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Your points are mostly well-taken, Mike. Not everything is better than it used to be. While the basic cryopreservation technology (vitrification) is better, and some important aspects of service delivery are better, Alcor does not have in-house expertise comparable to the era of you and Jerry Leaf. With the benefit of hindsight, I would say that people of such caliber willing to devote their life to cryonics are a historical anomaly not amenable to formulaic replication.
With respect to communications, the two new potential O.R. surgeons I spoke of were not a public announcement being withheld because Alcor is opaque and untrustworthy. Contact was made with them only within the past few weeks, as discussed at a recent public board meeting. I mentioned them only because your message seemed to imply that Alcor was content with the status quo.
I confess that you have a knack for twisting the knife of public criticism in ways that prompt me to "announce" things that aren't ripe for announcement, and that lead to more questions and criticism. When will I learn? :)
Mike, let's be fair about this. Veterinary surgeons for thoracic surgery (after loss of Jerry Leaf) and chemists for running perfusion machines were also used during your tenure managing biomedical affairs at Alcor two decades ago. You trained and utilized lay people to do all kinds procedures that would ordinarily be done by medical or paramedical professionals, including establishing airways, mechanical circulation, and I.V. administration of fluids and medications. Manuals provided to lay students even included directions for doing femoral cutdown surgery.
http://www.alcor.org/Library/html/1990manual.html
The good cases that you were able to do with lay help (and being only a dialysis technician by credential yourself) are the stuff of cryonics legend. That was how cryonics was done back then. With the resources that were available then, and the need to provide cryonics response over vast geographic areas, using trained lay cryonicists was the most effective way to deliver cryonics care for many years. Some history of this is discussed here
http://www.alcor.org/Library/html/professionals.html
In the 2000s Alcor began to supplement trained lay cryonicist teams by deploying a staff paramedic to cases whenever possible. In the 2010s, Alcor began using Suspended Animation, Inc., more extensively. As announced here,
http://www.alcor.org/blog/?p=2174
Alcor policy is now to use Suspended Animation, Inc.., (SA) for all cases in the continental U.S. outside of Arizona which SA can reach in time. Local trained lay teams are now only used as first responders, bridging time between notification of emergencies and arrival of SA.
The significance of this is that SA now uses board certified cardiovascular surgeons and certified clinical perfusionists on almost all cases. I've met two of SA's contract cardiovascular surgeons, one of whom trained under Michael DeBakey. These are top-rank professionals who go out on cryonics standbys, and get cryonics patients on cardiopulmonary bypass faster than ever before in cryonics. They established fem-fem bypass on one patient last year in only 15 minutes.
http://www.alcor.org/blog/?p=2175
Another patient was placed on bypass only 7 minutes after arrival in SA's vehicle using emergency median sternotomy, never before done in cryonics.
http://www.alcor.org/blog/?p=2267
These are professional surgeons and perfusionists who do median sternotomies and cannulations so fast that in their day jobs they actually save patients who suffer cardiac arrest from fixable causes (e.g. "fatal" DVTs). This is now the level of care available under ideal circumstances in cryonics.
In Alcor's O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years. Alcor has transitioned toward utilization of professionals whenever possible or practical. There are now more medical professionals doing the work of cryonics than ever before in the history of cryonics; not just scientists and technicians, but actual clinicians.
You are also mistaken, at least partially, about utilization of animal models in training. Even though professional surgeons and perfusionists already have extensive and ongoing clinical experience, SA uses a porcine model to train its contract surgeons, perfusionists, and other personnel in the specific procedures of cryonics.
There are shortcomings to this model. Contract clinicians are extremely skilled at specific procedures that must be done, but they are not cryonicists. For example, they don't understand cerebral ischemic injury, its mechanisms, and significance in the context of cryonics. This can hypothetically lead to difficulties understanding and managing cases with moderate periods of warm ischemia that would ordinarily be "written off" in conventional medicine. Cryonicist involvement is still essential. However on balance, as measured by the speed and competent handling of standbys and transports in which they have been involved, participation of cardiovascular surgeons and perfusionists has been very positive. I hope we can continue to afford it.
