TITANS OF NUCLEAR

Bret Kugelmass
So we are here today with Rafael Grossi, the Director General of the International Atomic Energy Agency. Rafael, welcome to Titans of Nuclear.

Rafael Grossi
Thank you. Thanks for having me. It's good to see you again.

Bret Kugelmass
Yes, absolutely. So, you're in the position that for those outside the nuclear sector may not know is the absolute top authority in the international world of nuclear. But you know, we'd love to always hear where people came from originally. You're Argentinian, correct?

Rafael Grossi
I am. Yes.

Bret Kugelmass
Can you tell us about what your life was like there growing up and how it led you to a world of international diplomacy?

Rafael Grossi
Well, yeah, like you say, and I'm basically a career diplomat, I made it to the top of a career as a diplomat, as ambassador, and joined the diplomatic school. And actually, from the very beginning of my career, as a diplomat, writ large, I started working on non-proliferation issues. To give you an idea, I joined the Foreign Service of my country when Argentina was returning to democracy, after a long, you know, dark period of military rule. And as part of that, the foreign ministry was establishing a unit to deal with disarmament and non-proliferation.

Bret Kugelmass
And how old were you at this point when, when this transition into your country? So this was formative? I mean, this is like, you're at the age where people are deciding, you know, what do I want to do for the rest of my life. And here you have around you, all of these political changes happening in your country.

Rafael Grossi
Yeah, I didn't lose, I didn't lose a minute, I went to university. And then I finished my studies and jumped immediately into the diplomatic school. Some were saying, you're too young, give yourself more time, but I knew what I wanted to do.

Bret Kugelmass
And so was that the same characteristic that you had leading up to that point growing up, where you have the mind where, if you see your eyes on something, you just go for it? You don't hesitate?

Rafael Grossi
Yeah, that has never changed. I always have a plan. I look ahead. And that was, you know, when this happened, I remember, you know, when the class that was about to graduate from diplomatic school, was going to be assigned tasks within the ministry, there was this new unit. And of course, it sounds too techie. You know, everybody wanted to go to the North American department with the hope to go both to the United States or the West Europeans. So if you want to go to Paris, you better work there. This kind of thing. We were all young diplomats. And I said I want to go there. And of course, there were not many candidates, there were only two of us. And, and the great, great thing and I always say this really changed my life, not only as a professional, I would say side of it, is that when I joined my boss there at that time, I thought he was an old guy. But he was still relatively young in the career and he had the incredible idea which has been continued that for whoever wanted to work on these issues would have to have to go to the nuclear facilities and institutions of the country for six months to be trained, to learn. Which was, of course, it sounds obvious, but you have to do it. You know, we diplomats, we immediately want to, you know, put on a nice suit, a hankie, you know, play diplomat. And, of course, there I was at a nuclear power plant, you know, making friends with engineers, people who were looking at, I mean, we didn't know who was the most surprised of the two if then for me, they weren't seeing this young diplomat saying, you know, I'm a diplomat, and what are you doing here? And so, but he was fine. He can imagine, it was fascinating for me to be there. You know, fuel. I mean, as you may know, Argentina has really been developed as a closed fuel cycle. So we have everything, even reprocessing, at that time.

Bret Kugelmass
One of the most advanced nuclear countries in the world. I mean, you guys are the ones that are building medical isotope reactors that go around the world to countries like Australia and the Netherlands.

Rafael Grossi
So I have this opportunity to see research reactors, nuclear power plants, fuel, fabrication facilities. I don't know, hot cells, radioisotope, everything, everything. So quite clearly, that changed my life. Because I fell in love immediately with that. And with the non-proliferation issues. These were the days that were, of course, also at the global level, all the changes were happening with Gorbachev and Reagan. And so for me, I couldn't imagine that anybody else would choose any other topic. That was the topic, non-proliferation was the best.

Bret Kugelmass
And just to break it out for the audience who might not know, non-proliferation, non-proliferation means weapons, stopping weapons, so stopping...

Rafael Grossi
Stopping the spread, stopping the spread of weapons, of course, disarmament is the other side, which is, which is of course, very important. That is another discussion if you want, but for us, it was relevant for us. The non-proliferation part, which goes side by side with another big chapter in my life and in the regions developed, which was all our things with Brazil, because very quickly, we got into this, this dance with Brazil. You have to remember both countries, we're coming from a long period of military rule, both countries with nuclear latency if you want both countries, against the NPT, right? It was another world, it was not unimaginable.

Bret Kugelmass
NPT. That's the non-proliferation treaty.

Rafael Grossi
That's the non-proliferation treaty, and neither Argentina, nor Brazil, were subscribing to it. So basically, there were concerns all over the world about that. But of course, with a return of democracy, common sense came back and the enlightened leadership of both countries decided to move away from that, but that took a lot of effort as you can imagine, we have to imagine how to put these two countries together. And we came up with something which is incredibly original in the form of a binational deal, the binational inspectorate will exist.

Bret Kugelmass
Actually, that's very interesting. So that means Brazil and Argentina are able to kind of look at each other, independent of other organizations that might not have been together.

Rafael Grossi
It's not independent, it's together. Argentina, Brazil, the IAEA and the regional Inspectorate, which is called ABACC or ABACC, Argentine Brazilian Accountability and Control Agency, ABACC. They have a quadripartite agreement. So we, I speak say we, I am no no longer there, I'm IAEA, but Argentina sends inspectors to Brazil, Brazil sends inspectors to Argentina, the IAEA is there, everybody is there. So the whole thing now is being studied, you know, in other regions in Southeast Asia, of course, and in the Middle East, as an example of what one could have as a way to move forward in the non-proliferation world. So although all of this jazz was part of my formative years, as a diplomat, so you can imagine why it was amazing. He was amazing. I was there and when the President, imagine it, look, it's like a movie, when the President of Argentina decided to invite the President of Brazil to visit a secret facility where Argentina was enriching uranium, how about that? Oh my god, that was historic. That was amazing. In the, you know what Patagonia is, apart from being, you know, sports clothes, is a really huge region in the south of Argentina and Chile. And this facility was of course, as in a good movie was in the middle of nowhere

Bret Kugelmass
In the middle of a mountain lair.

Rafael Grossi
In the windy deserts of Patagonia, you had an enrichment facility. So of course, the President, the first President of Argentina's democracy, Raúl Alfonsín, said, look, what is this, an arms race with Brazil? And so he phoned the President of Brazil and said there, there's something you have to see. And we were there, the diplomats working with my friends, Brazilian diplomats, who are now ambassadors, like me, and we are friends, brothers working together. And we decided to organize this visit, I can tell you that when our delegation arrived at the place, even micro nationals were not treating us very nicely. Of course, because there was this culture of secrecy. They were saving the country, and all these things coming from this military rule that we were inheriting. But of course, both countries and the region because many countries in the region moved on institutionally. So that was part of the beginning of my professional career. And of course, after that, what can excite you?

Bret Kugelmass
So after that, you decide to enter into the world stage and decide to bring these. I mean, these are pretty unique skill sets now that you have, but yours an issue around the entire globe. So what was your next, the next step in your journey?

Rafael Grossi
Well, you know, I was posted. I have different postings. My first was in Geneva, where I was dealing, of course, with many issues related to the Conference on Disarmament, where we were dealing with a number of issues related to nuclear weapons, and to non-proliferation, but also to other weapons of mass destruction. My other love, if you want, was chemical weapons. I also worked internationally, in the OPCW, for many years I was the Chief Cabinet there. And I negotiated for my country, of course, the chemical weapons commission, back in the back in the 80s. Then I was in Brussels. And then I worked for the OPCW, which is another important international organization, similar to the IAEA - chemical, chemical weapons. We were doing... That organization is very interesting, because it's also a disarmament organization, we were dealing with the destruction of chemical weapons stockpiles in the United States, in the Russian Federation, and in other countries as well. So that was a tremendous experience for me. Then, I returned to my country, and then I started to move much, much closer to the IAEA. Albeit, I had been for the first time here in Vienna, as a young delegate in the 80s. I came back as the chief of cabinet for my predecessor, for DG Amano, I was his first Chief of Staff, and worked for the agency in that position for a few years. And then I went back to my national service as ambassador to the IAEA and then the whole story begins. There's a period where I was working very actively on other things, I was the chair of the Nuclear Suppliers Group for two consecutive periods. And I did you know many things internationally, until I became a candidate for this position and I won the elections and here I am, here you are.

Bret Kugelmass
I mean, it's pretty amazing. You rushed over a lot of that. But yeah, so you would get a lot of first hand experience, though, at the IAEA before you were just elected to the top role.

Rafael Grossi
I mean, yes, I knew the house. Yeah.

Bret Kugelmass
You knew everything. I mean, it's serving as the Chief of Staff, and then the Deputy Director General. I mean, you had so much hands on experience, that there's probably nobody better to have taken this position.

Rafael Grossi
Well, but that's, you know, it was a hard election. You know, the history tells, when you look back into the history of the IAEA that elections here were always very disputed. And you could be perhaps the most qualified, but then you know what an election is.

Bret Kugelmass
It's very political at the end of the day, states that have influence and weigh in.

Rafael Grossi
Exactly, yeah. And even those... Finally, I won, I won, I won nicely. But even those who were not voting for me were saying, Ah, yes, Grossi, you are so good, but I'm not, I'm not voting for you. So anyway, I got the I required, more than two thirds in the end. But it was. Yeah. And the reason I ran for office here is because I knew the house, I knew the potential, I knew what could be done, I knew that we had in this institution, a formidable, formidable instrument for non-proliferation, and many other things that we may discuss. And I just thought that I had a number of ideas that I could put into practice, precisely because I knew I didn't, I didn't need to be trained, or educated.

Bret Kugelmass
You hit the ground running. So tell us a little bit more about what even is the IAEA? I mean, there's thousands of professionals working there from around the world, right?

Rafael Grossi
Wow, you know, this place you've been here and you know it. So, you know, this institution is an amazing place where roughly 3000 professionals from all over the world from all over the world and we have like Janus, the Greek or Roman deity, we have like two faces. We have like two faces. One is this political and strategic face that is the one that makes us known as the nuclear watchdog. Right? We are the inspectors. We are the ones...

Bret Kugelmass
You can actually send people around the world to nuclear facilities around the world with, you know, clipboards and checklists and hey, let's take a look under there and it was this tape, you know, put on top and you know, do we have an accurate accounting of this material and that material.

Rafael Grossi
Indeed, this is exactly why we run an international inspectorate and this inspectorate is the one that goes all over the world to all countries, those having nuclear power plants, and also those who do not because, I mean, wherever there is nuclear activity or nuclear material, we are there. So, so, we do this non-proliferation work. So, we are trying to make sure that apart from those who have nuclear weapons, there are no more and this is of course, a very important part of the mission, for some the only thing that matters, but for many others, no, and there are other things, then we have the all the nuclear safety and today as as as we speak, is the we are commemorating or rather tomorrow we will be commemorating 10 years after, after the Fukushima Daiichi accident, of course, which is remembered all over the world. So we have a lot of work in nuclear safety, which is so important. Nuclear security as well, you remember, and I'm sure some listening or watching this knows, we have all this work on, you remember the summits and and the protection of nuclear material. That is one thing. And then there is there is a very important work on technical cooperation, which, frankly speaking for the majority of the membership of the IAEA is what for developing countries is what matters because we help them in nuclear medicine, we help them in food security, water management, I mean, the array of activities that benefit from here, we do not speak about nuclear energy, but nuclear science and applications. So we are an organization that has a compound, an amazing compound of laboratories in the outskirts of Vienna, a few kilometers away from headquarters, in a lovely place called Seibersdorf. There, we have an amazing array of laboratories, doing all the science for all these projects all over the world. Also, we have our laboratories studying samples coming from hotspots in the world for our safeguards activity. So it is a very unique organization that it's not only pushing paper, or debating ideas, it is doing real work, inspecting countries, helping countries and in very concrete activities that change the lives of the man or the woman in the street.

Bret Kugelmass
Right. It's right. So I think to maybe paraphrase this, it's not just a you know, the inspectorate side okay. There's paperwork involved in there, that's fine. But it's not just a diplomatic paperwork organization. There's also a research component almost like a national lab, in a sense, in terms, to communicate and bring together other national labs, and allow them to exchange freely the information that will advance nuclear science forward.

Rafael Grossi
Indeed, indeed, that that is that is the case in your comparison with the labs is, is very pertinent because we work very closely with most if not all, the National Labs in the United States and similar institutions around the world, which value enormously the possibility and the scope they get by working with us, because these national institutions, sometimes they have their own international cooperation programs, but but by working with us, they have a real global scope. And they can with us hand in hand with us have a bigger reach than doing it nationally, I would suppose.

Bret Kugelmass
So, I mean, you touched upon some of the many functions of the IAEA. But I know that they're even more. I mean, I've been to the buildings and see all the different columns and all the different areas. How do you personally keep track of it all? And then how do you prioritize? And then coming into this position? What were your top priorities? You know, when looking at such a vast and complex organization?

Rafael Grossi
Well, you have to have a 360 degree approach here, because what may matter for one country as the central issue that they want the agency to be looking at, and you can imagine, politically, let's not put names. There are some countries that only care about the IAEA if the IAEA does this, or doesn't do that. But for other countries, it is more on the assistance and cooperation side. And I am everyone's DG, and I have to make sure that every country feels that the IAEA is there for them. Yeah. So what, really the work is as fascinating as comprehensive, as exhausting, because you never stop, you can't stop, there's always something coming, which is tremendously urgent. Let me know, since we are talking, we are having this conversation at a time of a pandemic, which is quite a unique event in our lives, your life, my life, everybody else's. We have been helping a lot on COVID-19. People, perhaps will be surprised. But of course, RT-PCRs are based on nuclear techniques. And we've been, we've been distributing PCRs all over the world. 128 countries have turned to us for help. So we are training them, we are sending the equipment.

Bret Kugelmass
This is a testing tool for COVID.

Rafael Grossi
It's for diagnosis, you know, and, and with an RT-PCR, you can make, you know, twice or even more as much tests, as with traditional techniques, which, of course, given the nature of this, of this virus is essential in attacking it and mitigating it and eventually defeating it. So we were there immediately offering countries this possibility. And you have to think, and this is what is so important when you analyze the work of an international organization, that there are countries, I'm talking about countries where they didn't have a single RT-PCR, which in the United States, you may have 25 in a small health unit of a small, the smallest town of a medium size, state. Yeah, whole countries with 10 million population, not a single. So. So we were there for them. And we still, we are still doing this,

Bret Kugelmass
And this, because I guess there's a few dots that we should connect for our audience. So first, the IAEA is part of the United Nations. It's part of the same organization.

