for example, you have healthy people who have extremely low levels of oxygen in their bloodstream by virtue of their physical environment. And somehow they manage not just to be alive but to climb mountains. If you show measurements of the blood oxygen and carbon dioxide levels in a mountaineer on top of Everest to a critical care physician, they will say: “When did this patient die?” The numbers don’t look compatible with life. How someone can go to the edge of human survival and come back to live a healthy and productive life is what critical care is all about. I’ve begun to regard intensive care as another extreme environment.
What do specific environments tell us?
Take zero gravity. It can tell you a lot about bone and muscle physiology because you are looking at structures that have evolved to support gravitational load. So looking at what happens when you take gravity away in space, then bring it back suddenly on re-entry, can tell you a huge amount. Deep-sea diving can tell us about oxygen exchange under different extreme conditions, and has given us hyperbaric oxygen therapy. This combines high oxygen concentration and high atmospheric pressures within a chamber that is normally used for treating the bends. It is not entirely clear how it works, but by dissolving more oxygen in the blood it improves wound healing. For example, foot ulcers in people with diabetes don’t usually respond well to treatment because the patient’s circulation is often very poor. But hyperbaric oxygen appears to work very well.
Have you got involved personally in any of these extreme environments?
I was always keen on space – absolutely. I would love to go into space. If someone ever offers me that ticket then I’ll grab it with both hands. Towards the end of my medical degree, I wrote to NASA asking to spend time in one of their laboratories. They wrote back telling me about their aerospace medicine rotation. There were five places worldwide, and the message was – apply if you dare. So I thought: I’ll apply, they’ll turn me down, and I can finally close the door on the whole space ambition stuff, and get on with my life as a doctor.
But they didn’t?
No. I got onto the course at Johnson Space Center with two Russians and two Americans. It was a fantastic experience on a truly American scale. One intense month of lectures in the morning, with the afternoons working on research and practical projects. My project was looking at the parallels between the physiology of old age and space flight. Going to Johnson began to open doors. I spent a couple of months at Kennedy Space Center looking at how to manufacture intravenous-grade fluids that could be used in a medical emergency from the potable water sources on board the shuttle.
Did you get to do things that astronauts do?
Yes. At Johnson Space Centre, where the “vomit comet” flies. It’s the sort of plane they normally use for refuelling military aircraft in flight – and it has been converted into this bizarre vehicle. Most of the seats are stripped out, except for a row of seats at the back. The walls are padded and the windows are blocked out, so this thing is one long, white padded tube, cruising along at about three-quarters the speed of sound at 25,000 feet. Suddenly the pilot pulls the stick back and puts you into a 45-degree climb and lets it coast up 10,000 feet, and idles the engine so you edge over the top of this 10,000-foot climb – and then dive another 10,000 feet before levelling out.
How long does that take?
About 45 seconds. You’re weightless in the middle of that time – just as you’re nosing over the top for about 23 seconds – and during that time you’ve got no net forces on you so the vehicle is falling at the same rate as you are falling – you’re in free fall. You have exactly the same experience of weightlessness as astronauts do, but for just 23 seconds, and it is truly amazing. Once you get used to it you can just fly around the cabin.
Did anything really get to you?
The g transitions are the bit that makes it feel extreme, because as you’re pulling out of the dive you get a period of about 2g. You’re oscillating between zero-g and 2g every every minute-and-a-half or so for about an hour and a half. It’s not for nothing that it’s called the vomit comet. I flew and I vomited, but not before I’d had some fun.
How do you vomit in zero-g?
You have a flight suit which has lots of pockets, and in lots of those pockets you have sick bags. And then we had a quick-draw sick bag that would be ready and primed that you get up to your face pretty quickly. The trick was to get the bag to your face before you started vomiting, otherwise it became unpleasant for everyone else.
Back in the UK, did you want to carry on combining space and medicine?
Yes, desperately! I was struggling to find a way to stay and do just that. I exhausted every possible formal source of funding. The bottom line was that what I wanted to do didn’t fit the mould. The space science people told me to go to medical science people, and the medical science told me to go to space science. I was near the end of my tether when I found out about NESTA, the National Endowment for Science Technology and the Arts, which distributes National Lottery funds. They gave me an award.