In my role as an Alcor director, I had the painstaking and unpleasant task of investigating the veracity of Johnson's book allegations to determine which of them required legitimate corrective action or litigation for defamation. Some of the allegations published in New York Daily News and wire services in 2009 promoting the book weren't even anywhere in the book (e.g. allegations that Alcor dismembered live animals). Such lies about the book itself were apparently just invented to get international media attention two days before the book's release. Some of the allegations inside the book were so outrageous that no reasonable person knowing anything about cryonics could believe them, such as Alcor kidnapping teenagers and homeless people and burying them in the desert, or engaging in drug trafficking and wild car chases. Other allegations, such as certain cryonics cases being "botched," I knew immediately were false because I had personal knowledge of the cases, or because they were repeats of false allegations Johnson made during his previous reach for fame in 2003.
http://www.alcor.org/Library/html/sportsillustrated.htm
Many other allegations required investigation. In some cases, such as false allegations of illegal waste disposal, public sources were sufficient to refute them.
http://www.cryonet.org/cgi-bin/dsp.cgi?msg=22461
To summarize, although there was enough superficial truth in "Frozen" and enough real controversy in Alcor's history to establish a veneer of credibility to the casual reader, the vast majority of the book is deliberately crafted to depict Alcor and cryonicists in the worst possible light, and uses literally hundreds of false claims and allegations to do it. It's not just a matter of poetic license, but fabrication of entire anecdotes and conversations that never happened. In some cases there was also editing of conversations to create completely different meanings than the original conversations (editing that ABC News co-participated in, but that's another story). There were accounts of cryonicists having loathsome medical conditions that they did not have (one of the legal definitions of defamation per se), partying with human remains, animal abuse, cultism, brainwashing, deviant sex, and poor hygiene. As one commentator on Amazon.com put it, Johnson could have been more credible had he not go so completely over-the-top.
Partial book rebuttals concerning matters they have personal knowledge of have been published by well-respected cryonicists Steve Harris and Charles Platt
http://www.network54.com/Forum/291677/thread/1258263309/The+Instability+of+Larry+Johnson%27s+History
http://www.cryonet.org/cgi-bin/dsp.cgi?msg=32722
Alcor chose to litigate 32 defamation claims in the present New York lawsuit that is continuing against the publisher, Vanguard Press, and coauthor Scott Baldyga.
http://www.alcor.org/Library/pdfs/NewYorkComplaintAmendedJan2010.pdf
We could have added many more, but those are enough work as it is. Someday, once the litigation is done, I may write a 100-page tome of everything that is false in that book. But in the meantime my time and freedom to do is limited by the fact that the litigation is still ongoing.
It's unfortunate and unfair that news media keep rehashing this stuff. It's so much easier to destroy things than create them.
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.
If I recall correctly, SA charges CI members $60,000 for field standby, stabilization, and transport. SA does approximately one or two cases per year, apparently using contract perfusionists and surgeons when available for the blood washout phase of procedures. The alternative for CI members is simple packing in ice some unspecified period after legal death, and shipment by a local mortician; no cardiopulmonary support, no associated rapid cooling, no blood washout.
As I understand it, Maxim makes two claims:
SA underdelivers and overcharges for services, ("incompetence") while representing itself in a disingenuous and probably legally prohibited way.
The industry SA operates in should be regulated because of claim 1.
If so, she is apparently saying that government regulations be put in place to force an organization with ~ $100K in annual revenues to spend up to $470K on salaries (recently computed elsewhere on Less Wrong) for a full-time certified perfusionist and a cardiovascular surgeon (how they would maintain skills is unspecified), or nobody should be allowed to attempt to provide any cryonics field service other than simple packing in ice. And the government should provide this consumer protection for two citizens per year even though nearly every medical expert, politician, regulator, inspector, and enforcement official will believe that these enforced medical standards are cargo cult science applied to dead bodies who could not possibly be revived because (a) they are already dead, and (b) the later cryopreservation itself is certainly fatal.
Why isn't there concern that by prematurely requiring highly credentialed people, by law, to do cryonics stabilizations that the government itself wouldn't be misleading people about the legitimacy of cryonics? The way things are now, people don't look to the government to evaluate cryonics procedures. (Nor should they for a field as small and misunderstood as cryonics.) People have to kick the tires themselves. They have to know how limited present cryopreservation procedures are. They have to read the case reports, know that mistakes happen, and decide for themselves whether $60,000 is likely to be worth more than simple packing in ice. They have to know what they are getting into.
