melmax comments on Suspended Animation Inc. accused of incompetence - Less Wrong

38 Post author: CronoDAS 18 November 2010 12:20AM

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Comment author: bgwowk 05 December 2010 10:23:09PM *  5 points [-]

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.

Comment author: melmax 05 December 2010 11:54:15PM 3 points [-]

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." 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.

However, I have also stated, on an equal number of occasions, that I don't believe the scientists of the future will be able to repair the damage being inflicted on cryonicists, by a bunch of unqualified, overgrown adolescents, who want to play doctor with dead people, while pretending to be surgeons and perfusionists. I'm sure Dr. Wowk's lack of understanding, as to why I defend Larry Johnson, can't be any more perplexing to him, than his defenses of Alcor and SA, or people like Harris and Platt, are, to me.

How many cryobiologists does Dr. Wowk think he can get, to support his opinions of the activities of Alcor and/or SA? The response to cryobiologist, Dr. Arthur Rowe's, remarks, regarding cryonics organizations not being able to "turn hamburger back into a cow," was clever, but ridiculous, at the same time. Yes, some of the molecules of the hamburger would be incorporated into the body tissues of the cow that ate it, but the original cow would still be quite dead. Being clever, in defending the cryonics organizations, isn't enough. The organizations are not going to be able to carry on the way they have been, much longer.

Dr. Wowk tries, yet again, to dismiss me as someone not serious about this matter, calling it my "hobby." I assure Dr. Wowk I am quite serious about not allowing people to bastardize procedures, near and dear to my heart, while pretending they are delivering some sort of futuristic medical care, with price tags up to $200,000, coupled with requests for trust funds and bequests, without objection. It seems more of a con game, to me, than a serious effort to make medical history.

Dr. Wowk fails to notice the situation IS ALREADY "a disaster," and always has been. If it were not for all the foolishness that has gone on, there would be no threat of regulation. Instead of debating with me, perhaps Dr. Wowk should start writing letters, directed at Alcor and SA, encouraging them to clean up their acts, before someone does it for them.

If Alcor and SA want to provide the public with FULL DISCLOSURE, regarding their capabilities and personnel, I'll limit my criticisms. But, for so long as cryonics organizations spew out reports I feel are clearly intended to deceive an unsuspecting public, I will feel obligated to inform people of the true nature of the situation.

Comment author: bgwowk 06 December 2010 05:13:43AM *  7 points [-]

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.

Comment author: melmax 08 December 2010 04:51:05AM 3 points [-]

I just want to make sure I have this straight…

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?

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??? Personally, I don't think there's much chance of success, with that attitude. If the damage is as extreme, and as unavoidable, as Dr. Wowk writes, maybe they should just straight-freeze their clients, until they can offer something better.

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. If this is the treatment an historical cryonics figure gets, what does the Average Joe get?

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 think this is a very well-established pattern, at organizations, such as Suspended Animation and Alcor, and I think anyone who spews forth that amount of deception, when trying to sell some very expensive services, should be arrested.

Once more… If Alcor and SA want to provide the public with FULL DISCLOSURE, regarding their capabilities, (or lack thereof), and the qualifications of their personnel, I'll limit my criticisms. But, for so long as cryonics organizations publish garbage I feel is clearly intended to deceive an unsuspecting public, I will be inclined to expose them.

Dr. Wowk writes: “As far as cons go, there has never been a bigger money losing pit for individuals than cryonics. 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?”

While cryonics endeavors may not have been lucrative, for Saul Kent and Bill Faloon, I think the business of cryonics has been quite lucrative, for many, especially the LEF-funded employees. I’ve never seen so many overpaid, underqualified people, accomplishing so little of significance.

Comment author: bgwowk 08 December 2010 06:24:41PM *  7 points [-]

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.

Comment author: bgwowk 08 December 2010 11:16:09PM *  5 points [-]

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.

Comment deleted 10 December 2010 05:26:52PM *  [-]
Comment author: bgwowk 10 December 2010 06:32:22PM *  2 points [-]

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.

Comment author: lsparrish 06 December 2010 12:38:38AM 2 points [-]

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

Can you please clarify whether you mean a state obtainable by present technology or some hypothetical future achievable state? The way you phrase it this could be taken either way.

However, I have also stated, on an equal number of occasions, that I don't believe the scientists of the future will be able to repair the damage being inflicted on cryonicists, by a bunch of unqualified, overgrown adolescents, who want to play doctor with dead people, while pretending to be surgeons and perfusionists.

It sounds like you think cryonics could work in the present day, but only if performed by trained, licensed medical professionals. If that is the case, would you sign up for cryonics if they started offering it in your local hospital tomorrow?

The response to cryobiologist, Dr. Arthur Rowe's, remarks, regarding cryonics organizations not being able to "turn hamburger back into a cow," was clever, but ridiculous, at the same time. Yes, some of the molecules of the hamburger would be incorporated into the body tissues of the cow that ate it, but the original cow would still be quite dead

Could you provide a link? I don't recall reading this response. Dr. Rowe's assertion always seemed to me to be rather ridiculous to start with because it does not address the structural preservation levels possible with vitrification (as opposed to freezing).

I assure Dr. Wowk I am quite serious about not allowing people to bastardize procedures, near and dear to my heart, while pretending they are delivering some sort of futuristic medical care, with price tags up to $200,000, coupled with requests for trust funds and bequests, without objection.

Most other medical professionals (aside from yourself and Larry Johnson) seem to completely ignore cryonics. Which is part of the problem. If you want to stir up interest in the scientific and medical communities in making sure this is done right, more power to you. But it has to be done one way or another.