How Can Medical Technology Work Without a Hospital?

From the episode captions, lightly cleaned. Speakers are not labeled, and the text may contain small errors. Time links play the episode from that moment.

0:00 We've always said that no one has ever been cured by a PDF. Space accelerates aging, it changes, it develops certain diseases. Today I'm with Savi Glowe. She is the CEO and co-founder of a truly unique company. It's called BioAstra. BioAstra specializes in providing medical care in extreme conditions: be it ice, desert, or even space. I spent most of my career, about two decades, in large academic medical centers. What a wonderful guest, the most unique I've ever had. I didn't move the hospital into space.

We can't take the hospital with us when we think about traveling to Mars. NASA realized quite early on, back in the days of the shuttles, that if ultrasound technology could be scaled down and made compact enough, it would become a critically important diagnostic tool on the station. We can literally take these individual technologies and systems and transport them to any corner of the Earth.

Profits don't stop because your team stops trying. It stops due to friction. I meet other business leaders who are finding this friction and eliminating it. I'm Terry Coutsolioutsos. Let's begin. Good day. With you, Terry Coutsolioutsos and the Zero Friction Podcast. Today we have a wonderful guest. This is probably my most unique opportunity to date to interview a person who is creating all sorts of amazing opportunities for breakthroughs in the world of healthcare. Today I'm with Savi Glowe. She is the CEO and co-founder of a truly unique company. It's called BioAstra.

BioAstra specializes in providing medical care in extreme conditions: be it ice, desert, or even space. So, glad to see you here, Savi. Why do n't you tell me a little about your journey, you know, what brought you here? And then tell us a little bit about BioAstra and what you do and, you know, how you think what you're doing today will help us create a better healthcare system in the future. Thanks for inviting me, Terry. This is a very exciting place, and it's great to talk to you. So, how I got here—it's a very long story. I won't go into all the details, but I will briefly say that I spent most of my career, about two decades, in large academic medical centers. Most recently, I worked at Mount Sinai in New York in institutes and departments focused on translational data science. So the idea is to use the vast amounts of data that we collect in electronic health records and through digital medicine to better understand human health and biology, and

3:01 To translate those discoveries into products that can come to market. We've always said that no one has ever been cured by a PDF. So this is still a core part of our research, my philosophy, and what I do. Because I had worked in academic medicine and large healthcare systems for so long, I began to encounter many obstacles, as is common throughout a career. And I began to seek new horizons. Where I saw a need was in healthcare systems, especially data-driven predictive systems that were not yet constrained by existing infrastructure. And I turned my gaze to space. Partly because I've been a lifelong Star Trek fan. But also because space is a truly untapped, nascent market for life sciences, biomedicine, and ultimately, future technologies. What particularly fascinates and intrigues me about space is that it is the perfect environment for both human biology and technology itself. As for human biology, once we enter space, microgravity and radiation literally change the fundamental processes in our bodies

And cells. Space accelerates aging, it changes and develops certain diseases. We have countermeasures and things we do to keep our astronauts healthy, but from a purely laboratory perspective, space does things to us that we can't replicate on Earth. So, in terms of discovery, we can learn a lot more and accelerate our research in a similar way. And when it comes to technology, the compelling factor is literally the environment we find ourselves in— space. Not space as outer space, but space as a container that we, as biological organisms, build for flight. Therefore, all technologies must be autonomous, robust, and to some extent independent. And when we think about building medical technology in a way where we're not building equipment that takes up an entire floor of a hospital, but something the size of a notebook that's sturdy enough to fly to the ISS, the Moon, or Mars. And when we talk about bringing these technologies back home to Earth, they can go anywhere.

5:59 We are not limited by the size of the hospital, its budget, or its location. We can literally take these individual technologies and systems and bring them to every corner of the Earth, and that's what motivates me—creating systems that help the entire planet become healthier and live in a state of optimal well-being.

It seems like a great tool for healthcare accessibility, because when you're talking about providing healthcare in extreme conditions, like you and BioAstra are doing, the idea of ​​providing care in Albuquerque, New Mexico, seems like a little bit of a simpler task, right?