The reason, in a nutshell, why I'm concerned about government regulation in the present state of development of cryonics is that by not understanding cryonics, not really caring about it, not actually valuing it, they will almost certainly get the regulation wrong. The extreme political hostility that has traditionally motivated calls for cryonics regulation also helps insure this. Good regulation requires good dialog, not name-calling.
There's another point that should be obvious, but perhaps not to those not familiar with cryonics procedures. The reason the patient cooled from approximately +20 degC to +12 degC during the long surgery was because HE WAS PACKED IN ICE. That's the same treatment he would have gotten for those five hours had SA not been there.
Before and after those five hours, the patient's treatment was enormously better than it would have been had SA not been there. Prompt cardiopulmonary support (CPS) and ice bath cooling after cardiac arrest supplied oxygenated blood and medications to the brain, and accelerated the initial phases of cooling compared to just packing on ice. After the surgery was finally completed, perfusion allowed cooling the rest of the distance to 0 degC in mere minutes. So,
What happened because SA was there, was:
Fast cooling during CPS / Slow cooling in ice / Fast perfusion cooling to 0 degC
What would have happened if SA wasn't there, was:
Slow cooling in ice / Slow cooling in ice / Slow cooling in ice .....
The criticisms that have been made about this case seem to imply that SA harmed this patient, or engaged in some kind of malpractice. But the patient objectively benefited from the procedures done (based on the temperature descent profile) despite the misfortune of his legal death occurring between the presence of the two contract surgeons.
I believe this is also likely true for the other SA cases that have been criticized; that the patients benefited from the presence and rapid response of a stabilization/transport team despite mistakes made. They would have been much worse off if just packed in ice and shipped by a mortician 1970s-style. However there is no criticism from recent critics when THAT happens in cryonics. There are no allegations of incompetence, malpractice, or demands that people be regulated or arrested. It's only when groups of people try to do better than just packing in ice that the fire and brimstone rains down.
The only logical inference from this would be that critics want regulation to prohibit anyone from having field cryonics procedures (or any cryonics procedures?) other than simple packing in ice unless those procedures are delivered by certified perfusionists and cardiovascular surgeons, guaranteed. As a practical and financial matter in the current state of development of cryonics, this would be tantamount to legislation that nobody in cryonics gets any field stabilization, or even cryoprotective perfusion were such regulations to extend into cryonics facilities.
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.
Something else that may not be apparent to casual observers is the selectivity of Ms. Maxim's criticisms. For the first two years after she left SA in 2006, SA was practically the exclusive target of her criticisms. Alcor officials, including myself, had cordial correspondence with her about a variety of perfusion topics in which she kindly shared her expertise. In August, 2008, one of my emails to her said:
I agree with you about the value of professionals in cryonics field work. I hope cryonics can manage to make that transition. It is regrettable that you ran into the obstacles that you did.
In 2009, for reasons unrelated to changes in service as far as I can tell, she began criticizing Alcor as harshly as SA. SA and Alcor have been targets ever since.
Conspicuous by absence have been criticisms of CI, except for criticisms that CI allows its members to contract with SA for standby/stabilization services. There is no criticism of what happens to CI members who do not contract with SA for service: packing in ice by a local mortician for shipment to CI with no stabilization or field perfusion whatsoever. There is no analysis or critique of the biological consequences of THAT, and no demand for government regulation to prevent such treatment.
Nor is there much criticism of procedures at CI itself, open-circuit perfusion by a mortician for every CI case. That is not even remotely comparable to a hospital hypothermic surgery procedure, but there is no criticism of it.
What SA and Alcor have in common is that they both aspire to a higher standard of cryonics care than possible with morticians, one that draws upon some aspects of hypothermic medicine for the early stages of procedures. So perhaps what can be said about the selectivity of Ms. Maxim's criticisms is that she focuses on criticizing those who aspire to a higher standard of care, but who fail to consistently deliver it. The missing context, and missing criticism, is what happens to cryonics patients when there is no such aspiration. And, frankly, when there is no cryonics at all.
these are testable claims that you could be testing.
If this wasn't clear from my last post (the one with "OF COURSE" everywhere), let me say it again. I participate in the leadership of a cryonics organization (Alcor). Speaking for myself, I stipulate to the correctness of Melody Maxim's central claim that cryonics procedures do not meet the same standards, or sometimes qualifications of personnel, as hypothermic medical procedures. There's nothing to test. It's true. It's the significance of this that is dispute, not the fact of it.
