Suspended Animation Inc. accused of incompetence

Is it Dr. Wowk’s position, the vitrification solutions are so very toxic, it’s acceptable to subject Alcor and Suspended Animation’s clients to additional injury, via grossly incompetent personnel, when delivering those solutions? Wouldn’t it make more sense for organizations advertising the possibility of future resurrection, (and charging up to $200,000 for their services), to provide the best possible care? Shouldn’t they be doing as little harm, as possible?

My position is to do the best you can within available resources, and that criticisms should be in-context and constructive. As far as available resources go, of the $200K of Alcor's new 2011 whole body minimum, $110K is set aside to fund long-term storage, leaving only $90K, the majority of which is consumed by costs that already exist without employing a full-time cardiovascular surgeon (leaving aside the issue of how such a person would maintain his/her skills). This itemized analysis

http://www.alcor.org/Library/html/CostOfCryonics.html

http://www.alcor.org/Library/html/CostOfCryonicsTables.txt

shows those costs as $37,000 in 1990, or $60,000 2009 dollars, neglecting overhead and advances in technology since then. However people cryopreserved in 2011 will mostly not be people who signed in 2011, but people who signed up in 2000 or even 1990, sometimes with much lower funding than current minimums.

Dr. Wowk’s attitude seems to be, “Oh shucks, we’re filling them so full of highly-toxic solutions, it doesn’t matter what else we do to them. We might as well throw in some warm ischemia, some inappropriate perfusion pressures, or maybe even massive boluses of air.” Is that the mentality???

If that was the mentality, then there would be no efforts at field stabilization. Patients would just be packed in ice without any cardiopulmonary support or field perfusion, and sent off to their cryonics organization as is now done for CI members without SA contracts. Obviously I think field procedures are important, and that good-faith efforts must be made to do them well with resources available. However, with the possible exception of air embolism (which can interfere with later cryoprotective perfusion), problems in field care of cryonics patients don't have the same prognosis significance in cryonics that they would have in hypothermic medicine.

Dr. Wowk attempts to trivialize the mistakes I've been criticizing, by making reference to “one hour of ischemia.” The truth is, most, (if not all), cryonics suspendees have likely been subjected to much more serious abuse. The last SA case report was that of historical cryonics figure, Curtis Henderson. Mr. Henderson’s groin was prepped, for cannulation, at 6:50am, but the washout was not started, until 12:11pm. That means it took SA about FIVE HOURS longer than it should have, to perform the cannulation. Even then, it was not the SA team that accomplished the cannulation, but a local funeral director.

That field case report is here.

http://www.cryonics.org/immortalist/july10/henderson.pdf

Let's look at it. A contract surgeon was on standby with the rest of the team from June 21 to 24 before having to leave because of work obligations. A second contract surgeon was to arrive on the afternoon of June 25. As luck would have it, the patient suffered cardiac arrest the morning of June 25, showing that cryonics field work is more like battlefield medicine than an elective procedure. The people on scene, with the assistance of the mortician, did the best they could. Note that cardiopulmonary support and rapid cooling was performed, bringing the patient's temperature down to approximately +20 degC, descending to +12 degC during the surgery, which greatly mitigated the biological effects of the surgical delays. Note also the surgical error that the mortician himself made.

What was most offensive about the Henderson case, was Suspended Animation’s published case report, in which Catherine Baldwin referred to herself as a “surgeon,” and spewed forth more than enough medical jargon, (some of which she used, improperly), to make the average layman think her team was comprised of knowledgeable and competent medical professionals. I think Ms. Baldwin’s report was, quite clearly, a blatant attempt to deceive the public and to defraud SA’s potential clients.

I did a text search of the above document, and I can't find where Ms. Baldwin represents herself as a credentialed surgeon. I don't think it's fair to represent a sincere attempt to report what was done in the interests of transparency as a "fraud." Wouldn't someone whose intent was fraud write a wonderful case report, superficial case report, or none at all? Saul Kent is ironically an extremely strong supporter of writing and publishing case reports in cryonics, including disclosure of problems.