And that's a really great thing to think about. So, tell me about some of the, um, how do you plan, from a mission perspective, what technologies to take with you into space or, say, Antarctica? How do you plan this whole medical part of your trip, because you're not just on an expedition, you need to take into account the healthcare aspect, because you're in an extreme environment, in the middle of nowhere, where there are no hospitals, right? So you have to create it yourself. How do you go through this process? You know, there are some pretty amazing people who have dedicated their entire careers to developing field medicine processes and protocols for just these kinds of cases. NASA has a very rigorous aviation medicine program and a team of payload specialists who determine what can fly, what comes as standard equipment, and then they train the medical officer on board. Now I'm talking about the ISS, and even on free- flight missions there is always a medical officer trained to use

What is available. And then rely on ground control for further medical advice. As we start to get into places that are less connected to us, I would say the ISS is probably one of the most connected places. And this is the International Space Station, right? Yes, this is the International Space Station. Excuse me if I go into, if I go into, um, acronym language. Abbreviations, please. Um, and in both of our fields, healthcare and aerospace, everyone relies so heavily on these acronyms, but I would say that the ISS, the International Space Station, is one of the most connected places that humanity has ever been. We can be there, those astronauts up there are constantly communicating with the ground control center, and they are all, you know, being watched very, very closely.

8:57 When we start thinking about extreme environments and extreme expeditions on Earth, things get a little different, because you don't have access to the ground control team in Houston to say, "Hey, we have a medical emergency here, you know?" How do we, for example, put a splint on this leg, you know? So with every expedition, with every mission in extreme conditions, there is always a field medical officer, similar to those aviation surgeons who fly into space and support astronauts. Um, and, you know, in terms of medical coverage, depending on what you do, what you take with you will depend. So, we just completed an expedition to Bikini Atoll. And our staff doctor on board, uh, you know, put together a pretty basic first aid kit, and we had the supplies that were on the boat. We were, you know, most worried about, um, um, you know, uh, uh, the buildup of oxygen, nitrogen, and, um, carbon dioxide from doing too many dives, and also the minor cuts, bruises, and, um,

You know, seasickness from the boat. So, you know, the medical supplies that we needed for that expedition were, let's say, pretty standard. We did n't really have a very big set. Um, for us at BioAstra, the work that we spend a lot of time on, especially in terms of field medicine, is more focused on scientific research. So how do you develop protocols, scientific protocols, when you don't have a full-fledged lab with you? You don't have access to all the necessary reagents and supplies, and there isn't always access to cold chain storage. So how do you design a study so that you can collect deep molecular samples that you later want to process, and keep them stable enough for a long time so that when you get them to the lab, they're suitable for discovery. And this is a significant part of our work at BioAstra: we build expeditionary science, as well as develop relevant protocols and catalogs of materials. The same goes for the ISS and spaceflight,

You know. How can we do genomics in space if it is impossible to deliver certain reagents because they contain ethanol, and ethanol is explosive? So you can't take this with you on a spaceship. So this is probably more in line with some of our newer protocols that we're working on right now.

11:50 That's pretty cool. So, since you're developing these healthcare technologies for extreme conditions, can you point to anything in the market today that was designed with these conditions in mind and is now playing a role in our medicine? Yes. My favorite example... There are several examples from NASA and the International Space Station, but my favorite, because it's relevant even to astronauts who are in orbit right now, is portable ultrasound technology. So ultrasound technology has been around, you know, since the 50s and 60s. Typically, in the early stages of development, these were large mobile scanners that moved slowly through hospital corridors.

And, you know, if you needed to scan someone's abdomen to detect a disease, or to look at a baby, or for anything else, you would use ultrasound. That was a lot of equipment that had to be moved. NASA realized quite early on, back in the shuttle era, that if they could shrink ultrasound technology down and make it compact enough, it would become a critically important diagnostic tool on the station. So NASA worked very closely with many different technology developers to actually miniaturize this device. And what we have today is the Butterfly ultrasound device, and it's...

It's amazing, just incredible technology. For example, I've seen versions of it that connect to the iPhone, meaning it's literally a nozzle that plugs into the iPhone. So, if you 're, say, in a humanitarian mission, in a refugee camp, and the Red Cross doctors or any other doctors nearby have access to this device, they have an ultrasound machine that they wouldn't have otherwise. And the reason I'm mentioning this right now is because a few months ago, or maybe even half a year ago - time means nothing at all now - an astronaut had to be brought home. Time means nothing now, but he talked about it recently, it's public information. His name is Mike. He had, let's say, a very strange neurological episode. He was having dinner with the crew when he suddenly lost the ability to speak, and they, they didn't understand what was happening, and 20 minutes later, his speech returned. They were able to use the ultrasound machine that's on the station to

14:49 Check, at least as much as possible, the jugular vein, the heart, and, you know, the throat, the vocal cords—and they didn't see any blood clots. But the risk of a repeat neurological episode was too great, and they couldn't find the cause with ultrasound. Basically, he needed to go home and get an MRI to figure out what was going on. They were actually able to deal with this medical emergency, so they were able to state: "Yes, this was an emergency. " The crew member is not in immediate danger. We can confirm all of this with this ultrasound device, but we really need to get him home. This is how this device is used in space today for medical and mission tasks. That's pretty cool. How to move a hospital into space? I understand that you can sort out equipment for space, but right now we're talking about infrastructure, surgical suites, and more. How does that change in space when you think about how therapy is delivered?