The moral outrage, indignation, allegations of fraud and self-interest, and claims of no progress in cryonics in 40 years are not justified. 40 years ago, cryoprotectants weren't even being seriously used. 35 years ago they were being administered by morticians with embalming pumps. 30 years ago a mainstream cardiothoracic surgery researcher brought medical techniques to Alcor. 20 years ago there were vigorous debates between Alcor and CI about the importance of medical techniques. 10 years ago, vitrification was introduced. Several years ago, contract professional perfusionists began to be used by SA for field procedures. None of this is ever acknowledged. Instead, it's an outrage that full-time cardiovascular surgeons and perfusionists don't yet work in cryonics. An outrage.
Animals with more sophisticated nervous systems than nematodes can survive vitrification.
http://www.ncbi.nlm.nih.gov/pubmed/20086136
Even more sophisticated neural networks, mammalian brain slices, can now be vitrified with present technology.
http://www.21cm.com/pdfs/hippo_published.pdf
Of course it is what happens to whole brains that are vitrified that really matters to cryonics. The only paper published so far on the technology presently used in cryonics applied to whole brains is this one
http://www.alcor.org/Library/pdfs/Lemler-Annals.pdf
with more micrographs from that study here
http://www.alcor.org/Library/html/cambridge.html
and many more here
http://www.alcor.org/Library/html/micrographs.html
Unlike slices, there is no expectation that cell viability is preserved in whole brains because the cryoprotectant exposure time is longer. However connectivity and extensive biochemical information is believed to be preserved, as these micrographs suggest. It is presumed, but not proven, that the effect of thermal stress fractures at cryogenic temperatures is displacement of fracture planes. This would theoretically still preserve connectivity information, although requiring hyper-advanced technology to do anything with that information.
This is precisely what I would have thought advocates needed to be researching, and I'm amazed there's so far just been defensiveness, circling of the wagons and ad hominem dismissal....
As I've tried to explain, the entire line of criticism is based on a false analogy of cryonics to hypothermic medicine.
OF COURSE, if cryonics were an elective procedure in which a patient were to be cooled to +18 degC and heart stopped for brain surgery, you wouldn't use paramedics, scientists, or contract cardiothoracic surgeons who may or may not able to show up to do the surgery. OF COURSE, you would use a Certified Clinical Perfusionist to work alongside the surgeon, no exceptions. OF COURSE, any less qualified people are bound to make mistakes, and have made mistakes, mistakes that could be fatal in a mainstream medical setting in which someone was expected to be warmed right back up from +18 degC and woken up at the end of the procedure. OF COURSE, anyone with common sense (no independent medical expert needed) would say that! But that's not what cryonics is, or could be with any near-term technology.
Cryonics doesn't stop at +18 degC. The hypothermic phase continues down to 0 degC, and then the cryothermic phase down to -196 degC, doing injuries far beyond reversbility by mainstream medicine. Cryonics is an information preservation excercise at liquid nitrogen temperature, not an attempt to recover people in real-time from minor cooling in clinical settings. The procedures during the hypothermic phase aren't even the same in many major respects, but I won't bother getting into that.
Isn't anyone else struck by the bizarreness of malpractice allegations that need to be vetted by hypothermic medicine experts for procedures that end with decapitated heads and brains likely fractured at liquid nitrogen temperatures?? What medical standards or established specialties exist for that?
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.
Alcor already employs a full-time paramedic with surgical training in large animal models to do vascular cannulations when it is possible to do so in the field. Cannulations at Alcor are typically done by either a contract neurosurgeon or a veterinary surgeon. I've written further details about who does surgeries at Alcor, and who has done them historically, here:
http://www.imminst.org/forum/topic/44772-is-cryonics-quackery/page__p__437779#entry437779
It's misleading for people to keep saying that Alcor sends out "laypeople" to do vascular cannulations.
The standard being applied to Alcor in recent criticisms is not just that people doing the cannulations be competent, or even have a medical credential, but that they should be the same professionals who do vascular cannulations for elective surgeries in tertiary care hospitals, i.e. cardiovascular surgeons. According to this website
http://www.studentdoc.com/cardiovascular-surgery-salary.html
the lowest reported salary for a cardiovascular surgeon is $351108 per year. According to this website
http://www.bestsampleresume.com/salary/perfusionist.html
the average salary of a clinical perfusionist is $122,000 per year. The sum of these two figures is approximately equal to Alcor's entire staff budget. Notwithstanding, a clinical perfusion credential was listed as a desirable qualification in Alcor's last clinical cryonics job ad. No perfusionists responded.
