This research area addresses the question of how pioneers and explorers are to receive effective medical and pharmaceutical care. Disease is an inherent part of being alive, and thus disease prevention, diagnosis and treatment will be critical to human missions. ‘Upmass’ issues would prevent the transport of a complete pharmacy into space. Or to the Antarctic. Or on a submarine. Or to a UN relief camp. The availability of safe and effective pharmaceuticals defines the extent of acceptably-safe exploration. And the problems of providing pharmaceutical support are amplified when considering the nutritional needs of our pioneers and colonists.In spaceflight, the human body changes in microgravity – muscles atrophy, fluids redistribute, the microbiome changes, bones decalcify, gut enzymes change. Astronauts face new challenges: haematological crises (stroke, myocardial infarction, pulmonary embolism, etc.) And challenges from bacteria, either brought with them or part of their changing microbiome. Bacteria become more resistant to antibiotics AND antibiotics become less effective. This, compounded with the fact that the immune system shuts down, means our intrepid explorers are probably going to be in need of some serious medical care. That is also a problem. The pharmacodynamics and pharmacokinetics changes with flight (as the astronauts change in flight), so medicines will need to be tailored for them individually and specifically at the point of need. We can’t afford to take everything we may possibly need with us, so we need to find ways to manufacturer pharmaceuticals in-situ and on demand.And with space travel becoming in reach of the masses, how will safety be ensured and who will be responsible?