I mean, the reality is this: we can't take a hospital with us when we plan a trip to Mars. We will be able to take with us, in essence, only the most necessary means to support life, and, in fact, that's all. So, when we think about long-duration, remote missions, we should think about medical technologies that meet all the previously mentioned requirements: compact, reliable, and non-volatile. I would also add diagnostic and preventive capabilities to this. When we talk about long-duration missions beyond our magnetosphere, beyond the Earth's belts that protect us from cosmic radiation, the ISS is located precisely in this "bubble " of low Earth orbit. They are exposed to cosmic radiation a little more than we are on Earth, but not as much as the Artemis 2 astronauts during their flight to the Moon, and certainly much less than the astronauts during their journey to Mars. So when we think about radiation exposure and prolonged microgravity or weightlessness in deep space, we should pay attention to prevention and

Diagnostics that track changes at the cellular level. This is a big part of the work we do at BioAstra, and it's why we spend so much time studying genomics in space. Because the ability to diagnose cellular mutations before they become dangerous, such as leading to the rapid development of cancer, is exactly the kind of task we need to solve quickly in the context of medicine for such long-term missions. I think there are also a number of other systems, including imaging, that should be considered, but we spend a lot of time analyzing molecular changes caused by spaceflight or extreme conditions. And, of course, developing on-site medical controls to counteract these changes. You know, this is our goal, this is our dream. This is something we need to work on. This is what will help the first colonists of Mars survive. You know, it wo n't be a Da Vinci robot capable of performing surgeries. I mean, maybe so, but it will most likely be something much smaller and less impressive, at least at first glance, compared to how we

18:42 Imagine hospitals today. And our modern idea of hospitals is also outdated in the context of our ability to travel and become an interplanetary species, because we only go to the doctor when we have health problems, right? Doctors treat you when something goes wrong, but when we're talking about sustaining life for years while traveling to and landing on another planet, it's about much more than just illnesses. These are things like nutrition, sleep and circadian rhythms, loss of muscle and bone mass, vision impairment—it's a whole complex of physiological and cellular changes that need to be taken into account to ensure our survival. Are there certain things that, you know, lead me to what you were just talking about, which is proactive health promotion? So, what are you learning today in your field at BioAstra? Are you researching how you can prepare the body to withstand these conditions more effectively before entering an extreme environment, so that it suffers less from certain influences?

We have a few questions. When it comes to human performance, NASA and exercise physiologists are doing a lot of work to understand how we can best strengthen our bodies before and during flight to reduce muscle and bone loss. One of the questions we are looking at is epigenetic changes, which is what genes are turned on or off as a result of spaceflight or stress. And that's a big part of what we do. So I can imagine... God, I think it would be very controversial in certain astronaut circles, but there will come a future where we might find that a certain gene is more protective against conditions of increased radiation. And, perhaps, we will choose such people for deep space flights, and not others with a different genetic makeup.

21:17 So for me, understanding the diversity of human health at the molecular level is particularly fascinating. It seems to me that in terms of exercise physiology, cognitive processes, and certainly the psychological decisions that are used in astronaut selection, NASA has everything set up very well, and they are getting better every day; But we still have a lot of answers at the cellular level, and that's really inspiring to me.

This is cool. So, how do you wake up one day and say, "I'm going to do this"? Listen, well, what, what, what is this...yeah, because this is very much your role in the company—it's a very mission-driven, very purpose-driven organization, so is there anything behind this mission and purpose for you? Is there an energy element that says, "This was my calling," or " This is what called me "? So what, what, what caused all this? There are a few different ways I can answer. I think I, I, I'll start with the energy and mission aspect.