Rafael Grossi
Well we are not within, we are part of the international system, but we are an autonomous international organization.

Bret Kugelmass
But there is a mandate of world good that runs through. And then also you guys have a lot of medical knowledge and medical expertise, because nuclear has a lot of medical crossover as well, whether it's isotopes for imaging, or for you know, tools for cobalt-60 for sterilization of medical equipment. There's just a lot of crossover between medical and nuclear. And so naturally there is expertise in house that you could call upon to help in a world crisis.

Rafael Grossi
We have top notch experts in the area, we have a, you know, a flagship program called PACT, for Programme of Action on Cancer Therapy. And we are helping countries all over the world, we have a big program on human health, where we are working, like you were saying on cardiovascular diseases, as you can imagine, with cardiac imaging, with, you know, myocardial perfusion then with radiotracers. We are working on other neurological pathologies. I mean, their work is simply amazing in so many areas, where we do the calibration and the symmetry for radiotherapy units for all over the world, you know, so they don't burn patients. So many countries don't have these capabilities. And here, we have them, so we do it for free for them. So the service, in terms of health, is really very important. And so you can imagine why I was saying that for some in the I don't know, I don't want to name names, but in some small country, in the center of Africa, to be honest, the Iran issue, or the JCPOA, is not the most important, right.

Bret Kugelmass
At the end of the day, since you serve everyone, you have to balance all of these priorities.

Rafael Grossi
You have to balance all of that, be present for all, be mindful.

Bret Kugelmass
The President in the United States has to be the President of all the states, you're the President of this international organization, you have to be President of the whole world, in that regard.

Rafael Grossi
Well exactly, if you look too much to technical cooperation, those who believe that non proliferation is the reason for being is their raison d'etre, as the French say is the reason for the existence of this, will not like it. So you have to, you know, be as much as you can, be present for all in every department. If you want our organization to reflect that we have a department for nuclear energy, we have a department for technical cooperation, and other department for nuclear applications. You know, if you use the image of a president, I have my ministers and my cabinet or my secretaries dealing with all these issues, and we have to make sure that we deliver at the end of the day.

Bret Kugelmass
Now, before you know, the COVID pandemic started, and you had assumed this position, there was probably a different set of priorities. And hopefully the pandemic will be winding down soon, we have new vaccines. And so hopefully, we can get back to some of our other world priorities as well. Namely, one I can think of, climate change is the other, you know, big issue that we have to deal with here. Can you tell me about where some of those priorities overlap? And what some of your efforts around nuclear energy and climate change have been?

Rafael Grossi
Of course, well, that is that is very important. And I think you yourself have been lecturing about this. So I know how important your own contribution has been on this matter, it is obvious that, you know, the I think the difference I brought as a DG is that I am very vocal on the importance of recognizing that nuclear has a place at the table. I'm not a nuclear lobbyist. But nuclear has a place at the table of energy efficiency. And at the table of climate change. My, you know, my first trip abroad was to the Conference of the Parties of the climate change convention, the cop The so called COPS, the COP 25, in Madrid, against the advice of many around me, who are saying no, don't go there. This is a place where nuclear energy,...

Bret Kugelmass
Why has nuclear energy been historically, you know, excluded from some of these conversations, given, obviously, its contribution to clean energy is so profound, and what can we do to try to change the narrative? I mean, I know you're showing up, which is definitely the first step and it gets crazy other people wouldn't want you to show up. I mean, that's just called being a leader and being brave and making sure that nuclear has a voice, a voice.

Rafael Grossi
So it's a mix, it's a mix of it's a mixed bag of perceptions, prejudices. Also commercial interest, ignorance as well, you know, you have in the pot, you put a little bit of that and the end result is a bad one, of course. So what we say is that we want an enlightened and science based discussion of what are the advantages. And for those who don't want to, as I say, again, we are not our local lobbyists, we are saying nuclear energy is a positive contribution, it is already we know it. And the facts are saying that it is not a simple conviction or an ideology that we are pushing for. So, in terms of what can be done about this, I think the important point here is information, education, and never being afraid of a good debate. I think one has to also be a little bit from the nuclear sector, which has been where I have been working for 40 years, there, there has also been some, you know, moments where the from the nuclear sector there was a bit opaqueness, maybe a tad of arrogance by saying we know better, it's obvious, or to close one oneself up to today's debate. I think it's important whenever, of course, there is a respectful and correct debate to talk to those who, who may have a, you know, a negative view and go down these days, of course, around Fukushima, and we are having lots of discussions. And still today there are people, you know, talking about completely fictitious figures about cancer and things like that. We all know that. There's no proof of any death caused by one by radiation effects in Fukushima, which claimed the lives of 1000s in Japan.

Bret Kugelmass
It's amazing. And on that note, though, don't you think then, because I know another big role of, of your organization is to shepherd newcomer countries through the process of acquiring nuclear energy for the first time, given what we've learned from Fukushima, and that not a single person died in the case of a meltdown, which we thought of as you surely this, you know, this is a horrible catastrophe that must be avoided at all costs, now that we're able to recalibrate the actual risk, see, and of course, it's still horrible. But now they're able to recalibrate the risks. Is it possible that certain countries that have a lot of other problems to deal with, air pollution that kills you, we know, kills millions across the world every year? Is it possible that we can recalibrate our perception of risk with nuclear energy to make it easier for them to acquire nuclear energy faster, such that they can mitigate some of these other more pressing and much larger health issues that they're dealing with today?

Rafael Grossi
I think we are seeing we are, Bret, we're seeing that already. You know, in my position, I talked to lots of policy, decision makers, ministers, and it's amazing, you know, the amount of people, especially ministers, ministers of energy from developing countries that are eager to see the possibility of small and medium sized reactors too because they are looking for solutions. And the solutions are not easy. And at the same time, they know and they are aware of their climate change, emission responsibilities that they have. And to be honest, they're not you don't have 1000 solutions out there. So what one sees is this, it is a trend, there are of course, financial aspects that need to be taken care of. And this depends, you know, in energy, not nuclear energy, but energy in general, there is no one size fits all solution. Each country has a configuration of human resources, technical resources, natural resources, financial resources, that is going to come to play in a different way. So some, this is why sometimes when I listen to some presentations, I'm a bit, you know, surprised by the simplicity of what is being said. There are countries where the opportunities lend themselves to this much easier, there are countries that have access for political reasons are closer to certain vendors. And we see this when you look at the so-called newcomers. In the jargon, as you know, those countries that are coming to nuclear, you will see some that have closer relations with one or the other vendor, and they can arrange themselves in a different way. So I think that each case merits a separate analysis, but what we see is for the benefit of our conversation, which is, of course, more general, what we see is that there is a trend there, which is very interesting, that looks at nuclear energy as a very interesting option for those who haven't. And for those who are dealing with a problem, it is an obvious choice, think China and others, I mean, these countries are doing this because they know that it is the sustainable solution to to economies that are so-called dependent, they have to if they want to do something about it, they need dispatchable energy, they need reliable energy that is going to be there all the time. And what I think it's very important is not to pitch one, as you know, I come from a soccer country, as if it was a team against the other. You know, it's nothing like that. It's really nothing like that. It depends on your capabilities, there are countries where hydro is an obvious choice, there are countries that don't have anything of that, and they will be turning to nuclear more, more easily. And in both cases, the IAEA will be there, you were pointing out to this assistance we gave to two newcomers, which is very important, because we are looking into, you know, each step we have, like a Bible that we call the milestones document.

Bret Kugelmass
We call them phases when we talk about it sometimes

Rafael Grossi
Then the institutions, the political class, learns what is necessary at every step of the way, the importance of an independent, wrong regulator, the importance of having an infrastructure, which is able to support the effort, these kinds of things.

Bret Kugelmass
I mean, you talk about infrastructure, you mean both human resources, as well, as you know, further electrical infrastructure as well, there's almost two sides to that coin, in terms of the things that are necessary to integrate nuclear into a country's energy portfolio.

Rafael Grossi
Indeed, the infrastructure thing is extremely important is one of the things that countries are looking at. But mind you, when you look at new types of nuclear reactors, like the small medium sized, modular and even microreactors, they are also a very efficient solution for those countries having a fragile grid, or problems of long distances, isolated places that need to be, you know, powered in one way or the other. So, I do believe in a very interesting, active, I didn't want to use words like bright, because it sounds too commercial but clearly an active, important, constructive role for nuclear energy in years to come. No doubt about.

Bret Kugelmass
Yeah, it's amazing. And I remember and I have to thank you for inviting me out to speak at the climates conference that you guys hosted. I mean, this was now it feels like forever ago, but a year, year and a half ago or so. An amazing opportunity. And just to show the leadership that you guys are starting to take now, with respect to climate conversations more broadly. And you have got one coming up as well, right, there's going to be the UN Climate Conference, you want to tell us about what's happening there?

Rafael Grossi
Well, there are a couple of things that I could mention. One is, of course, the global international, the COP 26, which is going to take place in Glasgow, so it's organized by the United Kingdom. And we are working with them. So this is a meeting for nuclear energy, this is the meeting for climate change the convention. And but we are going to be there to engage with that community with the energy and climate change community all over the world, to make sure that the voice of the nuclear sector is heard. And that we can engage, as I will say, in a constructive conversation with all these, as they say, These days, these stakeholders, we all of those who are in one way or another involved, including those who may have very critical views about nuclear energy, why not? So that is one thing and we are preparing ourselves for that. And the other thing is a nuclear specific conference. And I think it's important for you, Bret, to be aware of this because this is going to take place in the United States. As you know, there is a traditional conference on nuclear energy that takes place every four years more or less. There was one in China, one in France, one in Russia. And the last one was was in the United Arab Emirates, and the next edition will be in the United States, in Washington, COVID allowing, end of October, maybe it could be moved to next year, if that is not that this is the big, the big, round the room for everything, nuclear. And what I'm very happy to be working with the Department of Energy and the State Department organizing this, and also with the nuclear industry. The other thing I wanted to mention is this. The IAEA now is working very closely with industry. In the past, there was a little bit of, you know, apprehension, I don't think there needs to be really none. I think that we recognize our respective roles, but it is good for us to be working with them, because we are the norm, the norm setting if you want a global institution, and of course, we want the industry to thrive, and to work and to be comfortable with the norms we are promoting.

Bret Kugelmass
Yes, there's a bit of back, there has to be communication both ways. Because the industry is on the ground, right? They understand what the problems and challenges are. And it might be something small, that, you know, small and easily fixable, but that the industry isn't in a position to correct. So. So they've got these insights. And then you guys in setting the norms need insights. So there has to be this, you know, this communication both ways in order to be able to then make a more productive, move forward.

Rafael Grossi
Well, exactly, I couldn't say it better. But it wasn't happening. It was happening in a very haphazard way without a systematic, and I'm really reaching out to them. talking to them, I've been in contact already by now, in my year, year and two months, in, in the job, I've been talking to almost all the most important CEOs in them. And they are very welcoming they there they are they were surprised because they were not used to the DG of the IAEA reaching out to them saying, Here we are, if you have a problem, let's talk I have also established an excellent contact with with WANO, or the World Association of Nuclear Operators, which is a very discreet technical association, that that's a lot of good, because they are working really without any political attachment or agendas. They are a an apolitical institution that makes the connection among all the operators in the world. And of course, I think we all have to benefit from working together. So I'm trying to reach out to them too. I hope they will see this the new IAEA is working in an open way trying to offer whatever we can put on the table for everyone's benefit at the end of the day.

Bret Kugelmass
Yeah. You know, it's interesting, you've been in this industry for 40 years, you know, I've only been introduced to nuclear for the last three. But already in these last three years, I feel like I sense some momentum building. I feel like I see there's like this newfound energy almost, to bring solutions forward and to you know, to almost reclaim the idea that nuclear used to have, like, all the way back in the 60s where it's like this magical technology that was that was going to really, you know, increase prosperity, right, I mean, like you know, part of the original mandate of the IAEA and the Atoms for Peace program from the US was to spread technology around the world. And I feel like it's almost coming to fruition. Now. Do you have that same sense that no momentum is building?

Rafael Grossi
We haven't you know, there wasa here I would say the whole a few years ago there was talk about this Nuclear Renaissance. Yeah, some were saying, well, here's nuclear roaring back from this past, where it seemed to be the solution for everything, you know, I tend to try to take a view that has to incorporate everything that has happened, the good and the bad. The fulfilled promises, and the unfulfilled promises as well. Perhaps people were expecting too much nuclear energy. Nuclear energy could not be the magic wand that would solve the world's problems in terms of energy, and perhaps all those who now say, well, it was it was too good on paper and it never happened. I think there is the if the metric is solving the planet's need for energy perhaps is too high a bar. At the same time this is catastrophism for nuclear was equally unjustified and not based in any scientific, of course, if you hate nuclear, and you believe that is the source of all evil, there's nothing really that one can do in terms of a rational conversation. I think that always and perhaps my profession as a diplomat, we diplomats are always looking for the middle line. Compromise. And I think nuclear has a lot to give. Where do you put that? I don't know. Let's work day to day nuclear is there is a reality. That is also something that should be said, some people say, well, it's, it's a solution. But all these problems, and I'm and I remind them that nuclear is already doing all these things. For us, were it not for nuclear, the climate change crisis would be a climate change disaster? Yeah. You don't have it because in many countries, the United States, for example, or in France, or in China, and in India, in many countries, you have nuclear already mitigating pollution.

Bret Kugelmass
And air pollution as well, we can quantify, you know, how many lives nuclear has saved just from you know, offsetting, you know, potential air pollution from coal plants.

Rafael Grossi
Exactly. You're right, by any metric it is that so what we want is as a serious conversation, knowing that nuclear has a lot to put on the table. And ultimately, this is a market economy. And, and in most of the places where nuclear is deployed, and you know, that that will have its own logic. But the issue is there, the solutions are there. And I hope the world would ever, you know, I'm running this institution and the statute that I have to abide by, upon which I swore I was sworn in, says that we have to enlarge the benefits of nuclear energy and technology for the largest number, and this is what we're trying to do, Bret.