I think allegations of "fraud" and "abuse" are inappropriate in the context of the good-faith efforts being made, in the context of the biological significance of most field problems in cryonics relative to hypothermic medicine, and especially in the context of the alternative of just packing warm patients in ice and shipping without cardiopulmonary support or medications. There's also the context of nobody else caring to help or pay for what the infrastructure to support full-time cardiovascular surgeons at this stage of development of cryonics would really cost.

I'm doing a text search, and I can't find where I used the word "catastrophic." In any case, the damage done by present cryopreservation techniques is extreme by conventional medical standards (e.g. decapitation). The real question is the significance of the damage in the context of preservation of brain information encoding memory and personal identity, which is what cryonics seeks to preserve.

For decades Alcor has sought to be conservative and perform the first hypothermic stages of cryonics to a standard closer to that of medicine rather than mortuary science to make the early stages of cryonics closer to reversible. This has drawn criticism from two opposite directions. Bob Ettinger has criticized this approach because it is expensive, and nanotechnology is likely "necessary and sufficient" for revival of cryonics patients even without aggressive care immediately following cardiac arrest. More recently, Melody Maxim has criticized Alcor and SA because they fail to consistently deliver care following cardiac arrest to medical standards (even though there are no recognized medical standards for cardiopulmonary support, medication, cannulation and perfusion of legally dead bodies in an ice bath destined for cryopreservation other than the standards established by the cryonicists she derides.) It appears that the only alternatives that will please all critics are to either not do standby/stabilization at all, or to do it to a much higher and even more expensive standard than now being achieved.

With respect to fracturing, fracturing in cryopreservation is explained here

http://www.alcor.org/Library/html/CryopreservationAndFracturing.html

The problem is that there is still no known protocol for reliably cooling a large vitrified organ to temperatures ten or twenty degrees below the glass transition temperature without fracturing. More research needs to be done. Notwithstanding, there has been great progress in the past decade in developing engineering solutions to safe intermediate temperature storage. I gave a talk on this progress here

http://www.suspendedinc.com/conference/SA_conference.pdf

Alcor has experimentally used three different systems for intermediate temperature storage in the past decade. Some of these systems were grossly misrepresented by Larry Johnson as causing fracturing, rather than mitigating it (showing once again how difficult it is to make any progress in cryonics without the effort being misrepresented and used against you). In December 2008, the system described in the talk above was installed at Alcor. I'll be writing an article about it next year.

These systems reduce fractures compared to liquid nitrogen storage, but don't seem to eliminate them. Eliminating fracturing will require tedious research on cooling protocols. The research is tedious because it will likely require months, if not years, of holding at temperatures warmer than the final storage temperature to relieve thermal stress.

Finally, it is not "a little more expensive" to do storage at temperatures above liquid nitrogen temperature. It is about three times more expensive. It also took many years and six figures of research dollars to figure out it how to do it with a reliability more similar to that of liquid nitrogen rather than a mechanical freezer.

Yes, and I'm pretty sure I'm a typical enough example of a cryonics advocate for this to be a generalizable issue. If she isn't planning to sign up it really does at least communicate that she thinks it can't work -- that it's just an expensive funeral no matter who does it -- under present technological constraints.

Now, it's possible to think it can work and not plan to sign up. If you think it is too expensive of a trade-off on the risk-reward scale, or if you have an irrational fear of it. But Melody hasn't attempted to communicate either of these things. Her sole motive is supposedly her moral outrage at the horrible people in existing organizations perverting the sacred practices of medicine. Well if that's true, it should predict that once those moral outrages are resolved she plans to sign up -- that she believes in cryonics as an idea.

The explanation that makes the most sense is Melody is interested in something that is not fundamentally cryonics at all -- hypothermic hibernation for living patients, for example. She may call it cryonics, but it doesn't involve future-technological repair, clinically dead patients, long periods of time, etc. -- it is a fundamentally different concept with superficial similarities and much common ground basic science.