Because I think every founder, or most founders, you don't go on an entrepreneurial journey because you think it's going to be easy, or if you think that, you're doing it wrong. If you thought the founder's path was, you know, oh, I just, yeah, in a couple of years we'll figure it all out, and then I'll move on to the next thing. Um, all the best founders, CEOs, and entrepreneurs I've met are the ones who had something gnawing inside that just needed to come out. And it was the same for me. I started talking about this when I was still at Mount Sinai, I started talking about building enterprise medical technology systems for space back in the mid-2010s. And I nurtured these ideas and these thoughts for about 10 years before it became BioAstra. And, um, and so it was, it was like " Wonder Twin," or did you see some kind of vision, or, you know, what it was like, because it's really, first of all, it's a very abstract thing, what you're doing

Is so far outside the normal circle, right? And so your brain must be working on a different wavelength, because it's just phenomenal. Well, that would explain, that would explain a lot. My brain is working on a different wavelength, yes. Is that so? Um, I mean, part of it was, part of it was my frustration with, you know, trying to change something within the health care system, and I don't want to stand on any podium and talk about how broken it is. I know you have other episodes where you talk about these, you know, different elements of healthcare that are not working as effectively as they should, but I can say that working within these systems is difficult. It's really, really hard, and changing something from the inside is difficult. I deeply respect my colleagues who are still there, who are continuing this fight, who are moving forward, implementing amazing technologies, adapting AI, developing new drugs, new tests and devices—may God protect them. This is amazing.

24:52 Personally, I needed the freedom to be able to think about rebuilding this infrastructure from scratch. This was the impetus for creating BioAstra: if I could redesign an electronic health record, what would it look like? If I could rethink the way we conduct research with human participants in any, let alone such extreme, conditions. And if I could start creating technologies that don't necessarily have to be tied to an expensive, inaccessible, huge hospital.

That's where it all started: I saw all these separate fundamental problems and asked myself, "Where hasn't this been done before?" And I was pleasantly surprised that this was space. This is very cool. Tell me, is there a business behind this, or is it all based on grants? Is there a commercial infrastructure? Tell us about it from the company's perspective. Yes. BioAstra, that's a great question. This takes me back four years, because at the very beginning of BioAstra, my co-founder Chris Mason and I were probably in discussions for about two months, constantly discussing different options. We were wondering: should we register as a C corporation? Or as a type B corporation?

Or as a non-profit organization? We were just thinking, how do we create this? Ultimately, we founded BioAstra as a 501c3 non-profit organization. Our business model and charter define the goal of bridging the gap in understanding human health and biology in space, and transforming these findings into data available to the global scientific community. This is a big part of our mission— we don't believe in siloed information and closed data. We are working to make this as accessible as possible to the global community. And, as I said at the very beginning, my credo is that a PDF file has not cured anyone yet. We said it at Mount Sinai and we say it at BioAstra. So we always want our research to be focused on opportunities to bring technologies, compounds or products to market quickly.

27:37 BioAstra's business model is designed as a traditional 501c3 nonprofit organization. We apply for grants, we seek donations, that is, we follow traditional paths. But we also create new companies, and for each such project, our non-profit organization acts as a founder in the new structure. It preserves equity without dilution, and over time, dozens, if not hundreds, of opportunities will emerge for the nonprofit so that it is not forever dependent on grants and donations. We have created something that is capable of being self-sufficient for hundreds of years, because ultimately that is what I strive for. I don't want to work on a traditional venture capital schedule where the return on investment is 7–10 years, or 13 if we're talking about biotech. I want to think about how to build something that my daughter can use and that her grandchildren will inherit. My co-founder even wrote a book called "The Next 500 Years." This is a geneticist's view of how we will become an interplanetary species, a strategy for the

Future, right? We care about human health and well-being both on planet Earth and beyond, among the stars, for the next few hundred years. That's pretty cool. What does this look like in practice? So, do you have relationships with other similar companies? I'm sure there is, but if you can't talk about it, that's totally fine, but... No, no, I can absolutely talk about some of the things we do in space. I just think about all these little micro-economies starting to form around space travel; they have to evolve somehow, creating a whole ecosystem or structure around these processes, right?

Ugh. Well, I'll put it this way: our biggest ambition for BioAstra is not only to survive for the next 500 years, but also to create an independent research program for manned spaceflight in the next 10 years. So, I mean, right now, most manned spaceflight is done through the efforts of sovereign states. These are NASA, ESA, JAXA, but there are also smaller space agencies within individual countries. Basically, in this new commercial economy of "Space 2.0," we're talking about two, maybe three destinations in low Earth orbit. The commercial market still believes that only sovereign states will be the main buyers of such access. And BioAstra argues: no, if you really believe in the biotech and biomedical economy in space, then the commercial market deserves an independent share in manned flights. Therefore, we are quite ambitiously creating an independent manned space flight program built around biomedical research. And we are looking to buy our own flights. We are trying to buy space at the stations and we already have a

31:30 Booking agreement with Astra. I can't talk about it yet, but we have a booking agreement at one of the new stations. We are looking to gain access to some ISS missions that will be operated as commercial flights. They are called PAM missions. This is an abbreviation for "private astronaut missions." If any of your listeners are familiar with manned spaceflight and know the company Axiom, Axiom has been sending people to the International Space Station for the past 4 years. And all of these expeditions are PAM missions—private astronaut missions.