Bret Kugelmass
Okay, Rafael Grossi, thank you so much for taking the time today. It has been an amazing conversation, I have to say, when you first got elected, my whole team, we were up and cheering. And so we cheer for you, your leadership and just thank you for everything that you do.

Rafael Grossi
That's very kind, Bret, I enjoyed it. And I hope to see you soon. Thank you very much.

Bret Kugelmass
All right.

Rafael Grossi
Thank you. Bye, bye.

Bret Kugelmass
So we are here today with Dr. Ahmad Ameri, who is a clinical oncologist at the Imam Hossein Hospital in Tehran, Iran. Thank you so much for joining us today.

Ahmad Ameri
Thank you. Thank you for inviting me for this interesting discussion about radiation.

Bret Kugelmass
We're here to hear about the amazing work that you're doing. And so I'd love if you could start off by giving us an introduction as to your background, and how you entered into this field of study.

Ahmad Ameri
I'm a radiation oncologist. Now I'm an associate professor in Shahid Beheshti University of Medical Sciences in Tehran and working in the clinical oncology ward of Imam Hossein hospital. I'm on faculty since 2003 and now I'm an associate professor. I also study medical education now, I'm about to finish it, and my major duty in the university is education for the residents of radiation oncology or clinical oncology. In Iran, radiation oncologists treat cancer with systemic treatment and also radiation. That's why we named its clinical oncologist and but we also treat the patients in private and governmental hospitals. My interest is head and neck cancer, treating head and neck cancer with chemotherapy, radiotherapy or immunotherapy nowadays, but we do also research. But most of research or clinical research for our patients.

Bret Kugelmass
Can you maybe tell us what motivated you to become a doctor? Was there in your childhood? Did you have a family of doctors? Did you have an interest in medicine? What was the original passion?

Ahmad Ameri
My father pressure. My father asked me to be a doctor. I was not interested to medicine. I just started mathematics in my branch in the school was mathematics. But my father forced me to be a doctor. And I participated in the medical conquer and accepted in the Urmia University of Medical Sciences. That was the real reason.

Bret Kugelmass
That's probably the same anywhere you go in the world.

Ahmad Ameri
Yes, but now I'm happy with this decision

Bret Kugelmass
Are you going to pressure your kids to become doctors as well?

Ahmad Ameri
My son is an intern and he will finish one years later. But he also decide by own not by my pressure.

Bret Kugelmass
Sure he did. And then was there something that drew you once you became a doctor, was there something that brought you to the field of oncology and treatment of cancer? Why that instead of a different fields like orthopedics?

Ahmad Ameri
Back into my background about mathematics. I tell that radiation oncology is a field full of physics and technology. But when I entered the residency, I saw that this is not the technique. It's completely clinical branch. And especially in Iran, because we are involved with the patients from the diagnosis until the death. That why this was a misconcept about the radiation oncology in Iran. But now I, I think it's motivated branch and is very high level of education and treatment, you are involved in the technology decision and everything that has in the medicine you can have together to help your patients in this good feeling.

Bret Kugelmass
Most people that are not in medicine probably don't know much about chemotherapy, about radiation, about cancer treatment at all. And how many, but radiation saves lives most people are probably scared of radiation. But how many lives have we saved with radiation?

Ahmad Ameri
Yes, you are right. Cancer had treatment, three main treatments. One is the surgery. One is the radiation. And one is the systemic treatment, including chemotherapy, hormone therapy, and nowadays immunotherapy. But based on the research and based on the international organization surgery can cure about 40% of cancer patients. Radiation also cured about 40% to 50% of patients and systemic therapy in cure about 10% to 15% of cancer patients. But most of patients need a combination of these treatments. Consider that cancer, some of cancer are local, just local growth, but some of cancer have a propensity to designate in the body. That's why we need systemic treatment. And we combine systemic treatment with local treatment to achieve more and more effective treatment for our patients. I think radiation, I think most of people know the cancer with the chemotherapy because of the side effects. All patients are worried about the side effects of treatment. And in cancer treatment side effects of chemotherapy is more than two others options, including surgery and radiotherapy. That's why when you speak about cancer, all patient bring in mind hair loss, vomiting, and something like this. Although the chemotherapy just cure 15% of patients. But chemotherapy, use drugs, drugs has a support as the pharmaceutical companies, they support the medicine they support the chemotherapy drugs and that's why all patients know cancer with chemotherapy. All his studies has been done with chemotherapy. Radiation and surgery has less support especially radiation because radiation is the second step in patient management, most people have the biopsy site or then refer for radiation or had surgery and then refer for radiotherapy. So, when you are designing a trial for the radiation maybe you cannot accrue enough patient for this study or know what there is more study in radiation has been started due to immunotherapy because it was defined that the radiation with unusual fractionation can increase the effect of immunotherapy. That's why we have more to study with radiation. That's because of support of pharmacological companies

Bret Kugelmass
And but why why is that? Why has nobody decided to look at studies just with radiation or start with radiation before you cut into someone or before you apply chemotherapy to isolate the effectiveness of the radiation?

Ahmad Ameri
Because the study need money. Somebody when should pay for the study. All the studies in their chemotherapy or immunotherapy in hormone therapy, were supported by the pharmaceutical company that they are rich companies. But for radiation, no, for radiation, there is no support. It's a business that they sell the machines and then support for maintenance. And they can give their benefits. That's why we cannot have the radiation only a study we have, but most of them are supported by the government or or international communities, not by the pharmaceutical companies or by the radiation producing companies.

Bret Kugelmass
Where did you first see the idea to use radiation to fight the cytokine storm? The inflammation due to COVID? Where did you first see this in the world or in publications? How did you know to start conducting studies along these lines?

Ahmad Ameri
I didn't see at first. Our hospital was the center for COVID patients. And all our wards was full of COVID patients, neurology ward, orthopedic, any wards was occupied by the huge number of patients with COVID-19. We was in the very shortage of the human resources and the medical equipments, including ventilators, monitors and something like this. I think how can we help them? We we have an insulated ward, clinical oncology ward is isolated from the other hospital that was there. So we was not involved in the COVID. But we saw every day that patient passed and passed away. No. That's what we think about the helping them I asked a pulmonologist what's the reason for dying the patient with COVID. And he told me it's just by the bleeding in the lungs. I thought about it because we use radiation to stop bleeding. When a tumor is bleeding, we use radiation with the high dose per fraction just one or two fractions will stop the bleeding.

Bret Kugelmass
Why is that? What is the mechanism by which radiation stops bleeding?

Ahmad Ameri
Radiation has different affected in my opinion, today radiation is a systemic therapy could be a systemic therapy right but it depends on the dose per fraction, part of body that irradiated, how much body irradiated. They all affect the effects of radiotherapy on the patient. When when you use the large fraction, prescribing large fraction of radiation, they usually make the vessels to be shrink to constrict them yes that to constrict them them and that's the reason for stopping bleeding. But when you use with a lower dose per fraction, usually the vessels will repair themselves. When you use a large fraction severe inflammation will occur within the vessels and they cause too we say coagulation stopping the clotting the blood within the vessels and that's why the bleeding will stop what when you use lower fraction, lower dose in each fraction. This this kind of reaction was not accurate.

Bret Kugelmass
So what is the what is the dose where this occurs in grays? How many grays might be applied to cause this coagulation effect?

Ahmad Ameri
Five, six gray per fraction.

Bret Kugelmass
And what's a fraction? What is a fraction?

Ahmad Ameri
In cancer treatment radiation will prescribe in different fractionation. Total, those will be divided in fractions and each fraction, maybe one fraction per day, maybe two fraction a day prescribe to the patient for cancer treatment that's why the 30 fraction of two gray means 60 gray during six weeks.

Bret Kugelmass
Wow, that's a lot.

Ahmad Ameri
Yes, that's that for the cancer, for example, lung cancer. But nowadays, all things are changing. Now cancer patients who have not metastases and cannot be cured by surgery or surgery is not possible radiation with a fractionation of 18 gray 12 gray 16 gray 18 gray in three or four fraction will cure the patient. Wow.

Bret Kugelmass
So even higher per fraction

Ahmad Ameri
Yes, higher. We name it sbrt Stereotactic Body Radiation Therapy or Fractionated SRS stereotactic radiosurgery

Bret Kugelmass
And this 18 gray fraction dose, what are the consequences of this? What are the negative side effects of going that high? I understand the patient is in bad shape and so it's a last resort. But why have we not gone this high previously? What are the possible negative outcomes of going that high per fraction?

Ahmad Ameri
Yeah. Radiation goal is to prescribe high dose to the target and spare other targets. It's now possible but in the past, it was not possible, to cure patient with such a fraction for such a high fraction per day. With the new technologies as the it's apparent in the name is through tactic. When when with this new technologies, we can confirm the doses just around the tumor and spare one millimeter, two millimeter away. All the tissues.

Bret Kugelmass
I see, it allows you to focus the dose into a smaller area.

Ahmad Ameri
Yes,

Bret Kugelmass
I see.

Ahmad Ameri
Smaller area and confirm it.

Bret Kugelmass
That means the volume as well. You're able to narrow it not just in terms of like a cross sectional area but you're able to find a circle within the body. The balloon within and be able to target that balloon.

Ahmad Ameri
Yes, yes, like this. That's why we can now we can prescribe radiation in this regard with when you can spare more tissue, more normal tissue, you can prescribe more doses to the tumor. But whenever you cannot do this, for example, when the tumor is near the organ at risk, critical organs such as vessels, such as the brain, such as the when you are near the optic nerve, for example, you cannot prescribe that large doses. You will have to bring down the doses. But more than the previous you can prescribe now.

Bret Kugelmass
And I'm sorry, I interrupted you before. You had met with a pulmonologist and they had said the problem with COVID is the bleeding. And so you thought well I know how to stop bleeding with radiation please continue.

Ahmad Ameri
Yes. I thought about it that if we prescribe the high doses for the place the lung had - and started to study, we saw that the radiation has different affected we saw that low dose radiation was used for pneumonia about one century ago with good results.

Bret Kugelmass
How did that? How did you find that piece of information

Ahmad Ameri
I saw in there, I saw in the publications, I search for it.

Bret Kugelmass
You were able to just do an internet search through publications, journals, and it just appeared.

Ahmad Ameri
Yes, yes, yes. We found in the journals in the publications that the radiation has a different effect with different doses when we searching for the topics, we also know more and more about the mechanism of the ARDS in the COVID-19. And we actually do during time interested to the low dose radiation, we saw previous studies. And a good review in 2013 about the radiation, low dose radiation effects. We saw that most people about 30,000 patients treated with low dose radiotherapy for artheritis in Germany, every year, about 30,000 patients are treated with radiation, not with corticosteroids, not with aspirin, and other things. And

Bret Kugelmass
What is the dose that is applied in the Arthritis case in Germany to 30,000 patients a year? What's the dose?

Ahmad Ameri
I think it's about three, two, one to three different doses, because there is no standard doses for this it's perscribed per patient. I think it's between one as I remember, I hope to be correct. As one to four gray one to four.

Bret Kugelmass
So within a similar range as to what we're talking about here for treating COVID as well.

Ahmad Ameri
Yeah, that's what I think when they when they were searching for the plan you know. And I hope to can help the patient because we saw a catastrophic event in our wards. And when we decide to prepare a proposal for approval to the review board, we reach to 70, 0.7 gray as an optimal dose at this.

Bret Kugelmass
Yeah, so less than one gray.

Ahmad Ameri
Yes less than one gray.

Bret Kugelmass
That's all your asking for asking for to the review. Less than one.

Ahmad Ameri
Less than one gray. We also found some studies that use whole body 0.1 gray. The whole body. Whole body. 0.1 gray for treating lymphoma, Hodgkin lymphoma. Okay, as a system, I told you before, radiation, could be a systemic treatment.

Bret Kugelmass
How does that work? I know, I have limited experience personally. But I've been to the dentist and you know, they have the device that goes focuses on your mouth. What does the whole body machine look like? How do you apply a systemic dose of radiation.

Ahmad Ameri
You know it needs some special machines. We usually treat patient on the bed, under the head of the machine. But when we decide to treat patient whole body, we have to use the patient in upright position away from the machine and the machine head turn about 90 degrees with more distance from the machine head that you can fit the whole body in the radiation fields.

Bret Kugelmass
So it's just like a flashlight. If I were to hold the flashlight up against a wall it would only occupy a few inches. But if I walk back across the room, the flashlight will shine over a larger area, even at a lower level of illumination as well. Do you have to perform mathematical calculations to determine the dose as a function of distance from?

Ahmad Ameri
Yeah, I'm not a physicist, but it's a complicated calculation. And our physicists have to design the machines and the calculation and the monitor unit that this the machine will release for this treatment. I have no experience with this. But I just imagine how can we treat patients whole body radiation, with whole body radiation? Yes, I thought the 0.1 gray has prescribe it to the Hodgkin Lymphoma before the local treatment on the tumors, it low doses, very low doses modulate the immune system of the body. And when we know about the mechanism of the COVID-19, cytokine storm, we decide to try 0.5 gray as a prescription to the lungs. We also know that the effect of radiation on immune modulation will disappear after 48 or 72 hours and we decide to add a additional dose after 72 hours if the clinicians if their patient's physician requests us.

Bret Kugelmass
If you see signs of the immune system still overacting after 72 hours, you want to modulate it a dose of a low dose radiation system systemically across the body.

Ahmad Ameri
Yes, yes.

Bret Kugelmass
And when did you first start this study? What month?

Ahmad Ameri
We starting searching for the proposal and preparing the proposal to approve in the ethics committee about March. But the first patient was entered to our study I think it's 20 of May. I think so.

Bret Kugelmass
And is it difficult to to acquire patients for this type of study.

Ahmad Ameri
It's very, very difficult, especially in the first five patients that we presented, it was very difficult, more of our patients have unwanted or unwarranted fear of the radiation, also, scientific community in our hospital also has this fear. They was not agree with us.

Bret Kugelmass
And I'm finding similar stories as what you're telling me across the world with other research scientists that are conducting similar studies. But my perspective is COVID when you are in a hospital is very serious. A lot of people die when they get brought to the hospital with COVID. And they should be very afraid of that. Not just of radiation. And also if 30,000 patients in Germany are getting even more radiation and it's just to treat artheritis. It seems to me that that would calm people down and help reduce fears. What happened in your experience?