Surgeons and perfusionists employed full-time by a cryonics organization might only do a couple of cryonics cases per year, quickly losing their clinical-level skills, and employability outside of cryonics. The perfusionist making all these recent criticisms against cryonics, and insisting that full-time cardiovascular surgeons and perfusionsts be hired (not just contract ones), herself never had the opportunity to work on even one cryonics case during her entire employment at SA four years ago. Cases are that infrequent.
Dr. Wowk is being dishonest, in his representation of my opinions of cryonics. I have never said I "don't believe anybody's survival actually depends on cryonics because it won't work."
You've been saying it by implication. See below.
In fact, on numerous occasions, I've clearly stated cryonics has a basis in reality, based on existing conventional medical procedures, in which people are cooled to a state of death and then revived. Many times...many, MANY times...I have CLEARLY stated I believe someone preserved in a fairly pristine state might be revived.
There is no present technology for preserving people in a "fairly pristine state" at cryogenic temperatures. Present cryopreservation technology even under perfect conditions causes biological effects such as toxicity and fracturing that are far more damaging than the types of problems you've expressed concern about. Even if the hypothermic phase of cryonics were done perfectly, with completely reversibility, what happens during the cryothermic phase is so extreme as to make the damage from poorly-executed blood washout insignificant by comparison.
If you believe that for cryonics to work, preservation must be so pristine that the number of minutes taken for a femoral cannulation can determine whether cryonics succeeds or fails, then you necessarily believe that cryonics today cannot work no matter who does it. That's because enormously worse damage is unavoidably done during cooling to liquid nitrogen temperature.
Cryobiologists wouldn't be impressed if the Mayo Clinic did cryopreservations. Who does cryopreservations is just window dressing as far as cryobologists are concerned. They know that technology for preserving people or human organs in a reversible state (as reversibility is currently understood in medicine), doesn't exist. Most cryobiologists would regard the idea of repairing organs that had cracked along fracture planes as preposterous, as I'm sure you do if you believe that 300 mmHg arterial pressure or one hour of ischemia is fatal to a cryonics patient.
In summary, the force with which you believe that departures from clinical ideals in the hypothermic phase of cryonics are fatal necessarily means that you believe the cryothermic phase of cryonics today is fatal no matter who does it. As a cryobiologist, I'm telling you that the damage of cryothermic preservation is that bad independent of who does it. The technology for "fairly pristine" just isn't there.
It seems more of a con game, to me, than a serious effort to make medical history.
Maybe you are projecting here about why you took your job at SA four years ago (the medical history part, I mean). I don't care about making history, I care about surviving history. As far as cons go, there has never been a bigger money losing pit for individuals than cryonics. Anyone who bothers to look will see that money Alcor receives is either spent on legitimate activities or set aside to ensure continuity of patient care, and long-term survival of the organization. I don't have to tell you how modest compensation is at CI. Saul Kent often observes wryly that cryonics is the most famous least successful idea in history. I'll add to that, least personally rewarding. In what other fields do sincere people have the opportunity to be mercilessly pummeled as dishonest, incompetent, ignorant, unethical, con men while making below-market pay in most cases, and not seeing any results of their work for centuries, if ever? Although it's not my thing, cryonics would be great for S&M types.
It is ridiculously absurd for Dr. Wowk to write that it is his "understanding" that I, (a person who has probably written millions of words about cryonics), "have no personal interest in cryonics."
You've said elsewhere that you have no personal interest in cryonics for yourself, and that you don't believe cryonics will work. You imply that you don't believe it will work because it's not being done competently. However if the Mayo Clinic started offering human cryopreservation tomorrow, you would still believe that cryonics couldn't work. The reason is that if you believe that 10 minutes of surgical time vs. 90 minutes of surgical time is the difference between success or failure of cryonics, then you must surely believe that poisoning a brain with cryoprotectants and fracturing it during cooling utterly dooms it. However that is what happens with the best cryopreservation technology that exists today, no matter who does it. The success or failure of cryonics ultimately depends upon a type of information preservation that is outside the ken or even conception of mainstream medicine, and one that you yourself don't subscribe to because your criticisms are never with reference to it.