The astronauts that Axiom brings in—Peggy Whitson, led by Peggy Whitson, who is just an absolute phenomenon. What an amazing person. They fly for about 2 weeks. So, there are several new PAM missions on the table for the commercial space industry. BioAstra is trying to get its place. We are trying to get a seat, as well as seats at future stations. And we are also trying to cover greater and greater distances. We look at the Moon, we look at Mars. You might ask: How is what we do different from what NASA or anyone else does? And it really comes down to the design of our missions. We start with the twin missions. There was a NASA mission in which astronaut Scott Kelly participated in 2016. At the time, he had made NASA's longest flight to the ISS. And about 6 months before the flight, NASA realized: wait, it's Scott. He has an identical twin.

And his twin is also a NASA astronaut. So Mark and Scott Kelly agreed to participate in a year-long twin study to help us understand what happens to the human body in space. And identical twins are the best natural experiment because they greatly enhance our research, especially in genetics. This strengthens our research tenfold. And our statistical results. So you all, as scientists, are just thrilled about this, right? Yes, actually, my co-founder was the lead researcher on that project. Of course. Chris Mason led that study with Mark and Scott, so the basis of the data we have at BioAstra comes from them. We also have more data on astronauts collected during commercial missions over the past few years.

34:21 But we really want to get back to increasing the power of our research, especially in the early stages, to accelerate the pace of molecular discoveries and understanding of processes. So in the coming months, maybe a year, we'll be searching for identical twins all over the world. We are looking for qualified pairs of twins who might consider space flight or training, and that is actually very exciting. I think there will be a long line. I don't think you'll have to look for candidates for long. But it will be fun.

We hope so. It's difficult because it's a two-body task, isn't it? I think every twin study requires that both twins consent to participate. And in these studies, depending on your perspective, one twin gets all the fun of space travel, while the other has to stay home. At the same time, he still has to do unpleasant things, such as eating like an astronaut for two weeks. That's right. This will be an interesting and fruitful period of development. I see that over time, as access to such conditions increases, you may not always need twins for flight, and this work will evolve, as will all of science. But, um, that's the work that lies ahead of us for the next 5 years.

I like it. This, this is a good story. Well, I have one more question for you. And, um, this is kind of an unexpected turn of events, like a bolt from the blue. By the way, I always ask every guest about this. And maybe one day we'll dedicate an entire episode to answering that question. I'm going to ask you very slowly so you can think a little. This will involve going back to yourself in the past and giving yourself some advice. You know, you have a great career. Um, you're the founder. You are the CEO. You are overcoming barriers in many different aspects. You know, a female founder, a female CEO, you're pushing the boundaries by bringing healthcare into the space, and it's just a really transformative opportunity. So, if you could go back, draw on all your knowledge, and go back to 22- year-old Savi, and give just one piece of advice, not two? Not three, but just one piece of advice:

Based on what you've learned and experienced, what one piece of advice would current Savi give to 22-year-old Savi? Ovva. You know, that's an interesting question, but I know you have the answer somewhere. God, this is so difficult because 22-year-old Savi... everything she did is the reason why I'm here today. So, oh my god, I would give her a big hug and tell her to just keep swimming. Just keep swimming. Just keep swimming. Just keep swimming. Like little Dory from, you know, Finding Nemo, just keep swimming. Um, I think that's the best advice I could give her. Because she...

37:48 You know, I think there were a few moments in my life where I looked back and thought, "If only I had done this, or if only I had done that." Well, when you look at it from that perspective, you know, one change—and you wouldn't be where you are anymore, and, um, you know, fun fact: 22-year-old Savi lived in an ashram in Colorado.

You know, just keep moving forward. Like you, well, you know... you'll find it someday, right? You...yes, yes. And I mean, I still practice meditation. I still have those lessons, and those foundations, you know, of this work—that's what made it all possible. So, you know, even the great partners that I've had in my life and the not so great ones that came along later, and, you know, everything is where it is now. Maybe I would advise her, if I had to give her any advice, it would be, um, to call her grandmothers more often. Here's what I would do. I would advise her to call her grandmothers more often.

I really like it. Well, okay. Well, Savi Glowe, thank you very much. A wonderful guest, the most unique I've had so far, and we wish you and BioAstra all the best, keep up the research. Thank you, Terry. Ad Astra.