Ahmad Ameri
At at first nobody accept our tests, nobody. I treated first three patients by myself. Yeah, as patients. There was yes, there was a fear of radiation for patients. And there was additional fear about their radiation oncology ward staff, that bringing patients with COVID-19 into the wards and treat them that's what the resist about the treatment. We accept about 40 patients to participate all in our trials. And just five accepted, just five patient acceptance. Yes, I also asked about five our staff to help us to treat these patients. But just one accepted.

Bret Kugelmass
Why why was the staff who is dedicated to medicine not interested?

Ahmad Ameri
Yes because in our wars due to sanction we have a shortage bout most of the equipment and the monitors and somehow drugs. That's why everybody thought that if if if I got COVID what's happened for me? I think so.

Bret Kugelmass
And what about if there's a shortage of equipment for radiation what about diagnostic equipment, is it possible to use diagnostic equipment to get up to a half a gray dose?

Ahmad Ameri
I have no experience with this machine. But now I know that it would be very difficult because for the radiation machines were radiation treatment machines. They're one gray is a low dose, just as a blinking. But for the imaging machines, it would be very high dose, and it needed pressure on the machines, machines that are needed for diagnosis,

Bret Kugelmass
I see, I see

Ahmad Ameri
Yes, I think is not possible, at least in our hospital is not possible.

Bret Kugelmass
So you were able to get five patients into your initial study. What was the results?

Ahmad Ameri
I think our study has some shortcomings, especially we started in the emergency situation, we could not give the best supportive care to our patients after radiation. That's what we discharge some patients that will be admitted. Who will be who would be who should be on the ventilator or under supervision. But the result was very amazing. Every patient after the first doses after radiation therapy, the day after the radiation, all patient I saw all patients after the radiation and all have different face. They were very relaxed. But but the complimentary treatments was not effective was not available. We need our beds for more complicated patients. But I think it was very effective after three patients. I told my wife, if I got COVID-19 pneumonia, my first choice would be radiotherapy.

Bret Kugelmass
Yeah. So you're saying you got the the worst of the patients, most dire of cases, no support to help you know, in any treatment, you need additional resources and support to help nurture a patient. And even given these horrible circumstances. You saw incredible results from the radiation in a short period of time too.

Ahmad Ameri
Yes, yes, we we achieved a clinical response of about 80% in the first five patients

Bret Kugelmass
80% effectiveness in the first five patients you ever tried the song and you hadn't even figured out the right tuning the right amount of dose the right time, the right post treatment and still 80% effectiveness.

Ahmad Ameri
Yes. We achieved a key person's response. But you know, response was defined in different way in different studies. But we saw the oxygen saturation increased, inflammatory markers decrease, you know, and for five for first five patients, we achieve about 80% response for the when when he added five more patients. We we achieved a response about the 66%. A bit lower

Bret Kugelmass
And what four accounts for that. I mean, I know it's low numbers

Ahmad Ameri
When when we start to accrue the patient to the trial we saw that trials of Emory in a print publication. They use yes, they use the 1.5 gray with dramatic with dramatic response. And that's why we we know we knew that the lower doses is better to control cytokine storm to modulate immune response- In print version, we decide to increase doses. We decided to create it four more patients four less patients with one gray with longer the study is very small. But show us that half gray may be better than one gray. Yes, the results show us this differences that we tell from the first lower doses is more effective for modulation of immune system.

Bret Kugelmass
I see. And so where did, where do your studies stand now? Where can you now that you've done 10 total patients? Are you trying to increase the patient count beyond 10?

Ahmad Ameri
Yes, we asked our ethical committee to let us to conduct this study with the more patients they accept, but their resources don't let us to go ahead. We had the two machine in our wards for radiation. They these machines work from the 7am until 9pm. And we have a lot of problem with the services, this machine should be service should be maintained. And there is a lot of shortage about the accessories of this system. That's why I have haven't give the agreement of our wards or chief. That's why we are trying to conduct a more and bigger study with different doses we are interested in define the better doses for these kinds of patients. But I don't know I can.

Bret Kugelmass
It's so but it seems to me that while it might seem in the short term, that this treatment would consume resources, in the long term on net across the whole country, it could save many resources, because think of all the people that would not have to occupy hospital beds would not have to take drugs would not have to take doctors time. If it was as quick as the blink of a button from one of the radiation machines.

Ahmad Ameri
Yes, it's my, I think also like you, but somebody else should be decided about it. Make them make them happy with our mind is very difficult. It's very difficult, because this kind of trial, this kind of study have not been occurred before. And other disciplines and other disciplines have the patience, and the treatment will be deliver in with other disciplines. You know, that's why we cannot bring them in the table for this kind of study. We asked also for the earlier patient, earlier stage of the disease or for patients who just are very, very in good condition. And they can go to the radiation ward by walk and received the radiation to decrease the hospital beds, occupations, yes, we also write a proposal for this kind of the treatment. But we are still on que to approve it.

Bret Kugelmass
And tell me though, what access to resources do you have not officially but unofficially, beyond your hospital? For instance are you part of a society with other radiation oncologists across Iran, where you can discuss learnings and call them up and say, here's what happened with my equipment, maybe in your hospital you should try your equipment. Does this type of collaboration occur?

Ahmad Ameri
All over we have, we have a shortage of the radiation machines due to sanction.

Bret Kugelmass
The whole country.

Ahmad Ameri
All over the country, not just in our hospitals, all over the country. I also work in the private section but all of them have the machine and need to save their machine to treat cancer patients. Treating COVID-19 with just one fraction, has no money, has no money for the private sections. I was the secretary of the Iranian Society of Clinical Oncology and I asked all the other governmental hospitals to participate in our study to be a multi-institutional study, by no one's except this, all had the same problem all prefer to treat patients with cancer instead of the COVID-19.

Bret Kugelmass
And, and I can understand, I can understand if there's a shortage of equipment how, how people can't see, you know, all of the angles and all of the the bigger picture and how they're just focused on their short term and more immediate concerns. Which brings me back to my previous question. If the goal is to apply a half a gray dose, can't we look at other types of equipment, and just run them for a longer period of time, like a diagnostic chest X ray, or, or even dental equipment and just leave it on for 15 minutes, perhaps instead of a blink of time to still apply that half gray dose, and perhaps let people even in the private sector, apply this therapy off protocol to start getting more results and save lives?

Ahmad Ameri
I think it's not possible. I think their effects of radiation depends on the doses also dose rates, you can prescribe half gray in one second. Also, you can prescribe half gray in half hours. They have different-

Bret Kugelmass
I see, no, I understand.

Ahmad Ameri
Yeah. It has different effects. You can prescribe radiation half gray to just one tooth and you can prescribe half gray to whole body. If you prescribe 8 gray to total body, 8 gray to total body, we have seen we would see the actual radiation syndrome. And patient usually die within 48 hours. Yeah, yeah. What if you if you prescribe 8 gray to just, well, limited area nothing happen. After 10 years, you can see just a scar of this treatment.

Bret Kugelmass
I see. So they'll be like a local burn almost because energy being imparted. But it doesn't do damage to the entire system. Yes, I see. What you're saying is there is there's an art, there's a science to the application of radiation. And there are different dials. And one dial is time. Another dial is area. And the product of these different dials creates a whole range of effects on the body. And so there are maybe 1000 actually different types of radiation treatment, even with radiation with the same radiation based on how much you apply, how long you apply, and over what area you apply.

Ahmad Ameri
Yeah, we usually use this. I talked before that when we are near the critical organs we adjust the doses per fraction, we can adjust the time between doses, one day, two days, three days between two prescription of doses that help us to save normal tissues. Radiation affect all cells in the body and also micro environment around the body. For example, vessels, proteins, cytokines, mRNA, DNA. All of these are affected by the radiation, and all are affected in different ways by different doses. We don't know about the effect of radiation, I think radiation is all treatment for all disease. All treatment for all disease, but we just know about the side effects. We know about the side effects of radiation more than remdesivir because it's old. We know everything about the side effects but about effects. It was suppressed after the antibiotics for inflammatory disease. You No, that's why we need more and more about radiation. I thought at first, the radiation now I think is as is systemic treatment. Now one of the more exciting treatment for cancer nowadays is immunotherapy. What is a treatment that modulate the interaction between tumor and the immune system. The interaction just this we use chemotherapy, chemotherapy is a cytotoxic and kill the cells. But even modulation immunotherapy just modulating interaction between cells and immunes, cancer cells and immune cells. And I think radiation could be replaced for this immunotherapy.

Bret Kugelmass
And it seems to me by many of the people that I've met, that it's oncologists who have the most experience with radiation. Are there other doctors around the world like immunologists, that are now also developing experience with radiation? Or is it still mostly a discipline of oncologists?

Ahmad Ameri
No most of is related to the oncologist. Oncologist, I told you that we have clinical oncologists that prescribe systemic treatment and radiation. And also we have medical oncologists that just prescribed drugs. And we have also radiation oncologists that just prescribed radiation, not systemic treatment.

Bret Kugelmass
It seems to me, though, that based on what we understand of radiation's effect on inflammation, which is an immunological response, both in the German case, in the old case of viral pneumonia, and many other cases where even in oncology post cancer treatments where it's used to tamper the immune response and tamper inflammation or your blood clotting sample, it seems that the applications of radiation are broader than just oncology and it should be partially a discipline of immunologists. It surprises me that you don't have immunological researchers around the world around the whole world that are desperate to try studies with radiation to see how it might impact their field and move their field forward.

Ahmad Ameri
Yes, yes, yes, you're right. Completely, immunologist likes radiation two days because radiation with with high dose refraction, as we explained before you for lung cancer can produce new antigens. Different way yes, they in the high dose per fraction, high dose fraction suppress the immune system and excuse me, excite the immune system and cause inflammation, but at the same time, it could make new antigens, cancer have some antigen that is a foreign antigen to the body. And immune system will suppress by the cancer cells. When you use high dose radiation, you make new you make new antigen and the cancer cells and the immune system will assimilate against this new antigen and attacked him. That's why today we use high dose radiation with immunotherapy.

Bret Kugelmass
So just to paraphrase, the cancer has a mechanism to combat the immune system normally, it's able to suppress the immune system it does, though. It has its own way of of hurting your body. Yes. And so we need to find a way sometimes to supercharge the body's natural protective forces in order to defeat back the cancers force, a war between you the cancer and your immune system and the radiation is a signal to the immune system to gear up and fight the cancer.

Ahmad Ameri
Yes, exactly, exactly. I told you, we can use low dose ruled by the radiation to modulate the immune system to be activated and use high dose local radiation to the tumor to make new antigen, most of them- for more immune system in this for the immune immune system will be overcome the cancer cells.

Bret Kugelmass
And so, as we wrap up here, maybe just kind of tell me about the future of what you think might happen in with COVID in your country with this treatment, do you think that some of the shortcomings of the equipment might be overcome? Or that there might be more international recognition? Or do we think this is the best we can do for this time period and it's just going to take a long time to bring this therapy into practice?

Ahmad Ameri
I think there is some barrier for this hypothesis, because the shortage of the equipment in our country is one, just one reason. There are another reasons we know radiation was suppressed due to the Rockefeller Foundation decision. They decide about the side effects of radiation. They bring the acceptable doses lower and lower, you know, but but the effect of radiation is more than corticosteroid, I think more than remdesivir more than every other drugs. You know, dexamethasone has been approved as treatment for these in their large trials, recovery trial. Yes. But when you see most of patients stay in hospital after 20 days. You know, but about radiation, no. Radiation has no support. Yeah, but this is the second part. And the third one. If the equipment if the equipment provided in our country or other parts of the war, the interdisciplinary connection is very difficult. We don't have such kind of the trials. I hope that if if we could conduct a more, more larger trials, randomized trials, maybe maybe we can go ahead for designing a special machine for this kind of treatments. That no, no complicated, like, accelerators that we use for the treatment of cancer, I told you, we need to confirm those as to the tumor. But for this kind of treatment, we can use a more simple machines, and we'll design for this purpose.

Bret Kugelmass
Yes. And I guess maybe one last thing. You're able to, a lot of people are very closed minded about the application of radiation, but you're very open minded to it. What separates you? How come you are able to try new things where some of your colleagues might be more conservative and stuck in the old ways?

Ahmad Ameri
I should ask from them. But, but I think I saw a lot of this. I have to do something. What I can do, I bought about six monitors, six full monitor for our hospital from my pocket. That was the first things I do. I did. You know, after that, I decided to do other things. And that's why my caught my work. That's what my work. I don't know why there are others people's think, how they think. Especially, we had pulmonologist, we have ICU care, and other specialties in our team. But they are not deciding the people who decide about the radiation treatment should be open minded. It needs more work involved. If we could have the results of large randomized trials. They help us to convince them that help us for trating patient with this kind of radiation.

Bret Kugelmass
Dr. Ameri, thank you so much for the work that you've done so far. Thank you for taking the time to explain it to me and my audience, and we wish you the best of luck in the future as well.

Ahmad Ameri
Thank you for inviting me for this interesting talk. Thank you. Thank you very much.

Olubunmi Olajide
Hello, Victor, welcome to the Titans of Nuclear podcast. It's a pleasure to have this opportunity to speak with you.

Victor Nian
Thank you, sir. Pleasure to be here.

Olubunmi Olajide
Thank you so much. And we have a very interesting conversation we're about to have right now. But before we get too excited, I want you to take the time to introduce yourself to the audience, a little bit about you and how you got started in the nuclear industry.