So what do you plan to do with the money?
The major part of the £75,000 is for me to spend time at NASA field centres developing my expertise in space physiology and medicine. But a small bit will go on experiencing extreme environments. I’m planning to get spun on a centrifuge, among other things.
What do you hope to find out from that?
This is all part of NASA’s artificial gravity programme, which is important because many of the problems with human space flight are associated with weightlessness and the effect on the brain, the muscles, the heart and so on, and the fact that the longer you are in the weightless environment the worse things get. Because Mars missions entail a journey of six months out and six months back, plus a stay on the surface for as much as a year and a half, you are talking about a thousand days where all of it is spent either in reduced-gravity or microgravity environments.
So what can we do to counter that?
Give the astronauts drugs, get them to do exercise. But none of these is uniformly effective as far as I can tell. The new thinking is we take our light, our heat, our fuel, our atmosphere – so why don’t we take gravity as well? And then the question is how do you take gravity with you? There is the thought that you could use short-arm centrifuges, small enough to stay inside a relatively small vehicle at a radius of round about 3 metres, and spin people at around 40 revolutions per minute. Also you could give them a short but intense burst of gravity a couple of times – use gravity almost as a drug. If you can accept that concept, then you need to know if it would work and what the dose should be. And that’s where the research programmes in Johnson Space Center are starting from. Later on this year if I’m really unlucky, I’ll get to go on one of those centrifuges.
What sort of force will you experience?
You get a gradient across your body. It’s 2.5g at the feet and significantly less than that towards the head, as it’s much nearer the centre of rotation. It’s not the 9g fighter-pilot gravity you get in films, but you can picture it as a centrifuge with a radius of about 3 metres, lying on one of the arms, and being spun at 40 revolutions a minute for about an hour. It’s a funfair ride you probably don’t want to be on for very long.
You must be sad that the UK doesn’t really have much of a space programme?
I believe it returns value at all levels, and across the boundaries of science and culture. When I go abroad, the guys working on this say to me: “Why isn’t Britain involved in this?” In November I was in Beijing giving a lecture. Yang Liwei had just returned as China’s first astronaut, and it was clear there was a fervour for space science and exploration. They are hungry for it and it is clearly driving a whole new generation of scientists in that country. Like the US in the 1960s, it has captured the imagination of the nation.
But you have managed to do something about space medicine for the UK?
I realised that demanding £100 million from the government was not going to work – you had to demonstrate the value of this type of research. In 1999, I organised a conference to kick-start the process. The following year, I launched an undergraduate course in space medicine and extreme environment physiology at University College London (UCL) along with Mike Grocott. Lecturers from NASA, the European Space Agency and other UK universities can all take part. Stage two was to establish a postgraduate research programme, which will start at UCL next year. And we also have a network of research partnerships between national and international institutions. What happens next depends on whether someone picks up the gauntlet.
As well as centrifuges and space, you are also hoping to climb mountains?
I’m starting to learn rock climbing and preparing for some mountaineering. Initially, I will be going to Mont Blanc, but I hope to help put a research group on Everest in 2007. I’m not even going to think about attempting the summit though. I will be staying at base camp to provide medical support. It will be a fantastic trip if we can pull it off.
What do you hope to learn?
The goal is to take samples of arterial blood on the summit of Everest and check acidity, pH, partial pressure of oxygen, partial pressure of carbon dioxide, and so on. They’ve done work with a gas sample from the lungs, which gives an idea of what is in the blood but it doesn’t tell you what is really there. No one has ever done this. The alarming data that shows these people should be dead is an indirect measurement when we need a direct measurement.
What do your friends and family think about what you do?
I think they like the idea of being in exotic destinations. But then when I explain that you are going to be freezing half to death in poor visibility with the light closing in and wondering if you’re going to make it back to where you started that morning, they think you are totally insane, and ask why don’t you stick to a nice, warm, carpeted lab somewhere in central London?