On the rare occasion a medical professional, (someone who has had the potential to bring other professionals into the field), has expressed an interest in cryonics, what was the result? What happened when Larry Johnson brought up the issue of OSHA violations, at Alcor?
Johnson's claims are presently subject to an active defamation lawsuit. Numerous medical professionals have done work with Alcor at various times, including nurses, clinical perfusionists, a neurosurgeon, two doctors who served as CEOs, and two full-time paramedics hired after Johnson. None of them behaved as Johnson did.
Your consistent defense of Larry Johnson is incomprehensible to me. This is a man who absconded with photographs of human remains, and sold them on the Internet and bookstores. He violated personal privacies in the most horrible ways that had nothing to do with any wrongdoing. He told vicious lies about matters of which I have personal knowledge. He was shown to have falsified death threats, violated court orders domesticated in three states, found in contempt of court, and is now subject to an arrest warrant in Arizona.
Dr. Wowk maintains there is no one at Alcor, with a six-figure salary-and-benefits package.
I didn't say that. I said there was no one at Alcor who fit the description of having such compensation and wasting time reinventing wheels. It should be clear from the salary budget at Alcor that not many people make large salaries. There is certainly not the salary budget for the full-time cardiovascular surgeon and clinical perfusionist whom you seem to be saying Alcor should hire.
I disagree that Dr. Wowk has "nothing to gain by promoting or tolerating any culture of waste or procedural negligence." I think Dr. Wowk probably has HUGE professional and financial incentives, to defend the LEF-funded organizations and Alcor.
Forget defending, what about tolerating? Cryonics is something you criticize as a hobby. For me, cryonics is a matter of survival. It's my body those things will be done to, any my belief (correct or not) that how things are done matters to my survival. You've said that you don't believe anybody's survival actually depends on cryonics because it won't work.
Regarding my financial incentives, a few facts: I have 23 years of education, three college degrees, including a PhD, and 20 years of experience doing and publishing scientific research. My salary before benefits is five figure, and way below what it would have been had I stayed in the medical field in which I did graduate studies, and not foolishly and idealistically changed fields to do research related to cryonics. I received $700 from Alcor in 2010 for work I did on a cryonics case, and that's it. My employer receives a negligible portion of its funding from sales to cryonics organizations, and no grants from them. My employer prefers that I not make public posts about cryonics, and so do the people who fund them, believing its not a good use of my time. They are probably right. Not following those preferences is actually contrary to my career interests.
As to my motives for defending cryonics and those who do it, you overlook the most obvious ones that have nothing to do with money. First and foremost, after 24 years of advocacy and other work to advance the idea, I care about it being presently fairly and accurately. In that respect, I am as passionate as you are about areas of cryonics that you don't believe are being represented accurately. For both of us, that has nothing to do with money. Second, there is pride involved. When I am a director of Alcor, and among those ultimately responsible for it, it's hard not to take unfair criticism personally. Finally, once again, it is a matter of survival, not just of myself, but many other people who for better or worse I've convinced to sign up for cryonics over the years. If exaggerated, misrepresented, or out-of-context criticisms of cryonics lead to outlawing of it, or severe restrictions on its procedures imposed by people with no understanding or personal value of it, that would be a disaster.
Except for the very small number of people who choose to sign up for it, practically no one values or cares about cryonics. No one takes the time to learn its premises, its history, the technologies it's predicated upon, or what technical elements will ultimately determine its success or failure. There are no schools or generally-recognized standards. No one cares. This includes mainstream medicine and mortuary science. My understanding is that you yourself have no personal interest in cryonics.
Against this backdrop, it's not credible that there is a conspiracy among cryonics companies-- companies run by people who want cryonics for themselves --to suppress a tide of experts who could easily step in and do cryonics better. There is no corps of knowledgeable physicians or morticians ready and able to deliver cryonics services that is being displaced by incompetent lay people.
So what do cryonics organizations do? They train lay people and Emergency Medical Technicians to do tasks suited to those levels of expertise. They use morticians to help with some aspects of cases, including vascular cannulation. They contract with sympathetic medical professionals who help with expertise-intensive aspects of cryonics cases when they can, ideally multiple professionals for redundancy. They hire full-time medical professionals for certain roles when they can afford to do so, and when candidates can be found. Or they allow their members to contract with companies, like SA, who do the above.