Victor Nian
Right? Well, actually, my humble beginnings in the nuclear industry, goes back all the way when I was doing my PhD with the National University of Singapore. So my name is Victor Nian. Now I'm a Senior Research Fellow at the Energy Studies Institute. And actually, my main focus, my research is on atomic energy, both peaceful use and innovative strategy, but not so much on the military applications, but mostly nuclear energy policy, industry development, and looking at different technologies and how they might play a role in decarbonizing our global energy systems. So, when I got started back in 2010, with my PhD, I wasn't really thinking about nuclear at all, at that time, I was not so much of a person that is actually for nuclear. So I started off looking at this issue about sustainability, climate change, decarbonisation. And then I've been talking to my PhD supervisor, and we're having this interesting conversation as nuclear seems to be really big. I mean, back in 2010, this was just before Fukushima. And just before the whole world turns against nuclear, actually, everybody wants to have nuclear energy. And that seems to be the ultimate clean energy for the world. And I got really excited about the technology being something really sophisticated. And I'm a person who likes technology. So I thought, well, maybe that is the place to go into. A year into the work, Fukushima came at the wrong time. So, you know, when I, when I watched the news on the series of developments in Fukushima, with a view, I mean, nowadays, the media really sees everything from the tsunami to the blackout, and eventually seeing the hydrogen explosion that I was telling myself, you know, probably other people will say, well, this is the end of nuclear. But to me, I was actually having a different kind of thinking, I said, well, this might be really challenging for the nuclear industry moving forward. But it could be quite a bit of interesting lessons learned. And indeed, True enough. I mean, if you look at all the reports, and studies made globally, there are quite a lot of interesting lessons learned from Fukushima incident, and actually gave me the kind of stimulation to actually publish a paper to talk about the state of Fukushima, the state of nuclear power in Southeast Asia, and why is it still relevant despite having a major accident, so that's how I actually got started with the nuclear industry, actually, from actually starting from a dark age, if you like. But I think now the development is getting more and more promising and more interesting. So yeah, I'm kind of proud of myself for being where I am today, and looking, falling in love with nuclear energy development. Seeing how nuclear energy might be able to contribute in our energy mix in decarbonizing our economy. So I think, yeah, I'm really happy to be a part of this nuclear world.

Olubunmi Olajide
When you mentioned 2010, I was going to bring up what your experience was after the Fukushima accident happened, but it's very interesting that it didn't turn you away completely from the industry. And I'm curious, post your PhD, what kind of roles have you got into working for your country as well as in the industry for nuclear?

Victor Nian
Right, so my PhD is actually in the Mechanical Engineering Department of National University of Singapore. And you know, in Singapore we didn’t have any nuclear research program back then. I mean, we don't really have a complete research program, even today. So back then to talk about a PhD dissertation in nuclear energy, or nuclear engineering is almost unthinkable. So I mean, I think that was my first attempt. So actually, I was almost, I believe, that was the first thesis on nuclear energy from the mechanical engineering department. But it was more on the life cycle analysis and looking at a number of things in nuclear energy, from fuel processing, mining, conversion, enrichment, technology generation, and even looking at new technology. So, and that becomes actually the main thrust of my work for the Energy Studies Institute, where I do it from the technology development angle, and see how advanced technology might contribute or influence policy so that the new policy, or regulation, or even market design may accommodate new technologies from a nuclear industry, so that they can be safer, better managed, and also also offering safeguards to countries like Singapore where we are not a nuclear weapon state. And I believe it's the same for the whole region, which my work really is spanning out from Singapore to ASEAN, that's the Association of Southeast Asian Nations, which is 10 nations in Southeast Asian region. So looking at how nuclear energy might benefit the region as a whole and you might have heard about the regional integration project. So the idea is to connect the whole region with a power grid so that we can actually treat electricity freely using a common market framework. That was the idea. So with nuclear energy, perhaps that would contribute collectively in the decarbonisation efforts. So yeah, that’s my work for the Institute.

Olubunmi Olajide
And I'm a bit curious, what is the energy mix looking like in Singapore? What is the current situation on ground? And what is the transition plan if there is one right now? And where does nuclear play a role in it? It is something that we'd get knowledge of as a pathway towards a clean energy system, which is something that needs a lot of work right now.

Victor Nian
It's a very good question. You know, in Singapore, I would say, in comparison with the region, in most parts of the world, our energy system is generally considered clean, not in terms of carbon emission, of course, we are 95, or 97%, dependent on natural gas for power generation. So we use combined cycle natural gas power generation technology, which is really state of the art. It's very clean, it doesn't really pollute the environment, but it's very carbon intensive, because natural gas is fossil fuel. And we depend on LNG and also import natural gas from our neighbor countries to power our economy. Singapore doesn't have enough resources. So we are 100% dependent on energy imports to satisfy all our energy needs. And if you look around a neighbor, to Indonesia, Malaysia, these countries are mostly dependent on fossil fuel as well. And they are dependent on coal, oil, and gas for industry and for power generation. So if you look at the perspective of decarbonisation, then of course, today, there is a big conversation about renewables and battery storage, and even hydropower from Laos and Cambodia, on the Mekong River. But of course, nuclear energy also plays a role, you know, in decarbonizing the baseload because nuclear technology is a base load. But a concern, I mean, going back to Singapore the concern is a very small country, or urban island state. If you look at the conventional regulation, the existing regulations on the large nuclear reactors, then the exclusion zone, safety radius, the entire country is within that safety radius, depending on where you put the plant. So in the event of an accident, then well, we don't know where to go. So that is a major concern in the country right now, in terms of nuclear safety. But of course, you know, a lot of people are going to nuclear energy is not that dangerous, and it's not going to, the plant is not going to blow up like an atomic bomb, you know, it's just that Fukushima is one of a kind. And it's because a lot of these unfortunate, you know, unfortunate things that have happened behind the scenes is just a problem with the policy, the problem, the regulation. So there's a lot of lessons we have learned, we can make nuclear technology safer. But today, I guess, there is a new option, which is small modular reactors, a new kind of technology that claims to have a smaller radius in terms of planning zone or emergency planning and what’s really an exclusion zone. So then, some people might think, you know, this is actually a good option maybe Singapore should consider. And I would agree that that, you know, indeed, is an interesting option to explore to consider. But there are many other things, you know, beyond nuclear, just nuclear safety, of course, we want to make sure that technology has to be safe, right, it's probably government managed, you know, to deploy it to satisfy our energy needs. But I think the more important question is whether the existing market framework, yet the energy market framework, is able to accommodate a nuclear power plant from an independent private investment. And whether the country's energy mix, in terms of energy security, or in terms of other national energy objectives are designed or rather have an urgent need for nuclear energy at this moment. So these are the key considerations, the government, I believe they're already deliberating whether nuclear energy should come into the single energy mix now or in, in some sometime in the future. So I mean, also, this is my work in deliberating, you know, when is the best time or the right time for nuclear energy to enter Singapore's energy mix? And how should it come into the mix? Right, I mean, this is in the context of an ASEAN grid, you know, working with our neighbors bilateral arrangement, in a regional cooperation, because you've got an accident in the region, can most probably more than one country will be affected? Because we are all situated so close together. And if you look at Southeast Asia, we are literally sitting next to one another, all the countries. So if there's a major accident, then, you know, then I mean, you can be really unhappy because while you've been enjoying the benefit of clean electricity, if an accident happens, other people are suffering from the consequences. So I guess this is, you know, the political sensitivity, the risks, trans boundary risks. All of these are the factors that countries, not just Singapore, I believe every country would, would factor into consideration in the plan for a nuclear power plant.

Olubunmi Olajide
So from what you said, it sounds like major drivers that it's pushing these decisions or deliberative, the thing about insufficient climate change and energy security. And those sound like the two main issues that are currently in focus right now. And in a recent article that you wrote, you mentioned that a pandemic could act as a trigger to accelerate transition towards clean energy. So is this something that plays into the conversation right now? Is it something that's influencing the decision? Or is this something that it's still following the same time as it was before?

Victor Nian
Right, I believe COVID-19 has really excited a lot of new development, right? I mean, if you go, if you go back two or three years ago, working from home is something that nobody would think about. I mean, there was even a thing that you wouldn't want to live where you work. But of course, some people say you know, your work in your – you live in the workplace. So now, it's becoming really a work-life integration. So nobody thinks about that. So, what it brings to the energy system, this is our lifestyle change, maybe the new norm, but what is what is the implications of our change in lifestyle, it means that the residential electricity demand is going to increase, whereas the peak demand, where we normally assume there will be no commercial buildings, right to use the office towers, the shopping malls, the hotels, they will be the peak demand. And they will actually beat the major demand that has now been shifted to residential demand, we traditionally think, or even today, I will still say that we are the base load. So you're actually increasing the base load demand of your country, or in a major city, basically, it's actually increasing. And when an increase in base load, then there is the opportunity to think about what you can do to decarbonize the baseload. Well, on the nuclear side, you have the options of having renewables, like PV, wind, and you have battery systems, or maybe thermal storage systems, so that you can kind of like achieving a bit of certainty with renewable supplies. But if you look at the context of Southeast Asia, even Singapore, there is very limited renewable energy potential. So when that comes, when renewable energy resources are limited, then you kind of think about what you can do. And also with COVID-19, people working from home, there's not much travel demand. A lot of people are thinking maybe I should just take public transport, there's no point in owning a car or a car just sitting in my garage all the time. And some people might start thinking about going to electric vehicles, because you have a conventional petrol car, you still have to do maintenance, lots of it. And then if you don't use it for an extended period of time, you still have to spend money on the car, just to make sure it's to run by the time you need it. Whereas an electric car, I believe, I mean, I'm not an expert on electric car technology. But I think that will give you much greater flexibility. And if you think about today's - and Singapore, we have that - it's called BlueSG, it's a sharing economy kind of concept. So you basically rent the car as you need. And you return the car to the charging port when you when you're done with it. So that actually in a way of increasing the demand, with a bit of certainty, as well, because you've, I mean, if you're using electric cars, most of time you're at home, that means you're most likely probably knowing the Singaporean culture, you will definitely charge your car whenever you have the opportunity to. So then the thinking is, what if you could actually see demand is going to rise? And we know that there's so much we can do with renewables, then what is the next? We think about hydrogen, but hydrogen has to come from somewhere, right? Nuclear becomes the only natural option. But then, of course, then we can go all the way back to all the arguments about safety risks, politics, you know, social sensitivity, right? So this is, but I think, in general, COVID-19 would, in a way, change people's mind towards many things, international travel, how they work, right? How they see people in their social interactions, how they see clean energy systems being more important in their life. Because another thing that I think would really trigger people's mind is during COVID-19, during the lockdown that one and a half months or so, if I open a window, I look outside, it's clear blue sky every morning, every day. It's really beautiful. And you see flower blossoms, you see a regular rainfall, there's no urban heat island effect. And you start wondering, well, if you can get rid of fossil fuels, that will be wonderful, right, we'll have this clean blue sky everyday. And we don't have to worry about this, you know, dirty air and carbon dioxide and global warming. And we can really enjoy, you know, fresh air. So I think people will start to change their minds, which is what future energy and energy choice would be. So yeah, that was my inspiration for that piece.

Olubunmi Olajide
And let's jump right into some of these debates or discussions as you put it and let's start with the policy piece. Where is the country of Singapore right now? And what are the drivers that are going to move it to the next stage in the consideration?

Victor Nian
I think the national objective of Singapore is, we are a tropical country and we are mostly dependent on air conditioning, almost 24/7, whether you're working from home, you're working the office, you go shopping or you go to a hotel. Even some gardens are air conditioned. So I think the first national project objectives as you would read in our biannual update report, energy efficiency will definitely always be represented as first priority for the country. So we always want to make sure that we get the best use of the energy that we have, knowing that we are importing 100% of it. So this is always the priority. The second priority is to diversify our fuel mix with – that means renewable, bioenergy, in a way, energy storage, and now we're increasingly thinking about the role of hydrogen, actually developing a research program on hydrogen economy for Singapore to look at various other policy, infrastructure and technology gaps the country needs to see and the army, the R&D needs in technology so that we would have a sustainable hydrogen economy for the country. And then, of course one of the things, thinking of my own interest, is to see the role of nuclear energy in that, in the backdrop of cleaning up our electricity systems, our energy systems are playing a role in the hydrogen economy. But as far as policy, the existing policy or the official announcement is concerned, Singapore is not putting nuclear energy into the current planet. But that's not saying that we're going against it, I believe Singapore is still very much open to the option of nuclear energy. And if I can put myself in the shoes of the government, and if I could think for them, I would say nuclear energy is relevant. Right? It's relevant in addressing our energy import, it’s relevant in addressing our national climate change, and our INDC target. But nuclear energy must come at a time where our citizens are willing to accept it, where the region is willing to accept it. Accept it, meaning accepting the risk and the benefits. And that is the right time for Singapore to adopt. And also one of the critical conditions of technology has to be proven to be safe to deploy in our urban context. I mean, we are already an urban city, right. So it has to be safe for urban deployment. I mean, if I were to, you know, stretch that screen a little bit, what about SMRs? That is the option that industry promoted or advocated that it should be suitable for urban deployment. Okay, so I think I would stop there.

Olubunmi Olajide
And you mentioned it a bit. But let's go into another angle is compensation, which is the social acceptance, as you mentioned before, so where does the public stand in terms of this conversation? Because nuclear tends to generate a lot of interesting conversations about the general public. So where does the public of Singapore have this conversation?