Someone who wouldn't use a service but criticizes it is more likely to be criticizing it because they don't like the idea rather than because they have concluded it's done poorly based on evidence. Obviously it doesn't make it certain that that's the case.

it provides me no information that he thinks cryonics works.

I don't think cryonics "works." I think it's worth doing. That's not the same thing. I've explained that cryopreservation causes damage that is severe by contemporary standards. It cannot be reversed by any near-term technology. Nobody should confuse cryonics with suspended animation or established hypothermic medicine.

The purpose of cryonics is to prevent "information theoretic death," or erasure of the neurological information that encodes personal identity. Any evaluation of the effects of procedural details on cryonics patient prognosis must be with reference to that.

Unfortunately none of the recent criticisms of cryonics procedures address the issue of information preservation, which is what cryonics is all about. The criticisms that I've seen have all been with reference to what effect various procedural problems would have had on living patients expected to spontaneously recover at the end of hypothermic medicine procedures. The information preservation significance of a delay in cannulation for someone who already suffered a "fatal" period of cardiac arrest before cryonics procedures begin, who may be transported across the country on ice, who will be exposed to hours of cryoprotectant perfusion, their brain dehydrated, possibly decapitated, and then major organs fractured by thermal stress during cooling, has not been discussed. Yet that is the real context of cryonics. Cryonics is not someone having aneurysm surgery.

To be clear, this bad stuff is going to happen no matter who does the procedures. It's intrinsic to present cryopreservation technology. The scientific reality is that for a cryonics patient, as distinct from a hypothermic medicine patient, the composition and concentration of what cryoprotectant ultimately gets into tissue is enormously more important than how long cannulation for field blood washout takes, or who does it, within reason.

Getting back to the question of whether cryonics "works," it was actually Ms. Maxim who took exception to me saying that she didn't believe cryonics could work. She said:

I have never said I "don't believe anybody's survival actually depends on cryonics because it won't work."

I have CLEARLY stated I believe someone preserved in a fairly pristine state might be revived.

There are two possible interpretations of this. Either she believes that cryonics done by the right people today could result in a "fairly pristine state," and cryonics could work. Or she believes that the unavoidable cryoprotectant toxicity, long cold ischemic times, and thermal stress fractures in multiple organs, likely including the brain, that is intrinsic to today's cryopreservation technology is not a sufficiently pristine state to permit later revival. In that case, the entire debate over procedural details and who does them is academic. The technology isn't good enough to work for anyone.

Dr. Wowk has stated that he needs cryonics to work, and so it provides me no information that he thinks cryonics works.

I don't recall making any context-less statements that cryonics works. Obviously I think that cryonics is worth doing, but that's not same as thinking it "works."

I explicitly stated that the damage done by the best cryopreservation technology is severe by contemporary standards. It's not compatible with revival by any near-term technology, no matter who does it. Nobody should be under any illusions that human cryopreservation by available technology is easily reversible.

The goal of cryonics is to prevent "information theoretic death," or erasure of the neurological basis of human identity. Any criticism of cryonics procedures, and the extent to which procedures impact the prognosis of cryonics patients, must be with reference to that. That has been absent in any of the recent criticisms of cryonics related to qualifications of personnel. Recent criticisms of cryonics cases have been with reference to what would have happened to living medical patients had the same case problems occurred (i.e. they might have died). The criticisms have not been with reference to the biological impact on someone who's already suffered a "fatal" period of cardiac arrest before the hospital even let cryonics procedures begin, and who is going to be perfused with cryoprotectants for hours, dehydrated, and then cooled to a temperature that results in thermal stress fractures through all major organs of the body, likely including the brain. In such circumstances, ultimately getting cryoprotectants into tissue is enormously more important than how long cannulation for field blood washout takes, within reason.

