STELLA's Treat.

Another Thursday evening, another night in in front of a screen, another Skeptics in the Pub - Online. Not that I'm complaining. Though it will be great to go out and attend these events in pubs, or other venues, again soon(ish), I've really enjoyed the online talks the Skeptics community have been providing, for free - though donations are accepted, at a time when we've not been able to congregate in large, or medium sized, groups.

There have been speakers we probably wouldn't have heard from if they'd had to travel to be with us and there has been a chance for people in different Skeptics groups to chat, in what to me is an overly hectic sidebar, with each other. There's even a virtual pub afterwards people can go to. I've never been. So that, at least, is very different to my usual Skeptics experience!

Another great development has been the ongoing series of Skeptics in the Collider talks in which scientists working at the Large Hadron Collider at CERN in Switzerland share with us some of their knowledge and expertise. Last month, in the opening talk of the series, Harry Cliff spoke to us about Carl Sagan, the Big Bang, and particle physics (which was very interesting if a little too advanced to me) and last night it was the turn of Prof Manjit Dosanjh whose talk, Project STELLA:From Higgs to Healthcare in Challenging Environments, sounded, on the surface, like it might be a little dry.

I needn't have worried. Skeptics in the Pub have a pretty good reputation for making science fun and the Prof was an interesting, passionate, informal, and modest speaker who was generous in her time during a Q&A (hosted by Dr Alice Howarth of Merseyside Skeptics) that followed the talk. She's quite a CV too. She holds a PhD in Biochemical Engineering and her professional efforts in the fields of biology and the medical applications of physics span more than thirty years. During which she has held positions in various academic and research institutions in Europe and the US including the Massachusetts Institute of Technology (MIT), the Lawrence Berkeley National Laboratory (LBNL) at the University of California, and the European Commission Joint Research Centre (EC-JRC) in Italy.

She joined CERN in 1999 and since then has worked to apply technologies originally developed for particle physics to the domain of life sciences with the aim of translating and transferring knowledge about physics to society at large - which is where Project STELLA comes in. STELLA, in this instance, is nothing to do with Britain's most drunk, and reassuringly expensive, lager (though the Prof did offer up that she's rather be delivering the talk in the pub so who knows?) but instead stands for Smart Technologies to Extend Lives with Linear Accelerators.

The Prof and her team focus on the collaborative nature of the CERN project and how it, or they, can help with the world's most pressing healthcare problems. On a global scale, one of the biggest issues is access to radiation therapy for cancer treatments and how uneven that access is between lower/middle income nations and wealthier countries.

In Africa there are twenty-seven countries (including Chad, Congo, Niger, and Somalia) that have no radiation machines at all. In Mauritius, Africa's per head best served country primarily due to colonial links to France, there is one machine for half a million people. In Ethiopia there is one machine to serve a population of over one hundred and ten million people - the twelfth most populous nation on Earth.

To put this into some kind of contrast, the UK currently operates 348 radiation machines and in the US there are several thousand. Which means that they are considered to have 'sufficient' radiation therapy access. Not many countries do. The UK and US are joined on that list by most of Western Europe (Portugal a notable exception), Australia, New Zealand, Japan, Canada, and Uruguay.

Cancer's not going away (I lost one of my very best friends to it just over two years ago) and is, in fact, rather sadly, growing. In 2018 there were, globally, nearly ten million lives lost to cancer. It is estimated that by 2040 this figure will have risen to over sixteen million. Many of whom will be in lower and middle income nations.

To treat the cancer, the Prof told us of a maxim that I presumed to be well known but one which I had never actually heard before. Medical experts must treat "the tumour, the whole tumour, and nothing but the tumour" but to do that you must first be able to locate, and see, the tumour.

To see the tumour, doctors rely on particle detectors, X-rays, computed tomography (essentially a kind of 3D X-ray), and Positron Emission Tomography (which I don't claim to understand but seems to involve glucose, protons, and electrons). Once you can see the tumour you are presented with three main choices of how to go forward.

Surgery, chemotherapy, and radiotherapy can be used to complement each other or they can be applied individually. It is for the medics to decide not only what will best help the patient survive but to also remain mindful of what quality of life, post-treatment, that patient will have. Which is why surgery is so often followed by either chemo or radiotherapy, particularly in cases of breast cancer.

Radiation therapy, unlike Stella Artois, is comparatively cheap so that is why Project STELLA have focused their attention on it. It's no so much picking low hanging fruit (as an aside, my friend Cheryl amused me recently by telling me whenever she hears someone use the phrase 'low hanging fruit' she pictures somebody's 'dangly balls') as finding what look like workable, and affordable, solutions to real life problems. 

As with the CERN physicians, Project STELLA began by getting everyone involved together for a brainstorming session. There were two workshops in CERN in Switzerland, then one near Manchester, and then one in the Botswanan capital Gaborone. The idea was to find ways of revolutionising the delivery of radiation therapy machines using AI, cloud computing, and other relatively new technological advances. While also, at the same time, keeping in mind that training and mentoring would play a major role too.

A machine can't help treat a patient unless there is a person to oversee that machine, to tell it what to look for, and to report when it breaks down. To care for it, basically. Anyone who's ever had an argument with a Facebook algorithm will know that robots may be highly advanced now but they lack an understanding of subtlety and nuance. Their bedside manner, too, needs working on.

Project STELLA's goal is to make not just affordable machines but ones that are simple to use. To do this they gather data in the countries the machines will be used in rather than applying top down solutions that may fail to take into account particular circumstances in various territories. Conversations with people in all twenty-eight African countries that have at least one radiation machine discovered the sole machine in Madagascar was turned off more than it was used and that all five machines in Zimbabwe were malfunctioning.

Once data has been gathered and challenges identified, designs are made, and a prototype machine is created. Soon, hopefully - this is still very much a work in progress, these machines will be making their way to the places where they are needed. But Project STELLA would still not consider this job done. 

In many countries there is a lack of spare parts for the machines and there is a lack of engineers to fix, and work, the machines - so Project STELLA are looking to get involved with that too. Their aim, and it is without doubt a noble one, is to provide higher availability of radiation therapy treatment and higher reliability of the machines, and people, that provide it.

None of this would have saved my friend Bugsy (or the other two friends who have succumbed to cancer) and none of this would save every single person who gets cancer but it will, surely, save hundreds of thousands of lives eventually and having lost a friend to cancer I wouldn't wish for anyone, anywhere in the world, to have to go through that unless they absolutely have to. Thanks, again, to Skeptics in the Pub for another great evening and thanks to Prof Manjit Dosanjh for her time, her eloquent presentation, and for her, and her team at Project STELLA's, role in trying to make the world a better place for all of us.