Victor Nian
Yes, you raise a very interesting question. And actually, I am one of those shameless persons who have done something really, you know, out of the Asian context. So there was this one occasion, I was having coffee downtown, I can't remember where, one of those shopping districts. So I was having coffee and I overheard some conversations about radiation. I don't know what they're talking about, actually. So you know, I was the guy working on nuclear energy. So I just kind of I bring a coffee, and you're just starting to get started with that. And these guys were wondering, what is this guy trying to do? So I just, you know, throw the conversation, throw in questions. What do you guys think about radiation and nuclear power plants? Well, then, you know, the usual things will come, right? Radiation, you don't even feel that you can even see it. Right? It can be really dangerous. So I said, Well, if there's a nuclear explosion, and you stand right in front of Chernobyl, yes, nobody survives that. And you probably the same would happen if you stand in front of the Fukushima nuclear plant, the hydrogen explosion doesn't carry with it, the rest will surely make you suffer. But then I said, well look at it this way. People have been living in nuclear power, near nuclear power plants for years. If you go to the States, or if you go to some other countries, you actually see farms, near nuclear power plants, right. And then if I give you a list of things, where you will have exposure to radiation, for example, taking the transcontinental flight, right, having a banana, and I know it's talking to well, we're all having coffee, right? There is radiation, serious radiation in the coffee that we're drinking, so we're actually getting a steady dose of radiation every day. And if you're a coffeeholic, you get more doses and everything than other people. And every time you go for dental X-ray or you go for chest X-ray, well, actually then you're almost like living in the nuclear core of a nuclear power plant almost like that. So I said, well, in normal cases, you mean the nuclear power plant is nowhere close to danger like that. And then he was saying, well, there's this radiation, you don't realize it? Well, you know, you're already dealing with radiation and we are known, you know, aid and radiation. MRI, these are all radiations you go to the airport security that is one little radiation for you. And then they were saying, well, they never thought about that because nuclear radiation is so dangerous. So I said, well imagine that, you know, there's no Fukushima, the media didn't say all that, and then a nuclear engineer came to you and told you what are the safety measures? So that's what actually did a little bit about, you know, the safety measures of nuclear power plants, what is this defense in depth concept all about? And in comparison with the background radiation? And people start thinking you said, well, actually, nobody had told him that, you know, there was a you know, we didn't know that. So I will say, well, it's not wrong. It's not your fault. You know, there's just a lot of work that we need to do in terms of public education, public outreach, because the right messages are not really getting spread by the media, which is really unfortunate these days. I don't blame the media, because readership is always important. If you don't stare, you capture that and you report or what is happening in there, people are interested. But what I was really hoping is that if the media can take one step ahead one step further, in telling people what happened after that, what really triggered it and what really caused Fukushima to happen. And, you know, just wanting to actually mention to the people that say, well, if you look at Fukushima one more time, first was the major earthquake, and building, a containment building designed to for to protect the nuclear reactor wasn't designed to withstand an earthquake magnitude like that the earthquake magnitude of nine, but it's not designed for that. And the earthquake magnitude was much higher than that. And not knowing that you had a tsunami, which overpower the seawall defense, and come crashing down to the reactor buildings. No matter what happens. None of the buildings crashed. All the buildings stand very uneven over the rest of Fukushima, everything's gone. But the reactor building standing intact was unfortunate, because no design the whole concept. You know, people in Japan decided that that's safe enough for them. So they didn't really want to take recommendations from agents, the IAEA. So a lot of unfortunate decisions were made. So that caused Fukushima. So people are saying, oh, actually, we didn't think about that. I said, well, if you think about that, now, if I were you, if I were the people in Fukushima, if there's an earthquake and a tsunami, the first place I would run into the nuclear reactor building. Right, that's the safest place to be when it's a tsunami hit. Yeah, so you know, I will say public acceptance is something that's really subjective. Different countries have very different opinions towards nuclear or against nuclear. And so happened in Southeast Asia, people see that standard, because we are very close to Fukushima. We are very close to Japan. And if you go to the old days, once the media broadcast is gone, now it's on Wikipedia page, even at 10 years old if you Google Fukushima, that probably accident page will show up first, then the other things. So yeah, social acceptance remains an issue not to Singapore, actually, most countries in Asia.

Olubunmi Olajide
That's actually very interesting, because it's something that it reflects differently in different regions of the world, especially when Singapore is so close to the incident initially, and it's just very interesting how you see these, these perceptions play out, especially in the general public. So now, going into another angle, this is something we've talked a bit about, it's about the technology. You mentioned, you've talked a lot about small modular reactors, SMRs. And this, this seems like the logical fit if Singapore is to go into nuclear energy, and especially for the countries in the region, as you mentioned, sentence, these countries have a lot of - they're very close together, it's something that has to be supported generally. So how does this technology play in with the geopolitical situation that it's that Singapore is in? And what would it take to get a buy in from all the stakeholders involved

Victor Nian
Well, the nuclear SMRs or any other technologies, they are considered nuclear, right? So is without any treatment or without bias, I think they will be treated equally in terms of safety risks. So if you talk to a typical policymaker or people who work in the field of nuclear energy, they will say, well, in a worst case scenario, the impact is probably the same. So that in a way that it doesn't really eliminate political sensitivity in that aspect, but it does add an additional layer of assurance because people generally agree that SMRs, with these proposed designs, are considered safer than the large reactor is probably much safer than the large ones. And if indeed the nuclear, the SMRs can reduce the footprint to what it promised by the industry, rather than looking at a huge cooling tower, huge reactor containment, then maybe that would somehow change the public perception of the public perception starts to turn, then you will see, you might see a gradual change in the policy. Because after all, I think to an, to a knowledgeable person or to a, you know, reasonably skilled person in the art, he or she would understand nuclear energy is safe. It is the general public that are not fully convinced that SMR are safe. So that actually adds to the sensitivity. And, you know, in a way, geopolitics and the question with SMR, I think, today is, of course, safety politics. That's one side, I think another issue with SMRs is the clarity on technical performance, safety, and also on the economics. The large nuclear reactors, the conventional ones, we understand there's an economy of scale, right? So if you build larger ones, then the cost per unit kilowatt reduces. So that's an example in South Korea. But then, of course, you know, in the US in France, a lot of things happen. You mean, there's cost escalations that people say it doesn't reverse learning by doing? Who reviewed the material for that point, which does, that does one incident, but if you look at a South Korean case, they can deliver their project on time, really big. I mean, there's 1400 megawatt, it's a huge reactor. And then they can manage your costs, and deliver projects on time in the UAE, and their own domestic nuclear reactors. So all the risks are not understood: financing risks, economics, when it comes to SMRs, then the question is always, where is the sweet spot in terms of the best optimal entry point, right. So I believe the ASEAN countries would not really want to be the first to, probably want to see technology being demonstrated somewhere else, be proven to be working economically, at least, you can convince us on, you know, at least on calculations, or some economic models that SMRs can be economically deployed. But then we can probably make a decision. I mean, after all, it is a huge capital commitment, compared to other energy resources. I'm not comparing the latter, I mean, you compare the coal fired power plant, compared to a natural gas power plant, building an SMR is still quite a bit of financial commitment. And whether SMRs can fit in very well in the electricity market structure of different countries. And whether you want to give preferential preference to nuclear energy, these are all questions to be answered. So whenever I have, you know, cost curves reductions, depending on the number of units deployed, I mean, to me, my question is, at what unit is the point that ASEAN should deploy their first ones, right? So we are not going to be the global market, the SMR has to have a global market, you deploy hundreds, thousands of units, and we are part of that hundreds of thousands of units. So meaning we are, you know, fractional share of the market. So when do we go in, right? What is the right price and price point that we go in, and not forget that in SMRs you can buy a reactor core from a vendor and from a factory, you stand into a lot of seismic work constructions, building a containment that you have to do on site with your own industry. So then you turn back and look inside and say, well, can my industry deliver a solid containment? The necessary nuclear grade material? And also the nuclear the entire nuclear island? Other than a core? If the answer is yes, my industry can support that, then yeah, you can probably go for it. Because the rest is easier steam turbines, commercial items that your local industry should be able to do with it. SMRs, 50 megawatt, 100 megawatt turbines are well understood by the industry, or the steam turbine companies can do what the local companies are able to support in terms of maintenance, or maybe even some of the manufacturing. But yeah, but then the question is, you know, what is the entry point? And how safe are these, and these, I'm only having a one unit of SMRs, I will probably want to really enjoy the economies of multiples. But if I'm planning multiples of units in my country, then the question is, where my demands are? Where should I deploy this? In Singapore, when it's so big, right? When you only have so much demand, whereas Indonesia, the demand may be scattered across different islands, it actually makes a case for SMRs. Right? Smaller grid size, you know, you deploy a couple of modules here on one island, couple modules on the other island, overall, you still have multiples. So you see that the considerations of SMRs actually is what I would say at the moment is an additional layer of consideration or complexity in terms of economic planning, other than the political sensitivity, but I still think that compared to a large reactor, this is more feasible in the ASEAMN context at the moment.

Olubunmi Olajide
And I just want to go back quickly to the two drivers that identified in the beginning of conversation that was climate change. Energy Security, you mentioned that about 100% of the energy that Singapore uses is actually important. And this is, this is such a very concerning thing, especially when we see it in the context of the pandemic, we've seen how energy systems can be affected, and just global trade in general can be affected by just one single event. And you can never really tell how this has been to turn up in the future as well. So it's something that forces you to think a lot more intensely about what your energy system entails. So I'm just curious, from your perspective, do you think there are more drivers into this apart from climate change, and apart from the other one that I mentioned before, that are playing key roles into how Singapore is thinking about the energy system going forward.

Victor Nian
I believe definitely will be the COVID-19 and the post COVID-19 situations, the disruptions to global supply chain, and the possibility that countries might want to work together less than before. These will definitely trigger new thinking, new deliberations in the long term energy planning. Some economists or some people might think this is just a short term shock, maybe a very serious shock. But it goes back to normal anyway. Some people might think, well, this is the turning point where people would change to something totally different. How is nuclear going to be featured in that picture? Well, I guess, in my opinion, I think nuclear energy should now be considered more than ever. But of course, I'm not saying that we must go in and build a nuclear power plant today. No, I'm not saying that. I'm not saying that you should do the nuclear power plant in five years time, or 10 years time. I'm not even, you know, a predetermined time frame for this. But what I'm saying is nuclear energy, the relevance of nuclear energy really has to be considered more than ever. In terms, I mean, to achieve clean energy transition, it's not just about climate change. It's not just about energy. You know, energy import is also about building resilience in the energy system. You have if you have a supply disruption, in terms of natural gas supply, maybe 95%, 97% dependent for whatever reason, there is a disruption in gas supply, then we will face serious problems. Solar PV is not going to save us that much. I mean, it will help you deviate some of these energy issues during daytime. And the question is what happens during the nighttime, our industry runs 24-seven, and they cannot stop and cannot afford to stop when there's no electricity or there's no food? So how to make our energy system more resilient? Can nuclear energy play a role in resilience in building resilience to our energy system? If the answer is yes, then as then I really think that this has to be put on the table, the long term planning table right now. And also think about educating the public. This is not so much about how should I say the government, I have a very good understanding on the safety and economic and political implications of energy. But these ideas, these right knowledge also need to be educated or communicated to the public, so that the people understand and share the concern of the government. So that the people will be more supportive of the decision of having nuclear energy in the future. Genuine public attitude is not one that you can do if you want to build a nuclear power. And you probably can do that with today's you know, decision, if you go for contracting, you can have it in 10 years time is up to up and running. But to change the attitude of the public in 10 years, is probably going to be a much more complicated project than you know, putting off a nuclear construction project. So that was to say, you know, if resilience has to be the key consideration, moving forward into opposing COVID-19, which I very much believe so. Then this idea of resilience needs to be instilled into the minds of the public, so that they will be able to appreciate what nuclear energy can bring them while acknowledging the risks. So yeah, so I think yeah, post COVID-19. Yes, these people will start thinking about that.

Olubunmi Olajide
That's actually a very, very interesting insight. And I'm very curious to see how this actually plays out in reality. But on that note, looking into the future, kind of as a closing question that I always like to ask guests on the show, what are you looking forward to in terms of nuclear, not just being isolated to Singapore, maybe in the greater region of Southeast Asia or just in a global context? What are you looking forward to, to the development of nuclear space and what excites?

Victor Nian
Oh, you know, I'm really, actually this is my curiosity of where nuclear energy would be actually that would be my question, where your energy would be five to 10 years from now. 10 to 20 years from now, or maybe five decades from now. You know, you might, if it was my wish, I would really hope to see that nuclear energy would bring will be really safe, right in the future will be safe, reliable, and offer safeguards assurance to countries that are not the nuclear weapon state, while providing clean energy and affordable energy to communities that are not so developed. I'm hoping that what you can achieve will play a role in decarbonizing the developed countries energy sectors, as well as developing energy systems, especially for Africa, for South America, Southeast Asia. I think more than ever, the developing countries or even less developed countries will need key energy systems. And with SMRs, having the ability to do water consolidation, to offer alternative fuels, high temperature heat, for sanitation, I think they made it - I mean, these technologies may even offer clean water to countries that don't have – to countries that water is a luxury, for example, Africa, South America, or even parts of Southeast Asia, South Asia. So if you can, if you can offer them a word, it's still resilience, right? Building resilience in society, then I think nuclear energy really should have a main role in our energy systems. But beyond energy, in water, into hydrogen into medical applications, I think there is a great greater role for nuclear in general. And I believe the SMRs will certainly play a role in cleaning up our energy systems and making our society more resilient. But of course, I also hope that the nuclear industry will work together, rather than just pure competition, competing on cost. Don't do that, you know, competing on technology, competing on safety, competing over the past few human societies. I think that would really be my wish.

Olubunmi Olajide
That will be the next thing. Thank you so much for joining us on the Titans of Nuclear podcast. It's been a very great conversation, and I really appreciate you making the time for this.

Victor Nian
Thank you very much. It's been a pleasure speaking with you.

Olubunmi Olajide
Thank you.

Bret Kugelmass
So we're here today with Jim Conca, former guest, but here to talk to us on a new topic. Jim is a trustee at the Herbert M. Parker Foundation, and a prolific author at Forbes. Jim, thank you so much for coming back and welcome back.

Jim Conca
Sure. Welcome. Thank you so much. This is exciting.

Bret Kugelmass
Yeah. Well, you know, it's so funny, because when we first met, we were talking all about Yucca Mountain and your history and everything. I had no idea how many topics of nuclear you are an expert in because when you reached out to me about this COVID treatment, and I was like, woah, this guy knows his stuff.

Jim Conca
Oh good. Thanks. Actually, I've had a bizarre career. I mean, I started out as a planetary scientist and exobiologist, studying life on other planets. I actually did Urey-Miller Experiments and things like that. It was quite amazing. So going from NASA to nuclear is interesting, but they're both outside the box thinking. So it actually was kind of interesting.

Bret Kugelmass
So let's get into it. COVID-19 is a pressing issue right now. Here we are. And one of the things you told me was radiation, low dose radiation, could have these benefits. Just tell me, how did this come about? What's the high level and then we'll get into all the details.

Jim Conca
The high level is actually, although unintentional, it's criminal, negligent homicide not to use this because 300,000 of the 400,000 people who have died in the United States did not need to die, period. All they had to do was, when they were admitted to the hospital, they needed to just roll them down to radiology for 15 minutes, give them a half gray dose to each lung, and put them up in their bed. There's the cytokine storm, viral pneumonia would have reversed in 24 hours and they would have been discharged in three days.

Bret Kugelmass
And okay, so what's happening here? We're using existing equipment essentially, right because hospitals are already equipped. And you blast it at the lungs so it's locally targeted, you're not affecting the rest of the body.

Jim Conca
And it's 100 times less dose than we use for cancer. This is a low dose, we do this all the time.

Bret Kugelmass
So we know radiation saves lives, right? We use it for imaging, we use it for cancer treatment, you're saying this is 100 times lower and knocks back the COVID? What's actually happening, though, so it's going on the lungs? What's it hitting?