Regarding what Ms. Maxim believes about cryonics working, it was Ms. Maxim who took exception to me saying that she believed cryonics won't work. She said:

I have never said I "don't believe anybody's survival actually depends on cryonics because it won't work."

I have CLEARLY stated I believe someone preserved in a fairly pristine state might be revived.

There are two possible interpretations of this. Either she believes that cryonics today done by the right people could result in a sufficiently pristine state, in which case she believes that cryonics today could work. Or she believes that the cryoprotectant toxicity, long cold ischemic times, and thermal stress fractures that are unavoidable with today's technology are not sufficiently pristine to permit revival. In that case, the entire debate of qualifications of personnel and procedural details are academic to whether cryonics today does anybody any good because the technology is intrinsically not good enough to work.

it provides me no information that he thinks cryonics works.

I don't think cryonics "works." I think it's worth doing. That's not the same thing. I've explained that cryopreservation causes damage that is severe by contemporary standards. It cannot be reversed by any near-term technology. Nobody should confuse cryonics with suspended animation or established hypothermic medicine.

The purpose of cryonics is to prevent "information theoretic death," or erasure of the neurological basis of personal identity. Any evaluation of the effects of procedural details on cryonics patient prognosis must be with reference to that.

Unfortunately none of the recent criticisms of cryonics procedures address the issue of information preservation, which is what cryonics is all about. The criticisms that I've seen have all been with reference to what effect various procedural problems would have had on living patients expected to spontaneously recover at the end of hypothermic medicine procedures. The information preservation significance of a delay in cannulation for someone who already suffered a "fatal" period of cardiac arrest before cryonics procedures begin, who may be transported across the country on ice, who will be exposed to hours of cryoprotectant perfusion, their brain dehydrated, possibly decapitated, and then major organs fractured by thermal stress doing cooling, has not been discussed. Yet that is the real context of cryonics. Cryonics is not someone having aneurysm surgery.

To be clear, this bad stuff is going to happen no matter who does the procedures. It's intrinsic to present cryopreservation technology. The scientific reality is that for a cryonics patient, as distinct from a hypothermic medicine patient, the composition and concentration of what cryoprotectant ultimately gets into tissue is enormously more important than how long cannulation for field blood washout takes, or who does it, within reason.

Getting back to the question of whether cryonics "works," it was actually Ms. Maxim who took exception to me saying that she didn't believe cryonics could work. She said:

I have never said I "don't believe anybody's survival actually depends on cryonics because it won't work."

I have CLEARLY stated I believe someone preserved in a fairly pristine state might be revived.

There are two possible interpretations of this. Either she believes that cryonics done by the right people today could result in a "fairly pristine state," and cryonics could work. Or she believes that the unavoidable cryoprotectant toxicity, long cold ischemic times, and thermal stress fractures in multiple organs, likely including the brain, that is intrinsic to today's cryopreservation technology is not a sufficiently pristine state to permit later revival. In that case, the entire debate over procedural details and who does them is academic. The technology isn't good enough to work for anyone.

it provides me no information that he thinks cryonics works.

I don't think cryonics "works." I think it's worth doing. That's not the same thing. I've explained that cryopreservation causes damage that is severe by contemporary standards. It cannot be reversed by any near-term technology. Nobody should confuse cryonics with suspended animation or established hypothermic medicine.

The purpose of cryonics is to prevent "information theoretic death," or erasure of the neurological basis of personal identity. Any evaluation of the effects of procedural details on cryonics patient prognosis must be with reference to that.

Unfortunately none of the recent criticisms of cryonics procedures address the issue of information preservation, which is what cryonics is all about. The criticisms that I've seen have all been with reference to what effect various procedural problems would have had on living patients expected to spontaneously recover at the end of hypothermic medicine procedures. The information preservation significance of a delay in cannulation for someone who already suffered a "fatal" period of cardiac arrest before cryonics procedures begin, who may be transported across the country on ice, who will be exposed to hours of cryoprotectant perfusion, their brain dehydrated, possibly decapitated, and then major organs fractured by thermal stress doing cooling, has not been discussed. Yet that is the real context of cryonics. Cryonics is not someone having aneurysm surgery.

