When we think about innovation in medicine, which is tied to an exponential in- crease in the pace of breakthroughs in technological applications, and, furthermore, amplified by a synergistic convergence of nanotechnologies, biotechnologies, IT, cognitive sciences (NBIC), virtual and augmented reality (VR/AR), robotics, cybernet- ics and cobotics, additive manufacturing (4Dbioprinting), doubles and avatars, hap- tic sensors and holograms, big data, artificial intelligence (AI), the internet of thing (IoT), low-latency telecommunications and guidance (5G, optics, lasers, lidar), high- throughput sequencing of “-omics” and functional imagery, it becomes the focus of consensus to view the now wide-open paradigmatic field in terms of a transition from an art based on causality or significance (evidence-based medicine) to the current big-data driven P4 medicine (for personalised, predictive, preventive and participa- tive). It is possible to see global benefits represented by these “P4”, supported by a “tech for good”, but also drawbacks and new risks (e.g. reliability and deep fake hack- ing applied to data or to cancer detection 3D imaging [Mirsky et al. 2019] and the con- sequences thereof) along with ethical questions that come immediately to the fore- front, all the more a revolution given the resistance to change and the digital divide which has for so long blighted the medical world and dominated its practice.
The challenges inherent to aerospace medicine have always been particularly receptive to these breakthroughs: An ascending and descending dialogue between the realm of human spaceflight (constraints imposed by mass, life support, counter- measures to specific pathologies in microgravity, radiations’ effect) and terrestrial medical applications (telemedicine, disaster relief, remote medicine challenges, mod- els of aging, deconditioning and rehabilitation, imaging algorithms, miniaturisa- tion, training) has been a marvellous vector of innovation for the transfer of technology (e.g. MRI, senology imaging, osteoporosis, insulin pumps, artificial hearts, surgical robotics, rapid blood tests, photo-dynamic therapy, prostheses and exoskeletons, freeze-dried and enriched foods, smart textiles and sensors, smart fluids).
In terms of “Deep Space” exploration missions in particular (e.g. life supports, spare parts, 3D printing, bioprinting, telecommunications’ time delay sensitivity, train- ing of non-doctors in medical-surgical skills, optimum automation and autonomy) since situations requiring medical care will undoubtedly arise on missions which last several years, out of around a hundred probable identified conditions of which 30% would require a physician’s level intervention (Exploration Medical Capability 3.01; NASA 2018), one of the major issues is the ever-present concern of the real impact of not having an “MD” present for a reduced and multi-skilled crew with respect to the onboard health system, whose technical capabilities will be limited (Blue et al. 2014).
In any case, a number of solutions based on not only the understanding and mastery of technological advances, but ingenuity, transdisciplinary serendipity and “Moon shot thinking” remain to be devised (see fig. 1).
In fact, the shared consensus already mentioned concerning the expected applica- tions of exponential technologies is, for the most part, again driven by linear think- ing. Foresight is however not a continuous present but rather a succession of breaks, from paradigmatic revolutions to unexpected leaps imbuing the future with an in- credible and unpredictable aspect that only a few visionaries intuitively open to a range of faint signals and often happen to be the very source of these leaps forward. After all, the best way to predict the future remains to co-create it.
us, innovation is paramount, even more so than convergence, divergence and emergence. Too much convergence, underpinned by thought patterns (formatted by culture, expertise, cognitive biases or such linear thinking) results in a “red ocean” approach with a “winner takes all” competition in a world of giants. By contrast, a “blue ocean” approach is underpinned by a divergent creative vision that develops a nascent good idea because they can often resemble bad ideas at first, as a “radical solution” (because everyone jumps on good ideas that resemble good ideas, the fact remains that many bad ideas are just that ... bad ideas).
Therefore “Moon shot thinking” involves committing to a “massive transform- ative purpose” by envisaging a surprising solution to a major contemporary problem by relying on exponential “breakthrough” technologies.