This mixture of people is then cast into world where they must perform these unscheduled procedures at short notice anywhere within the country, and sometimes beyond. Where they must lug hundreds of pounds of equipment and perfusate to do it. Where sometimes they have to wait weeks at bedside, only for the patient to recover. And where there is no mainstream infrastructure, support, or understanding of what they do. And, recently, where they are bitterly criticized when cryonics cases fail to meet the same standards as scheduled mainstream medical procedures with entire hospitals, universities, and industries that support them.
There have been claims that cryonics has not progressed in 40 years. Leaving aside the enormous improvements in the cryopreservation process itself, it would be instructive to critique reports of past cryonics cases performed only by morticians without today's bedside teams. What was the E-HIT (equivalent homeothermic ischemic time) when the mortician was called after someone legally died, then packed them in unstirred ice with no cardiopulmonary support? What anticoagulants or ischemia-protective medications were administered? What perfusate did the mortician have, and what happened when it was perfused by an unsterile high pressure embalming pump?
With great irony, it is actually a sign of progress in cryonics that cryonics procedures are now being held to the standards of mainstream medicine. Twenty five years ago, there were raging debates about whether the kind of mortician response I describe above was completely sufficient for cryonics. Really.
I'm sorry that you had a bad experience working at SA under different management four years ago. I'm sorry that you worked with some difficult people. I've read your accounts of not purchasing commercial level detectors, and of building ramps instead of purchasing lift gates for cryonics transport vehicles, etc. I sympathize because I too have had the experience of people in cryonics sometimes underestimating the difficulty of building things rather than buying them. In my experience, these miscalculations occurred not because of personal profit motive, but because of the universal tendency of cryonicists to underestimate the difficulty of tasks, myself no exception. A belief that cryonics could work may be the ultimate example of that.
Re:
"If it were not for a handful of six-figure salary-and-benefits packages, being paid to unqualified persons, who have wasted decades trying to reinvent these procedures, cryonics might be a lot further along."
I can tell you that there is absolutely no one at Alcor who fits that description. Alcor employs approximately 10 people on a salary budget of $500K. There is very little room for waste.
I respect your knowledge of clinical perfusion as it pertains to certain specific aspects of cryonics, and I hope you respect my knowledge of the cryobiological aspects and other technical issues after 24 years of scientific and personal interest. As an Alcor board member, I have nothing to gain by promoting or tolerating any culture of waste or procedural negligence. I'm sorry that has become your perception of the entire field of cryonics because of your negative experiences for a short time with certain people years ago.
I don't have enough information to comment on the cases in question, except that I believe SA, like everyone else in cryonics right now, makes a good faith effort to do work that nobody else wants to do, and that most cryonics cases don't fully pay for. SA was founded and is heavily subsidized by people who want the cryonics stabilization service it provides. SA has motive to do a good job, and use the best people that resources and case logistics permit. Prior to SA, the best CI members could expect was to be collected by a local mortician. Prior to CI, the best CI members could expect from clinical medicine was to be put in the ground.
I can attest from experience on the board that Alcor also makes a good faith effort to do a good job consistent with resources available. In fact, it often makes extraordinary efforts. Nobody has any personal financial incentive to skimp. In fact there is incentive to develop and implement high standards of care because we are all signed up for that care. I've explained the qualifications of the contract surgeons (including a neurosurgeon) whom Alcor uses in its operating room, and I'm generally satisfied with the quality of cryoprotective perfusion.
The financial challenges of employing more full-time medical professionals than Alcor already does at its present size is apparent from this analysis
http://www.alcor.org/Library/pdfs/EconometricModelOfAlcorFinances.pdf
For example, although the new whole body cryopreservation minimum at Alcor is $200K, $110K of that is required for the Patient Care Trust to fund long-term storage. Of the remaining amount, $20K is earmarked for the CMS fund, and the balance pays for consumables, contract labor, overhead, and sometimes legal expenses to gain access to remains. Worst of all, the $200K is inflation-discounted future dollars at the time of cryopreservation, which may be decades in the future. Signing up today requires a six-figure life insurance policy, but some of the people actually being cryopreserved today are funded with only $35K policies arranged when they signed up in the 1980s.
Cryonics is a constant struggle to meet expectations that exceed available resources, while subject to withering public criticism and even personal attack. I believe that's why cryonics leaders don't engage in public dialog anymore.
A couple of factual corrections:
Alcor did sue Larry Johnson in 2003 for selling photographs of human remains on the Internet that year. Johnson had no misgivings about it because he did the same thing in bookstores in 2009.