Jim Conca
Good point, it's not actually treating the virus itself. It's not killing the virus, okay, because, again, these are low doses. So the whole idea is that what COVID does, in general, why it kills you, is it makes your immune system go wacko. So that's why not everyone dies. I mean, you know, in fact, you're talking about people who are non-symptomatic, that just means that their immune system can handle it, that's fine. Now, there may be long term cardiovascular effects, things like that. But in general, you know your immune system can handle it if given time. Unfortunately, there are some people whose immune systems go wacko, okay. And they, though there are certain immune cells, in fact, there are many immune cells, you know, within the body, dozens of different types, T cells, killer T cells, macrophages, all that kind of stuff. And what happens is that, when they go wacko, they start to be pro-inflammatory.

Bret Kugelmass
Okay, so the inflammation that is the body overreacting to something. Is that, like, am I wrong in saying it's kind of like an allergic reaction where it's your body trying to overreact to something that got into your system? Or is it something a little different?

Jim Conca
Sort of, I mean, it's not a chemical reaction, like most allergies are. It's a biochemical response. Inflammation is one of those things that is really harmful in the long term. Osteoarthritis gives you inflammation, joint pain, stuff like that. But it actually has a particular role in bringing fluids to that area. And that usually knocks things out and it's fine. But if there's too much inflammation, it's not good.

Bret Kugelmass
And how come some people overreact? Why is it that some bodies overreact, I guess, to some sort of foreign agent and some do the right amount of acting?

Jim Conca
Probably because their immune systems are compromised in some way. So in fact, that has been one of the things that has popped up over and over again, if you have comorbidities or other issues, like diabetes, or heart disease, then your immune system just is not in tip-top shape, and it just does not respond well. But actually biochemically why, who knows?

Bret Kugelmass
So what are these cytokines? I hear about cytokines all the time? I have no idea what a cytokine is?

Jim Conca
That's a good point. Let me see a cytokine. Let me actually read it correctly. Cytokines are specialized small regulatory proteins, they're not cells, they're just proteins that pretty much signal cells to do something. So what happens is that something invades you. And the immune system sends out the cytokines and they tell the T cells to attack. And unfortunately, if you send out too many, you get this overreaction, and it's called the cytokine storm.

Bret Kugelmass
Where does the cytokine come from? Does it come from within any given cell? Does it come from the pancreas? Like, where do they originate these cytokines?

Jim Conca
It comes from the lymph system. And so again, although I know a lot about this, I am not the expert on this, Jim Welsh can tell you exactly what's going on. And so you're flooding the system, especially the lungs with the cytokine storm, and that tells everything to go insane. And it starts inflaming and so your lungs fill up with water, by definition, that's pneumonia. So this is a special case of something called viral pneumonia as opposed to bacterial pneumonia, and viral pneumonia isn't that common, although it occurs. About 70 to 80 years ago, people who were just starting out radiation and radiotherapy, realized that viral pneumonia, which was resistant to everything else, could be treated with radiation. We've been doing this for 80 years.

Bret Kugelmass
Okay, so this is not new. When was the first time that radiation was used to treat pneumonia?

Jim Conca
I think 1939.

Bret Kugelmass
That's like, yeah, we have real technology.

Jim Conca
Absolutely. And it was 80% effective. Oppenheimer. Oppenheimer used this.

Bret Kugelmass
Robert Oppenheimer?

Jim Conca
Yes, right. Robert Oppenheimer, our favorite nuclear bomb maker. So he actually did this and others did too. And Jerry Cuttler actually did a study looking at all these old trials and all these uses, and it was 80% effective then.

Bret Kugelmass
So how come, and yeah that's before we had proper instrumentation? How come this fell out of favor if it's so effective?

Jim Conca
Let me just throw one word out there that everyone knows, LNT. Linear no-threshold dose.

Bret Kugelmass
Our archnemesis.

Jim Conca
Yes, it was, of course, it's wrong. And you know, people don't know that because they don't understand this.

Bret Kugelmass
We got to take steps back to explain to the audience what LNT is. Our nuclear audience knows this but we're gonna get a lot of people that are just interested in the COVID stuff.

Jim Conca
So in about 1940 we had pretty much figured out a lot of the effects of radiation. I mean, you know, we did a lot of bad things in the 20s, the radium dial women and that kind of thing. But we figured out how to do things and how to keep safe from them. In fact, all of our nuclear protocols right now that we use at Hanford Site, and at nuclear power reactors and radiochemistry laboratories, were developed by Herbert M. Parker, of which I am a trustee. Okay, he developed those in 1943. They're still what we use, there is nothing really new here. And we realized that about 20 REM, you know, either acute or chronic. Below that there really wasn't any measurable effect. I mean, the effects are so low, that you can't even see them in the general population.

Bret Kugelmass
You're saying what we figured out was the dosing like the dose in the response of the human body, what we can handle? What's a big deal? What's not a big deal, right? Like, if I hit my fist into my hand like this, I didn't do any permanent damage but I had an impact, I had a dose, but it's low so it doesn't matter. But if I were to really punch it I might bruise myself, and that's a force where you actually have an effect.

Jim Conca
Right. And another good example is aspirin and something called a cumulative dose effect. Okay, so that's all in there. If you take one aspirin a day, for 100 days, you're not going to be harmed. But if you take 100, aspirin in one day, you're going to be harmed. And so in the late 40s, and early 50s, when the Cold War got started, there was this push to stop above-ground nuclear testing, there was just this push to deal with weapons. And Hermann Muller and a few other people came up with something called the linear no-threshold dose hypothesis, meaning that it doesn't matter the amount of radiation all radiation is going to kill you. Which is insane. It doesn't make any sense. And take it back to our analogy, that means that what these guys were now saying was that if 100 people just take one aspirin a day, one of them's gonna die. Right, the risk is the same. And that's stupid.

Bret Kugelmass
Makes no sense, but that is the metric by which the radiation protection industry has established over the last, you know, five decades and holds us accountable to, which restricts the use of low amounts of radiation for positive use cases, because they're saying, even if it's low, someone's gonna die.

Jim Conca
Absolutely. There's always a risk. Yes, there's always a risk. I mean, there's a risk of a meteorite hitting you, but you don't worry about that day-to-day. Unfortunately, the medical community generally doesn't know a lot of this. They just use protocols, they use procedures, this is what you do blah, blah, blah, then they don't think outside the box in that regard. So, yes, we use 100 times these doses to treat cancer, but you're treating cancer. So if you don't have cancer, then you can't use it, according to a lot of people. So even, you know radiologists even, you have to be a researcher, and as you know researchers are different than just people doing things. So if you're just an ordinary MD, that's fine. And I've talked to many of them, and they're interested, but they would never do it. Because they would never step outside the protocols.

Bret Kugelmass
Aren't doctors allowed to prescribe things off label, like, quote-unquote aren't they allowed to make their own decisions about what treatments for their patients?

Jim Conca
Yes, yes. And in fact,

Bret Kugelmass
Like “FDA approved”, you know,

Jim Conca
Absolutely. In 2018, Congress passed an act called the Right to Act legislation. So yeah if all else fails, and you're dying. Sure. Why can't I try this? Yeah, and they used that for hydroxychloroquine, which is insanely stupid. And even remdesivir doesn't work very well about 20% of the time so, if it's a drug, see people like drugs. They think drugs are great. But radiation ooh, don't even touch that.

Bret Kugelmass
Magic pills, give me some.

Jim Conca
Yeah, absolutely. So the thing about, so right now we're trying to do trials in this, which is insane because we've been doing this for 80 years, we've done the trials, okay? But they say, oh well, it's not COVID. But it's not treating COVID, it doesn't matter what the virus is.

Bret Kugelmass
And how come there aren't emergency exceptions that can be I mean, this is an issue that has the world's attention, like the global economy has seized up, if we had an effective treatment, it would at least dampen the impact on hospitals?

Jim Conca
Oh yes, the hospitalization rate would drop like 80%.

Bret Kugelmass
So what's the holdup?

Jim Conca
Fear. Just fear of radiation. In fact, what's even weirder is that you know, doctors can, they can step outside the box, but they're always worried about being sued, right? You know, everyone's worried about being sued. And I said, Well, I'll sign whatever you want to sign. I mean, I'll, you know whatever, to keep you free of any charges, just don't let me die because you're afraid of radiation. The problem is, patients are afraid of it too. So there's, some of my colleagues are trying to do trials and there have been very small numbers, like a trial of 10 people here and 10 people there. But they have trouble getting people to sign up for a trial, even though they're dying of COVID. I mean, this is, it's like, wait for a second, at this point, you have a 50/50 chance of dying of COVID. And the radiation we want to give you is less risky than crossing the street on foot. Okay. Less risky than crossing the street but you're not going to do that because you're afraid of radiation. This is how insane the idea of radiation has become.

Bret Kugelmass
Okay, so what's the type of doctor that would normally administer a radiation treatment?

Jim Conca
Radiation oncologist.

Bret Kugelmass
Okay, so that's a cancer doctor and they should know something about the risk trade-offs, right? Because they're making that every day, they're saying, okay you have cancer let's blast you with some radiation. And they can't like, is there like a forum of these guys that we could go to? And we could like say hey it's been used to treat pneumonia since the 1940s.

Jim Conca
Well, see that the problem is even many of them are not researchers. I mean, again, the people I'm working with, like Jim Welsh and others, they're researchers, they know this. But even they couldn't get permission from their institutions to do trials. I mean, this is like, you know, you can't do trials without permission, per se. So the idea that even they couldn't get permission is rather insane.

Bret Kugelmass
Okay, but we do have a couple of small trials going on at least. Right?

Jim Conca
Right.

Bret Kugelmass
So what are the results of those so far? Do we have any data coming in?

Jim Conca
90% effective.

Bret Kugelmass
So what you do is you bring them in for a 15 minute? What is it a 15-minute blast? Can you give me some numbers?

Jim Conca
Oh, from rolling them down to rolling them back? It's about 15 minutes. I mean, the actual,

Bret Kugelmass
Not just 15 minutes of radiation, the whole thing?

Jim Conca
Yeah, the whole thing. I mean, it's one moment. You're talking about, you know, basically less than a second.

Bret Kugelmass
Oh, it's like when you go to the dentist, and they go behind the thing, and they press the button,

Jim Conca
And they go boom, and that's it.

Bret Kugelmass
And that could be 90% effective. I mean, you can imagine a hospital being able to handle an unlimited capacity that way. I mean, this is a whole assembly line of people going in and blast roll them out, roll them in and blast roll them out.

Jim Conca
This is why it's horrible. And it's really, I mean, I just want to cry because these poor people do not have to die. Okay, now, let me backup a bit. Because you're treating the inflammatory response, you have to wait till you get the inflammatory response. If someone just tests positive and you go do this, it won't do anything. Okay. When you have to go on oxygen, or when you look like you're going to need a ventilator. That means you know, things have started. And so that means your T4 cells are going wacko and they start killing the T8 cells to keep producing inflammatory, pro-inflammation, then you hit it with a half a gray dose just to the lungs. And that reverses the pro-inflammatory and makes them anti-inflammatory. Because a bunch of these cells work together. And it's really incredibly complex. And so, you know, you're like resetting the stage with this. And then they kind of calm down and the T4 cells actually become anti-inflammatory as they should, and all that kind of thing. So, again, but if you wait too long, and there's too much lung damage it doesn't work. In fact, the 90% effective was 90% because the 10% were too far gone.

Bret Kugelmass
Okay, so is there a good way of measuring? Like, what is the right timing for this, by some sort of practical, like a physical response? Is it when people are having trouble breathing? Is like is that when

Jim Conca
Yes, it's when you get viral pneumonia. So when fluid starts entering the lungs.

Bret Kugelmass
And how do doctors know that? How do they measure the fluid? Do they have to jab something in you? Or they shove a tube down your throat? What are they doing?

Jim Conca
They probably I mean, they usually just listen in if they can hear bubbling, you know, that's why they put the stethoscope on your back at your lungs.

Bret Kugelmass
Not even intrusive, a trained doctor with a stethoscope can say you are in this range, where if we gave you this, you know, one-second blast half a grade dose, it's gonna essentially hit the reset button on your immune system, right? And so let's talk about this reset analogy for a second. So it's like, okay, so your body is overreacting, all these complex things are happening. It's going haywire. This would almost be like, if your computer seized up and stopped working, you turn it on, you turn it off, all of a sudden, you're like back in steady-state operation again.

Jim Conca
Basically, yeah.

Bret Kugelmass
Okay. Alright, so we've got some real-world cases, the 90% efficacy rate, have papers been published? Like, is this in medical journals?

Jim Conca
Yes, it has. In fact, I might have sent you a couple of Forbes articles that have links to those. So that's good. And again, the best technical paper was written by Jim Welsh and company.

Bret Kugelmass
We’re going to be talking to Jim Welsh next.

Jim Conca
That's perfect because he's the one who knows. What I bring to this is a lifelong career, a 35-year career, dealing with low-level nonsense. The fact that people are so afraid of nuclear waste, I mean come on, nuclear waste is so trivial compared to COVID. I've been dealing with this and I understand that, but the number of people who die each year from the fear of radiation is on the order of dozens, hundreds. I mean, Fukushima was 1600. But now we're talking about, you know, millions, I mean, worldwide there are millions of people who are dying.

Bret Kugelmass
Okay, I want to be very precise with our language. The numbers you were referring to are the ones who died of fear of radiation, not radiation, right?

Jim Conca
Yes, fear of radiation.

Bret Kugelmass
Because they either acted in a way that led to their early demise, or they didn't act in a way that could have saved them.

Jim Conca
Right, right. So a lot of people will not get CT scans of your brain and stuff like that, because they’re afraid of it, which is even worse, because your brain is highly, highly resistant to radiation. That's why radiation doesn't work against brain tumors, you know, those horrible aggressive brain tumors that kill you in a year that, you know, Ted Kennedy died of, and things like that, you know, Beau Biden. So you know, it doesn't work, it doesn't hurt you, it doesn't hurt cancers in your brain. So the idea that you're not going to get a CT scan to see if there's something wrong if something actually was wrong. And that because of that, you're gonna die because you're afraid of incredibly low levels of radiation, is insane. I mean it's like getting a chest X-ray in that regard. It's like, people don't really not get a chest X-ray in general, because it's in the culture. It's okay to get a chest X-ray. Yeah, it's okay to get, you know, dental X-rays because everyone's been doing it forever. So it's all you know, it's a cultural thing. And this is horrible.