To be clear, this bad stuff is going to happen no matter who does the procedures. It's intrinsic to present cryopreservation technology. The scientific reality is that for a cryonics patient, as distinct from a hypothermic medicine patient, the composition and concentration of what cryoprotectant ultimately gets into tissue is enormously more important than how long cannulation for field blood washout takes, or who does it, within reason.

Getting back to the question of whether cryonics "works," it was actually Ms. Maxim who took exception to me saying that she didn't believe cryonics could work. She said:

I have never said I "don't believe anybody's survival actually depends on cryonics because it won't work."

I have CLEARLY stated I believe someone preserved in a fairly pristine state might be revived.

There are two possible interpretations of this. Either she believes that cryonics done by the right people today could result in a "fairly pristine state," and cryonics could work. Or she believes that the unavoidable cryoprotectant toxicity, long cold ischemic times, and thermal stress fractures in multiple organs, likely including the brain, that is intrinsic to today's cryopreservation technology is not a sufficiently pristine state to permit later revival. In that case, the entire debate over procedural details and who does them is academic. The technology isn't good enough to work for anyone.

My objection is not so much that she isn't signed up but that she has no plans to sign up, even when her moral outrage issues are resolved. So if it is to be considered as a criticism at all (and your comment seemingly supports the notion that it is), it's not simply a criticism of the cryonics industry, but of cryonics itself.

What makes it suspect to me is that she argues as though it is a criticism only of the current cryonics industry and yet makes no defense whatsoever of the general notion of cryonics (except a very vague version that sounds more like long-term hypothermic hibernation). Most critics seem to support some kind of future advancement suspended animation -- but that's a very different idea from cryonics from a service (and technological) perspective.

Dr. Wowk is misrepresenting the situation, yet again. It is not misleading to say Alcor has allowed laypersons to have performed vascular cannulations. Not only have they done so, but they have falsely referred to such people as “surgeons,” and even "Chief Surgeon," in their public reports, (something that is a violation of Arizona law). If they want to send a layman to do a surgeon's job, FINE...but, let them so note, in their case reports, and on their website!!!!!

Dr. Wowk also distorts the truth when he writes that recent criticisms (mine, I assume) call for cardiovascular surgeons, at a price of $351,108 dollars a year. Personally, I think if SA tried hard enough, for Ms. Baldwin’s salary, they COULD convince a retired vascular surgeon to move to Florida and do their few cases a year, but MANY times I’ve also suggested other persons, familiar with vascular cannulations, (such as embalmers, scrub techs, or physician assistants). The average embalmer’s salary, in Florida, is $43,171, as per this site: http://www.cbsalary.com/state-salary-chart.aspx?specialty=Embalmer&cty=&kw=Embalmer&jn=jn013&tid=2523&sid=FL , Does Dr. Wowk think a skilled embalmer wouldn’t love to have Ms. Baldwin’s six-figure salary-and-benefits package, and an easy caseload? Wasn't it an embalmer, not even employed by any cryonics organization, who had to perform the cannulation, for the Henderson case, because Ms. Baldwin could not do so, even in five hours time???

Dr. Wowk pretending SA and/or Alcor would have to pay $122,000, for a perfusionist is equally absurd, and has already been proven to be untrue. I am a perfusionist, and I worked at SA. My salary was $75,000 a year, and if it would not have been for the unprofessional and unethical activities, it would have been the highest-paying, least-demanding, job I had ever had! (Perfusionists who make the kind of salary Dr. Wowk quotes, work in demanding positions, doing MANY scheduled cases, AND getting called out in the evenings and on the weekends, on a regular basis.)

I could come and go, from the SA facility, as I pleased, and do whatever I wanted, as long as I did not complain about any of the totally absurd projects, (for which one of Dr. Wowk's peers was earning a whole lot of money!). As Dr. Wowk points out, I never even had to do a case. Who is Dr. Wowk trying to fool??? Many people would love to have a high-paying job, in sunny Florida, with so little to do, and so much freedom!!!