I never called Johnson's book “400 pages of lies.” Without referring back to the original transcript, my recollection was that I said it was full of "disparagement, defamation, and privacy violation" or words to that effect. If I am to be quoted from a legal proceeding, I respectfully request that the quote be accurate and in context.
Peace.
I assumed readers of this blog would recognize my name, which I wouldn't have logged in under if my intent were concealment. I've been on Alcor's board since 2004. In any case, most of what I said was objective and can be verified.
Lies travel halfway around the world while the truth is putting on its shoes. This reply is mostly directed to David Gerard, whose comments have been generally sensible except for some misinformation.
Re:
"And Alcor (Mike Darwin in particular) is famously litigation-happy against those it perceives as critics, which is a BIG cultural warning sign these days."
That Alcor has a history of suing critics is apparently becoming a self-perpetuating myth. The truth is that Alcor has a long history of litigating rights to cryopreserve its members and keep them in cryopreservation. However, since 1972, I'm not aware of anyone being sued for defamation by Alcor prior to Larry Johnson in 2009. Not that there's been any shortage of people saying false things about Alcor during all that time. Anyone who wants to know why Johnson achieved the dubious distinction of being the first to actually be sued can read the civil complaint
http://www.alcor.org/Library/pdfs/NewYorkComplaintAmendedJan2010.pdf
and other information about the case
http://www.alcor.org/press/response.html
While he may have been the first, I can't promise he'll be the last. There comes a point where defamation becomes so extreme, persistent and damaging that if you don't seek legal redress, people will assume you can't. In Johnson's case there were also other issues that no decent organization could allow uncontested, such as selling alleged photographs of the remains of Ted Williams on the Internet. Not suing for something like that would expose the organization itself to liability.
By the way, I'm not aware of Mike Darwin suing any critics, at least not in the context of cryonics. Also, Darwin hasn't done anything for Alcor since 2002, or been an Alcor employee since 1991.
Another misapprehension is that Alcor doesn't use medical professionals, or is averse to using them. This is dealt with at some length here
http://www.imminst.org/forum/topic/44772-is-cryonics-quackery/page__p__437779#entry437779
and here
http://www.alcor.org/Library/html/professionals.html
Alcor also has medical doctors among its advisors and board of directors.
The person making criticisms against SA hasn't worked there in years, and never under present management. SA in fact contracts with professional perfusionists and surgeons, despite the efforts of critics to sabotage that relationship. Something is really wrong when an organization that makes conscientious efforts to professionalize is held by critics at a lower stature than other organizations that are committed on principle to using only morticians to do cryonics procedures, and that criticized Alcor for decades for aspiring to a medical model.
Re:
"Cryonics deeply needs strong advocates who apply scepticism to it."
I don't know you if you mean skepticism in the card-carrying sense, or some other unspecified standard that you assume no advocates adhere to. If the former, for whatever it is worth, Alcor's Chief Medical Advisor, Steven B. Harris, MD, has sat on the Editorial Board of Skeptic magazine for many years and is respected for his contributions to scientific skepticism.
There are data showing the quality with which cryopreservation can preserve the fine structures of the brain.
http://www.alcor.org/Library/html/cambridge.html
http://www.alcor.org/Library/html/micrographs.html
and vitrification is currently a leading contender for the Brain Preservation Prize as a method for preserving "the connectome"
http://www.brainpreservation.org/index.php?path=prize
Finally, with respect to the question of whether there is skepticism in cryonics, and whether cryonics advocates are properly circumspect, consider this comment from a leading advocate of cryonics:
"There will never be proof that cryonics will work."
http://www.alcor.org/Library/html/NeuralArcheology.html
The basis of the comment is that there are two separate ideas called cryonics. The first is the proposition that people cryopreserved under ideal conditions with the best available methods might be recoverable in the future. That is certainly amenable to skeptical analysis and discussion, and maybe someday be provably correct. Indeed it must someday be proven correct if cryonics is ever to succeed. However the second idea called "cryonics" is that cryopreserving people even when they are badly damaged, and you don't know whether they will ever be recoverable based on present analysis, is the morally right thing to do. That idea, when adopted as a matter of principle, is hard to subject to scientific scrutiny barring obvious dissolution of the brain. However I don't think the difficulty of that scrutiny is reason to think less of people who adopt that idea as a moral principle or personal "medical" preference.