Bret Kugelmass
Is there, is there a chance? We have a new president, we just switched over the administration. That means there are new people in charge of assessing all of the solutions. Is it possible that this treatment might now get a second look like Biden might tell his team I don't care what they looked at before, now's a chance to reassess everything that we've ever done. We gotta get this right. This is my chance to shine and show leadership. Is there a chance that his new Corona task team will surface this as a potential treatment?

Jim Conca
I wish, I've been trying to contact them. I wish. But yeah, they kind of, you know, it takes a champion, a champion who's who has some real clout. And who am I, I'm just a scientist it doesn't make any difference so and you know, so that's a problem, and

Bret Kugelmass
Maybe we can help, are there champions that you have come across? I mean we probably can't get in touch with Fauci. That's the only other name I know in the space. But are there other real respected senior government leader-type people that if we got them this evidence that we can use our audience to

Jim Conca
I even tried to contact Jim Clyburn's office because he's actually the Chair of the Subcommittee on the Coronavirus Crisis. And you'd figure I'd get some response to that. But, you know, it's also hard to contact people directly, it always goes to their staff or their people. And those people have to decide whether it's worthwhile to bring up and of course, all you have to do is see the word radiation and just throw it away. So that's one of the issues. Again, this fear of radiation is so pervasive in this society. I mean, I keep seeing commercials for things like insurance that mention radiation is bad. It's like, what is that doing in a car insurance commercial? This is insane. So it's just one of those things that is becoming a negative image, so just say the word radiation or nuclear, and suddenly, mushroom clouds appear in your brain, and it's hard to get by that.

Bret Kugelmass
I just, you have my brain going right now because it's almost like we could use this as an opportunity to kind of re-educate the world. You know, rebrand? Right? What if we use this to rebrand radiation?

Jim Conca
I've actually talked to the nuclear industry and you know I say, okay listen, this is where radiation comes and saves the day, nuclear can come and save today better than anything else.

Bret Kugelmass
And what about the IAEA? They're always pushing, hey, medical nuclear, they're trying to rebrand themselves. Could we call up Grossi at the IAEA and say, hey use your UN connections to get us in.

Jim Conca
Yeah, absolutely. That would be great. But I want to back up a little bit too, because the first thing they'll do is, oh we need year-long trials. And it's like, this isn't a new drug, we don't need a trial. We've been doing this for 80 years, we know exactly what it is. No new PPE, no new equipment, no new training, no new anything. There's absolutely nothing new about this. And the fact that COVID causes viral pneumonia, like, a lot of other viruses do, that's okay. I mean, this isn't treating the virus. And so that's what's key.

Bret Kugelmass
Yeah, that's really important that we don't have to get anything new approved. It's the same equipment. It's the same process. It's the same doctor’s. It's the same technicians. It's the same nurses. All you have to do is say, let's enable. I mean, it's funny, because like, they used ventilators. I remember reading about the whole ventilator shortage, right. And they were all of a sudden, they were like, well, you know, we can repurpose the ventilators from our anesthesiologists because they've got ventilator-style equipment. So clearly the hospitals are capable of saying let's use equipment from one department that maybe wouldn't have been used for this. And let's reorganize, let's get this equipment into this other department, because hey we need it. Right. It seems like there are precedents for not just using drugs off label, but for using equipment off label.

Jim Conca
Yeah. I mean it's so simplistically horrible that this simply comes down to LNT and fear. That we've just bred, you know, three generations of fear about radiation. And the consequences are large now, they've never been this large. Right. I mean 1600 people died at Fukushima because they evacuated them when they didn't need to and they forced evacuated them quickly. And these people were on ventilators and other things and they died during the evacuation. And they never would have gotten more than a REM. So now we're talking about hundreds of thousands to millions of people that don't have to die.

Bret Kugelmass
100,000 just in the US.

Jim Conca
Yeah,

Bret Kugelmass
I'm really worried about something like, okay, so we've got a vaccine, we're like, hooray, we pat ourselves on the back, warp speed, faster than ever. But like, I can even see we're not getting the vaccine out to the whole world. I mean, right. People are still gonna be waiting in the US for six months. Some of these poorer countries are not, they're at the back of the line when it comes to getting this stuff. So it seems like we're not just talking about the 300,000 that have died here. We're not just talking about you know, maybe another, you know, a couple 100,000. Before we get it here, we're talking about 5 million, 10 million people worldwide.

Jim Conca
And not just that, but the vaccine is only 90% effective. So, again, you're gonna have 10% of the population that's not going to be protected. You need treatment.

Bret Kugelmass
So how come maybe we can get a little bit more into the tech weeds just for a second, I've got a couple of questions. So like, what the radiation does is it combats the inflammation? Or don't we have other things that combat inflammation? And how come those haven't been so effective?

Jim Conca
Yeah, so they're anti-inflammatories. And that's one of the treatments that we do give now. And that's why the survival rate has gotten better. But again, chemical, anti-inflammatories are different from radiation. And so you know, the radiation gets everywhere, it gets everything. And I don't really know why chemical anti-inflammatories would work. One case, not work the other way, work better or worse than radiation. I don't know enough about anti-inflammatories. But there are many types of anti-inflammatory steroids. There are nonsteroidals, I mean aspirin is an anti-inflammatory, as is Tylenol and Advil and everything else. So again, they all work differently anyway. Right? And why do they work differently? Or how do they work differently? So this is just another, you know, it's just a really good tool in the arsenal that if you don't look at it, and let people die I mean, it's just insane. But again, if you ask a patient, whether they want to go to radiology and get a blast of radiation they might say no. And it's like, but you're gonna die or your risk is really high for dying here, and the risk from the radiation is not even measurable. So that's one of the issues.

Bret Kugelmass
So maybe we'll continue to take a second to talk about what is radiation because like, you know, I, as a researcher, can imagine radiation, it's like a wave. It's like a light wave, but at a different frequency, you know, how can we explain this to the common person? Like, what is this invisible thing that?

Jim Conca
Well, all radiation does is it actually acts like oxygen. It's an oxidizer, okay, which means it removes an electron. So oxygen is very, very toxic to cells, it's one of the most toxic things to cells you can have, yet we live in an oxygen rich atmosphere because cells learned about two and a half billion years ago when oxygen first came into the atmosphere, because of photosynthetic bacteria. And so oxygen came up, and it did kill a lot of things actually. And then the eukaryotic cell formed, which was a physical symbiosis between bacteria, larger single-celled organisms, spirochetes, and they got together and made a big cell with a lot of possibilities. And that's what all life is now, all multicellular life is based on eukaryotic cells. And part of that was the mitochondria, which used to be the old purple sulfur bacteria that could handle oxygen. And so that's fine. However, if oxygen is not handled correctly in a cell, it'll simply destroy the cell, because it steals electrons off of things. And that changes the charge, that changes the chemistry. So what radiation does is the same thing. It comes in, and it knocks an electron off. That's all it does. And it's mainly off of hydrogen because we are mostly water. So it knocks that off, and that electron then knocks off another electron and you get a cascade, okay, and different types of radiation cause slightly different cascades. So alpha, beta, gamma, but gamma just hit one and it cascades out, and then that's gone. Okay. Now, the change in the biochemistry of a macrophage, you know, immune cell, is such that it is an important change. And that's what's going on. That's all that's going on. And so exactly how the macrophage changes and becomes an anti-inflammatory to pro-inflammatory, I'm not quite sure.

Bret Kugelmass
And just to kind of help visualize what oxygen is and what it does, like rust on metal that's like oxygen attacking something.

Jim Conca
Yes, it's oxygen stealing an electron off of the iron.

Bret Kugelmass
And we know what oxygen can do. And then what you're saying was two and a half billion years ago, instead of the oxygen being purely toxic and just destroying things like rusting metal, our bodies adapted and figured out how we could utilize that attacking force of oxygen to become almost like an energy component of it.

Jim Conca
Yeah, we got almost 40 times the amount of energy out of a sugar molecule using oxygen than not. And this is just a single cell. So this is a eukaryotic cell. It took another billion years to come up with multicellular organisms, and then eventually to us.

Bret Kugelmass
So then let's rewind again a little bit. So tell me again, how the radiation works like oxygen, you're saying that the wave comes in, the X-ray comes into the body, and it knocks

Jim Conca
It knocks an electron off of a molecule mostly hydrogen, sometimes carbon

Bret Kugelmass
And then does that allow then the oxygen to release? Or is oxygen not part of the equation at this point?

Jim Conca
Oxygen is not part of this equation.

Bret Kugelmass
Does it just trick the body into thinking that something oxygen like has happened?

Jim Conca
No, I'm sorry. The oxygen analogy is simply an analogy to radiation. Okay, so oxygen is not involved in this particular treatment of COVID. But people don't realize that oxygen is much more dangerous than radiation. And also, when this came about two and a half billion years ago, there was about 10 times the background radiation as there is now. So we came up with mechanisms to repair radiation damage that was really quite efficient. That's why it takes a lot of radiation to hurt you. Because our cells, our immune system, can handle it really well.

Bret Kugelmass
So the radiation comes into the body, knocks off an electron, and that tells the macrophage which is part of our immune system to do something different than it's been doing before. And that's the whole key here is you sent a new signal. It's almost like we're communicating with our immune system.

Jim Conca
Yeah, that's a good analogy. And it's, you know, we've seen the anti-inflammatory effects of radiation a lot. I mean, the Germans have used this to treat, you know, joint inflammation and things like that. I mean anything, it actually looks to be useful in Alzheimer's disease which is an inflammatory issue. So, again, anything that involves runaway inflammation in the body. This is probably a good thing. But right now it certainly is a good thing for COVID. I mean you're gonna wait years to do trials. It's just sad. It's very sad.

Bret Kugelmass
Anything else that we should know about? You know if we got in touch with the right people, if they understood the value? How would it play out from there? What do you think that they would do? Would they roll it out in some hospitals first?

Jim Conca
The only reason you would do trials, let me backup a little bit, is to find out the exact best least dose that would work. So instead of a half a gray, I mean half a gray works, one gray works. In fact, the first trial had 1.5 grays, which is still I mean, still very low, but it was three times what actually works, you could get away with perhaps point three grays, you know, but who cares? Okay, all of those dose ranges are trivial in terms of the effect of COVID. So you've never seen any real effects, any adverse health and health effects from those targeted doses to the lungs. And again, we use 100 times that to treat cancer. So it gets back to why do people use radiation for cancer? Why aren't they afraid of it? Because they're afraid of cancer? So now, it's like COVID, wait for a second, you need to be more afraid of COVID than you are of this dose of radiation? Yeah. Especially if you're like, filling up with water. Yeah, it's rather strange. So that's what we have to get over is that you have to be more afraid of dying from COVID than you are of dying from low levels of radiation.

Bret Kugelmass
And the work being done right now is like an international effort. Right? These are just some of the studies that are being conducted. Where are some of the places that they're being conducted?

Jim Conca
Iran, Israel. I'm not sure where... in Spain, and Italy.

Bret Kugelmass
And the doctors who have like, taken this on, they just have a more, I guess, a progressive outlook

Jim Conca
No, they're struggling with the same thing. I mean, they're absolutely struggling with the same thing.

Bret Kugelmass
It sounds to me like we need a big communications push, we need to open up some people's eyes, we need to make them, you know, at least at the policy level. And then make it more acceptable to start implementing this. And then I bet once some hospitals start doing it, like name-brand big hospitals, I feel like the learning is happening faster than ever. Like hospitals sharing good learnings across COVID more than anything else, just because there's so much attention on it.

Jim Conca
Right. And, but this is weird here. We had this little trial at Emory University, Emory Medical Center at Emory University, and you know, it's only 10 patients, but hell it was 90% effective. But that wasn't enough. You could see the administrative aspect of the scientific community, just pushing back. Oh my god, that was not enough, it wasn't a big enough trial. Okay, so it was just a fluke, you mean 90% effective was just a fluke. Okay, so what do you want? We want a big trial, bigger trials going on a year. It's like, why do you want I mean, the, again, the fact that the LNT is administrative, you know the linear no-threshold dose, was an administrative thing. It was a bureaucratic thing. It was not a scientific thing. And so when you start trying to push this, you get the huge, huge bureaucratic pushback, which is amazing. And you know, science doesn't work that great against bureaucracy. It's really hard.

Bret Kugelmass
Yeah, no, it's tricky. I mean, I've looked into this a little bit. And, you know, whenever one of the big radiation agencies takes it on, like the ICRP, they'll establish a committee, they'll say look into this, the committee will be like, yeah there's no low dose effects. And then at the very top levels they'll say okay well, better safe than sorry, let's just say

Jim Conca
That's exactly what they've done for 50 years.

Bret Kugelmass
But you can kind of see why that is, it's like a super misalignment of incentives. If they were to essentially establish the position that low dose radiation is no big deal, then all of their jobs would be at risk. I mean, you're talking about thousands of professionals whose only job is to like, “protect us from minor amounts of radiation” or the people who are setting the standards for radiation. So it's right for their incentive to say, better safe than sorry, let's keep these standards.

Jim Conca
And I've thought about that. I've heard about that. I mean, I'm not yet, I'm getting there, but I'm not yet that cynical.

Bret Kugelmass
I don't think that they're doing it on purpose. It's like you can't pay a man to understand something or you can't get him to understand something his job pays him not to or something.

Jim Conca
Exactly. But I don't think it actually would kill many jobs. Because again, you still need to monitor you know, whatever limit you put in, to monitor that limit. And so I don't think that would do much. I think it's simply a cultural, administrative bureaucratic culture. That does not want to say we've been wrong for 60 years. And, you know, even then, it's like, so what? Who cares? So we were wrong for 60 years. We were wrong for 1000 years on certain things. Okay, so now we know, so get over it and get on with this and save lives.

Bret Kugelmass
That's coming from a guy like you who's got like a low ego, the big ego people don't think like that.

Jim Conca
Yeah, they don't think like that. Oh, yeah. Well, we'll see. Compared to this kind of stuff with what's going on right now in America, I'll tell you nuclear waste just seems so trivial.

Bret Kugelmass
Okay, well, we're gonna do our best over here to kind of bring some attention to this issue. We're gonna interview a few more of your colleagues, thank you so much for recommending them. And you know, I'll use some of my political connections as well to maybe get a voice at the table.

Jim Conca
Good, good. Thank you so much.

Bret Kugelmass
Yeah. Thanks, Jim. Talk to you soon. Thanks. Bye.