There was no supervision, at SA, for the most part. Some people punched in, and then left the building; some people played on the Internet, all day. If the surf came up, in Delray, some of the employees grabbed their surfboards, and left. When Bary Wilson (SA's manager, for a short time), complained about not being able to complete projects, because no one was ever there at the same time, (even in the middle of the day), they banded together and got rid of him. It was a total, and absolute joke, and not one meaningful thing was being accomplished. (Bill and Saul seem to be clueless, as to how much they have been taken advantage of.)

Dr. Wowk's facility might be doing some valid research, but the "research" at SA consisted of things like seeing how many tens of thousands, or hundreds of thousands, of dollars one could spend on "reinventing the wheel." Want to buy a reasonably-priced, professionally-built cooldown and transport box, from a company that had specialized in cryogenic containers, for many years? Forget it. SA's answer to something like that was to run out to Home Depot for materials, and engage in endless email discussions, (with Dr. Wowk, and others), in regard to the project.

Dr. Wowk is just making excuses, including those about professionals losing their skills, due to the low frequency of cases. People who have been performing cannulations, or perfusion, for many years, don't just forget how to do those things. Even if their skills get "rusty," they would certainly be preferable to laymen, who have only practiced on a few pigs, in the back of SA's van. It's insane, and I don't understand how any reasonable person could defend such activities. It seems dishonest for Dr. Wowk to pretend money is the primary issue, here, when most, (if not all), of the salaries at SA, are significantly more than salaries earned by paramedics, nurses, and other medical professionals.

Finally, Dr. Wowk misses the key point…that being HONESTY. If SA is going to send golf pros, metal fabricators, and other laymen to perform their procedures, THEY SHOULD JUST SAY SO, ON THEIR WEBSITE, AND IN THEIR CASE REPORTS. Not disclosing that information, and writing case reports in a manner intended to deceive the public into believing their cases are being performed by competent medical professionals is DISHONEST. Dr. Wowk wrote, (in another post), that SA’s manager, Catherine Baldwin, did not refer to herself as a “credentialed surgeon.” Does Dr. Wowk think the readers of lesswrong are unintelligent??? I'm sure most intelligent people are able to ascertain that, when someone fills a report with medical jargon and refers to “surgeons” and a “backup surgeon,” their intent is to deceive the reader into believing qualified medical personnel were present. It's ridiculous for him to maintain that it was acceptable for Ms. Baldwin to refer to herself as a "surgeon," because she did not place "credentialed" in front of it.

Do what you want, at Alcor and SA, Dr. Wowk, but at least be honest about it!!!

I want to Welcome you to LessWrong, and say that I hope you will stick around beyond this argument.

In my opinion, to provide any sort of funding to them, (whether directly, or indirectly), would constitute participating in fraudulent activities, perpetuating extremely substandard services, and delaying any possible real progress, in the field of cryonics.

What would be useful to know is whether that was your opinion at the time you made the decision not to accept the services. Also it would be useful to know if you plan to accept the services of an organization that does meet your standards, once it has come into existence (by whatever route -- be it regulation, reform, or replacement). If you are simply not planning to sign up at all, that's fine of course -- but it should not be surprising if this does not exactly inspire trust among cryonicists.

I know of no evidence. Closest I know is the promising result that a percentage of pinewood nematodes (a favourite of cryobiology researchers, having about the simplest known nervous system that is definitely a nervous system) survive cryoprotectants and vitrification and, if they survive, go on to parasitise pinewoods much like they did before. (E. Riga and J. M. Webster. "Cryopreservation of the Pinewood Nematode, Bursaphelenchus spp." J. Nematol. 1991 October; 23 (4): 438–440.) Preserving a neural network is of course the holy grail. But this is getting way off topic for a blog about the art of human rationality.