This commitment undoubtedly requires a very deep sense of purpose, certain traits linked to resilience, true grit or even hardiness (i.e. an appetite for a challenge and a belief that one is capable of influencing the world, whatever the scale).
The human factor is always decisive when it comes to shaping the world technologically.
Moreover, the main limitation of “Moon shot thinking” which summons an anticipated technological exponentiality should be compared with another human factor: e widespread belief of modern societies in a “materialism” in the philosophical sense of the term, according to which new properties emerge with each increase in the level of complexity. For example, the famous singularity of an Artificial Intelli- gence development course, a technology whose power and complexity marches to the rhythm of Moore’s law refers to this point of inflexion in the exponential which will see an Artificial Intelligence with consciousness of itself emerge. Consciousness would therefore not be anything other than a particular property of the brain’s or system’s complexity, such is one of the current paradigms of neuroscience. Consider the transhumanist movement which could appear as a downward spiral that is strongly linked to this belief, motivated by a solution to the existential angst allowed by technology capability of enhancing humans in the physical dimension (for example, bio-hacking, anti-ageing and neurocognitive improvement).
Is not better to choose a human with enhanced wisdom rather than an augmented human?
Gödel’s incompleteness theorem allows us to rationally re-examine the idea of transcendence (e.g. our brain could have the ability to be informed from outside the system, i.e. Spacetime; Penrose 2006) and dialectically refute the previous materialist systems.
Overall, biology is more accustomed to sigmoidal curves than exponentials. Chang- es in the exponential pace in the world of biology quickly become saturated, once again describing successive stages and successive nascent leaps, as well as potential curves. Regarding the suggested idea of wisdom, we note that it can continue to grow over the course of adulthood and this continued maturation described in the work of Robert Kegan in developmental psychology, to be compared to that of Lawrence Kohlberg, Abraham Maslow and James Fowler, fits precisely with this model (see fig. 2; Lewin et al. 2019).
This illustrates the notion of integrative complexity which is undoubtedly the model of knowledge best suited to our complex and accelerating world (Csikszentmihalyi 2013). is corresponds to the ability to hold and develop seemingly conflicting traits, values and ideas and to integrate them into larger ones that resolve the issue at hand. It allows one to express a wide range of traits from the human repertoire which is too often reduced to one extreme or the other because we are taught that if one trait is valued socially, the opposite is undesirable.
In this way, the final stage of the Kegan model, the “self-transforming mind” (i.e. as a “meta-leader, that leads to learn, appears multiframe, holds contradictions, finds new problems, is aware of interdependency”; Kegan et al. 2009), goes beyond the contradictions of human nature and its numerous paradoxes to freely explore its subtleties and complexities from multiple points of view of an optimal experience in the autotelic sense of Mihaly Csikszentmihalyi’s “flow” (Tse et al. 2018).
These coexisting paradoxes are indeed significant in terms of the challenges that a manned mission to Mars presents:
� perseverance and renunciation, �
accomplishment and self-denial,
� detachment and connection,
� autonomy and extreme dependence on life support, �
oecumene and profound isolation,
� presence and absence,
� action and contemplation,
� integrity and risk,
� exploration and confinement,
� acceptance and resilience,
� relative and absolute, to name but a few on first consideration.
The necessary dedication to a meaningful cause, closely aligned to a sense of “Ikigaï” (Ishida 2012) that one requires from a crew engaged in such a mission, will clearly find in wisdom the best method of overcoming and resolving, and in life itself the best form of training.
If the challenges posed by a manned mission to Mars are concerning, including technological and physiological issues and exposure to radiation and the effects of pro- longed reduced gravity in particular, it is possible to agree on one point:
The biggest challenge is a psychological and human one.
