For a pharmacist who works as a contractor with Wyle for the National Aeronautics and Space Agency (NASA), Tina Bayuse is surprisingly down to earth. “Getting to work with the astronauts!” she exclaims when asked what the most exciting part of her job is. “But, outside of that, being able to witness the change in pharmacy practice. We have a long way to go, but it’s amazing to see where we’ve come in the space programme since I first started in 2000 to where we are today.”
Bayuse was the first pharmacist ever to work for NASA and now heads a team of four in its own pharmacy at Johnson Space Center (JSC) in Houston, so she has certainly seen change during her career. Much of the team’s work now focuses on preparing the ‘med kits’ for astronauts at the International Space Station, of which there are two types: ‘convenience’ and ‘contingency’. The convenience kit contains medicines that one would usually take on a trip, whereas the contingency kit is made up of drugs such as antibiotics and cardiac life support. “We have an entire group of people who are responsible for the design,” Bayuse expains, “but the contents of the kits actually come from the pharmacy here at JSC. We’re responsible for preparing them for flight and then also packing them into the flight kits with the engineers.”
Medicines in space
Sending medicines into space is much like dispensing medicines terrestrially, but with a few additional concerns. “If there is a shortage of a drug, it affects what the astronauts are trained on and what the biomedical engineers understand to be in the med kit,” she emphasises.
Medicines also have to be selected based on volume and mass on board the space station, which can prove problematic with certain formulations, such as soluble powders or drinks. “Most of our veteran fliers understand this, but sometimes we’ll get somebody who’s never flown before or, more importantly, a doctor who has not been on a mission before,” she says. “On the rare occasions that something like that would be requested, we try to take care of those questions prior to preparing the medicines for packing. Because at the time of packing it’s too late.”
Additionally, there are limits on what the environmental systems in orbit can handle — managing alcohol levels in medicines, for example, can be a challenge. Astronauts may need to take medicines while wearing their suits, outside the space station, so this also needs to be taken into account. “We also make sure that we try to advocate a drug tolerance testing for our crews for medicines that they may not take routinely, in case something they take in orbit affects their cognitive abilities or produces unwanted side effects,” she says.
Planning for missions to the space station is fairly routine for Bayuse, but she is currently considering additional challenges that may be introduced when astronauts begin flying to Mars. “We’re not going to have resupply like we do for the station,” she highlights. “In the [United States] we have a rule where, once you take something out of the manufacturer’s packaging, it is only good for one year.” At the moment, this means that items in the convenience kit are repackaged, but those in contingency pack remain in their original packaging. The effect of radiation on medicines outside lower Earth orbit is also unknown.
It is imperative that quality control is enforced, so a triple-check process is in place, with a different pharmacist checking each time. “We haven’t had a mistake that leaves the door because, if it’s going on orbit, it could be national headlines. International headlines,” she emphasises.
Getting into NASA
Bayuse was interested in space flight since she was a child, but knew that she could not be an astronaut for various health reasons. She began working in her local pharmacy and, after a couple of false starts reading physics and biology, started studying pharmacy. “When I was in my first year of pharmacy school, I attended a presentation about the fact that drugs may not work the same in space,” she remembers. “This presentation was after school in a completely different location I had to drive to. I was in a new city, I wasn’t really comfortable with that, but I thought, heck, I’m going to go anyway and see this speaker.”
After the meeting, Bayuse approached the speaker and asked if there was an opportunity to be involved in any way. “She put me in contact with the person who was running the pharmacology lab at the time and, through years of talking back and forth with this person, I was able to create a rotation to come to Houston and look at what it meant to be part of the space programme with pharmacology as a focus.
“I spent a month at Houston, working in the lab, not doing anything in depth but getting a cursory glance at the work they were doing. Then I did a couple of pharmacy-related projects, working on some drug monographs for the space shuttle — the content of the space shuttle med kit.”
Her work intrigued the medical and pharmacological teams at NASA — so much so that they decided to create a pharmacy position at the lab. “That took quite a long time to come to fruition,” Bayuse recalls, “I actually almost gave up on it, I was in the match programme for residencies. But then I got the phone call that they had created the position and they wanted to know if I would apply for it. So here I am.”
Finding a place at the table
Although Bayuse started work in the pharmacology lab, a review of NASA’s medication management revealed that practices were out of date. “The decision was made that they would have an on-site pharmacy with pharmacy staff to manage everything that we do here terrestrially. We opened the pharmacy on 31 March 2003,” she says.
“It’s not like there’s a training programme for this,” she explains. “I had good mentors who were willing to help me understand things. A lot of it is self taught.” She adds that a good understanding of how to read literature — “not my favourite thing” — is important for the role, as are excellent writing and speaking skills.
“My particular position has morphed into educating people outside the healthcare discipline about what pharmacy does and why we should be involved,” says Bayuse. “Most pharmacists are going to be working with other healthcare providers like physicians and nurses on a routine basis, so you all have the same common language. When you step outside that, and you’re working with non-healthcare providers such as engineers and programme managers who bring a different perspective to the table, being able to communicate with people in those disciplines is imperative.”
She is proud of how far pharmacy at NASA has come. “Before we had to beg to be able to sit at the table, or we would find out after [work had already begun] and then have to do some quick work to make [a project] feasible. But now we’re actually being included from the ground floor and that would probably be my greatest professional achievement,” she enthuses.
Despite these advances, Bayuse says she has to continue to champion the role of pharmacy, particularly to those monitoring the bottom line. “Nobody likes metrics!” she notes. “But choose metrics that will help to prove your point, especially to budget people. And then stay on top of it. Pharmacy is more proactive than a lot of medical professions because being reactive in the pharmacy profession is a bad day.”
For example, with regard to the potential advent of commercial space flight, Bayuse explains that initially pharmacy was not included in the conversation. “It’s not because they are trying to leave you out intentionally, it’s just because they haven’t thought about it from that perspective yet,” she says philosophically, adding that the department is now involved in the plans because of her persistence.
However, her patients do appreciate the work she does — one of the astronauts recently called her from the space station to thank her for helping him get ready for his flight. “Actually having your work recognised by a patient — let alone an astronaut on a space station — is something that pharmacists in general don’t see… so having that recognition for all the work that you do accomplish on their behalf is rewarding,” she adds.
Seeking out a role
Bayuse does not yet see a role for an expanded pharmacy team at NASA, but says that the advent of commercial space flight may present new opportunities, for both pharmacy research and practice. “The health of the general public is not going to be as pristine as our astronaut corps so there will be a role for pharmacists in managing those kinds of disease states and the medicines that come along with that,” she explains.
For any pharmacist looking to work in a pioneering area, Bayuse recommends being persistent. “Along with that, if you have an interest in an area, learn as much as you can about it,” she says. “Understand the rules and regulations that go along with that particular area because that’s a big deal. If you’re interested in something outside the box and there are organisations tied to that interest — such as, in my case, the Aerospace Medicine Association — reach out to them and find out when they are having meetings so you can attend.”
