by Jordan Roberts
Director of Government Affairs, John Locke Foundation
Recently a doctor treated someone via telemedicine in space from earth. Yes, you read that right. As an article from Forbes describes, a doctor from North Carolina treated an astronaut on the international space station for a blood clot:
No, it wasn’t a trip to the USS Enterprise, either in the current Star Trek movie series or back to the famed TV series in the 1960’s and ‘70’s. If only. But this adventure in space medicine was a close second. Two months into a six month stint on the International Space Station (ISS), one of the astronauts developed a blood clot in one of the large veins in the neck. This was found as part of a research study they were engaged in, whereby ultrasounds of their neck veins were being performed during the trip—not to look for blood clots, but to look at other issues related to space travel and bodily fluid function. A large clot was found in the large vein that drains the blood in the head and neck (internal jugular vein), even though the astronaut (who remains anonymous) was not having any symptoms.
NASA contacted Dr. Stephan Moll, a Professor of Medicine and Hematologist-Oncologist at the University of North Carolina, who has specialized expertise in thrombosis (blood clots) and use of various anticoagulants, or blood thinners. While Dr. Moll, who is also the founder of the Clot Connect outreach project, did not get the opportunity to make the trip to the space station, he did provide the longest distance telemedicine consultation to date, helping make the decision on how to treat the blood clot…
…Dr. Moll had a tough decision to make: the ISS was equipped with one type of blood thinner (enoxaparin, to be given as an injection), but there was only a 40-day supply. The astronaut had a rare type of DVT, as it was in the neck, not in the leg, and was without any symptoms. Dr. Moll weighed the risks of leaving a large clot untreated, and decided it would be best to initiate treatment. A similar anticoagulation medication was shipped to the ISS in the interim (apixaban), so that the astronaut would be able to continue therapy once the 40-day supply was completed. But the risks of trauma to the body on re-entry to earth were high; thus Dr. Moll and colleagues decided that the astronaut should stop taking any blood thinner four days before re-entry to earth. All went smoothly, and the clot did not require any further therapy after the astronaut returned safely to earth.
This is an incredible story of human ingenuity that happened in part because of one of our doctors here in North Carolina. But it also raises some other points about the future of telemedicine. First, we are only scratching the surface of what telemedicine can revolutionize in medicine. It’s an incredible feat to be able to treat someone in space from North Carolina, but we still haven’t realized telemedicine’s full potential here in our American health care system. Second, this procedure shows how exactly telemedicine can revolutionize modern medicine. Telemedicine shouldn’t be used to replace traditional care, but instead, supplement what’s already happening to make it easier and more accessible to use. Third, this is a brand new technology. Therefore as the technology grows, so to will the individuals who feel the need to regulate the use of telemedicine. We need to make sure any attempts to regulate the practice don’t hinder the adaption and evolution of telemedicine.