The “out of view effect”, corresponding to an isolation borne of the fact that Earth is no longer visible for the majority of the voyage or is reduced to a “pale blue dot” in the dusty orange sky of Mars—imposing a response latency of six to forty minutes during telecommunications—has major operational and psychological consequences which cannot be tested during preparation for the mission. e selection of initial crews should therefore meet new criteria, whose protective psychological dimensions in an ICE situation (isolated, confined and in extreme environments) become para- mount. No longer will individuals be selected but rather mixed, multicultural teams of three to six persons, putting social psychology factors and the group dynamic to the forefront of the process. is resonates with the concept of hyperprosociality, that capacity of H. Sapiens to cooperate with unrelated groups, which has already allowed our species to prosper with an evolutionary advantage over other hominids. Collective intelligence rises favourably with a diverse and synergic group.
Another concept would illustrate the capacity of H. Sapiens—who, far from having the physiology best adapted to space like extremophiles or the tardigrade in multicellular organisms—of adapting to the restrictions of extra-terrestrial life: neoteny.
Ontogenesis studies of our species suggests that this clear characteristic of conserving juvenile-like traits into adulthood plays a special role in terms of the emergence of hyper/cognitive functions during evolution, including reflexive consciousness, cerebral plasticity and its psycho-cognitive adaptability, creativity, imagination, ingenuity or wisdom, all sought-after ingredients in deep-space class exploration. Our immature species is more dependent than others on the technologies, stories and cultures it develops but this delayed autonomy needs a long period of socialisation, learning, differentiation and technological maturation. It is, paradoxically, our best chance of success for a mission of unprecedented autonomy. Here again, this necessary autonomy does not involve a simple omphalic disconnection, but rather connections in time, space, between eco-systems, concepts, the world of ideas and he who crystallises them, of a species that could become multi-planetary in terms of Reliance. is last concept, very relevant in a crew that relies on one another like never before, was initially proposed by Roger Clausse to emphasize the psychosocial need for information and reliance in terms of isolation, but was taken up and developed by Bolle de Bal and Edgar Morin (LeMoigne 2008), to add meaning, finality, integration in a system, a dialogic and a relevant way to understand the complexity of the world by a human creator of meaning through exploration and reliance and an ability to know and transmit.
Finally, the true key to the “Mars shot”, understandably, is inextricably linked to the human factor, and it is with the addition of extra soul to the Moon shot’s “out of the box thinking” that one achieves a certain “out of the planet thinking” which would appear a positive, decentred and humanist counter-disruption. In the end, the Mars shot resembles a Moon shot that would incorporate a Pareto-type principle which notes that, in most structures, with remarkable consistency, 80% of the etiological systemic implications are due to the human factor (Avena-Koenigsberger et al. 2014).
We are on the cusp of a transformative age in which our way of living on Earth may, and must be, reinvented.
Beyond the enlightened catastrophism that reminds us of the probability of the mass extinction to which we are exposed, be it anthropogenic or exogenic in nature, “each one is responsible for all” is also the philosophy of action of Saint-Exupery (Forest 2010) who orders us to act and not leave to future generations—who will have their own share of challenges—that which can be tackled now. Combining our know-how and being present at all times should be our solemn intention and commitment.
The first step could be that of decentration, found in the “overview effect” (Vakoch 2011), this “cognitive shift” shared by all astronauts who observe our planet from space, a broadened field of consciousness on the environmental emergency but which places us in the perspective of a larger world, open to the property of boundlessness. Contrary to the collapsological forecasts of the question of infinite growth in a finite world, it is a potential solution to the current great global and societal challenges relating to the illusion of a closed world (e.g. the major environmental impact of this “Anthropocene”, climate change, competition, conflict, inequality, scarcity, etc.), whose exhaustion is exacerbated by the false “cloud” virtual virtuosity still greedy for resources (e.g. energy, rare earth and metals, leading to the asteroid mining externalization solution idea). is new horizon of development and sustainable “collective growth” of species in their eco-systems is in line with the extra-terrestrial im- perative philosophy of Krafft Ehricke (2009) and our very own transition towards a “Type 1” civilisation on the Kardashev scale (1997), which is the next leap of the tech- nologically fertile. Humans are clearly at the centre of medicine and all innovation.
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