I searched but did not find any discussion comparing the merits of the two major cryonics providers in the US, so I figured it might be productive to start such a discussion myself by posing the question to the community: which provider would you choose, all things being equal: Alcor or the Cryonics Institute?
From my research, Alcor comes across as the flasher, higher-end option, while CI seems more like a Mom-and-Pop operation, having only two full-time employees. Alcor also costs substantially more, with its neurosuspension option alone running ~$80k, compared with CI's whole-body preservation cost of ~$30k. While Alcor has received far more publicity than CI, much of it has been negative. The Ted Williams fiasco is probably the most prominent example, although the accuser in that case seems anything but trustworthy. However, Alcor remains something of a shadowy organization that many within the cryonics community are suspicious of. Mike Darwin, a former Alcor president, has written at length on both organizations at http://www.chronopause.com, and on the whole, at least based on what I've read, Alcor comes across looking less competent, less trustworthy, and less open than CI.
One issue in particular is funding. Even though Alcor costs much more, it has many more expenses, and Darwin and others have questioned the long term financial stability of the organization. Ralph Merkle, an Alcor board member and elder statesman of cryonics who has made significant contributions to other fields like nanotechnology, a field he practically invented, and encryption, with Merkle's Puzzles, has essentially admitted(1) that Alcor hasn't managed its money very well:
"Some Alcor members have wondered why rich Alcor members have not donated more money to Alcor. The major reason is that rich Alcor members are rich because they know how to manage money, and they know that Alcor traditionally has managed money poorly. Why give any significant amount of money to an organization that has no fiscal discipline? It will just spend it, and put itself right back into the same financial hole it’s already in.
As a case in point, consider Alcor’s efforts over the year to create an “endowment fund” to stabilize its operating budget. These efforts have always ended with Alcor spending the money on various useful activities. These range from research projects to subsidizing our existing members — raising dues and minimums is a painful thing to do, and the Board is always reluctant to do this even when the financial data is clear. While each such project is individually worthy and has merit, collectively the result has been to thwart the effort to create a lasting endowment and leave Alcor in a financially weak position."
Such an acknowledgement, though appreciated, is frankly disturbing, considering that members depend utterly on these organizations remaining operational and solvent for decades, perhaps even centuries, after they are deanimated.
Meanwhile, CI carries on merrily, well under the radar, seemingly without any drama or intrigue. And Ben Best seems to have very good credentials in the cryonics community, and Eliezer, one of the most prominent public advocates of cryonics, is signed up with them. Yet the tiny size of the operation still fills me with unease concerning its prospects for long-term survivability.
So with all of that said, besides cost, what factors would lead or have led you to pick one organization over the other?
1: http://www.alcor.org/Library/html/CryopreservationFundingAndInflation.html
Brian, when you say: "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," you are either not reading what I wrote or are not being fair yourself. I not only acknowledge that this was so, I go so far as to say it is completely acceptable with the caveat that such people are instructed, vetted and mentored properly. I'll go even further (as I have repeatedly, elsewhere) and state that the most highly qualified medical personnel can be dangerous, or even worse than useless unless they have been trained and mentored in human cryopreservation as a specialty. There's nothing remarkable about this; no reasonable person would want a psychiatrist or a dermatologist doing bowel or brain surgery.
Some of the same people who performed very well in the past, and who are not medically qualified, are still at Alcor. The individual people, per se (in this instance), are not the problem. Rather, it's the absence of the paradigm of cryonics as a professional medical undertaking that's missing. The evidence for that is present in Alcor's own case histories where highly qualified medical personnel do things like discontinue cardiopulmonary support on still warm patients in order to open their chests for cannulation (http://alcor.org/Library/pdfs/casereportA2435.pdf) or drill burr holes without irrigating the drilling site with chilled fluid to prevent regional heating of the brain under the burr. We are in complete agreement on these issues, as far as I can tell. Where we apparently differ is on how to resolve them.
The most interesting thing to me about this post from Brian is information it communicates for the first time. I follow Alcor's announcements, read its magazine and track its public blog, as I necessarily must, so I am surprised to learn that "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." This is the kind of information that I would expect to see showcased in the organization's literature and on its website, not disclosed here. This is the kind of thing that happens over and over and which degrades member confidence in the transparency of the organization. The next question is, who what, where and how? What are the details of this training? What kind of model is being used? What are the results to date?
Yes, SA does use pigs for training, but they use them in a non-survival mode - they get no robust feedback about errors, and no new insights. In fact, Brian might have mentioned that Alcor has used both animals and human cadavers in this manner, but I think he understood that the point I was making was about vetting your skills in an outcome driven fashion. That is not being done.
What's even more disturbing is that there is virtually no visibility into the outcome from even these training operations. SA and Alcor are both essentially black boxes - there is no data, no performance reports, not even any reports or internal scoring of how well simulated cases proceeded. There's at least one reason for this, and that is that there is no scoring system, internal or external. When things go wrong, well, it's oops, we shouldn't do that next time. And if that isn't the case, then I'd love to hear it and I want to see the data to document it. That is an eminently reasonable request.
It's great that Alcor can sometimes mount skilled perfusionists and highly skilled emergency vascular surgeons. But that isn't the issue. The issue is the framework of knowledge, understanding and consistent performance that is absent. A surgeon or a perfusionist are, absent mentoring (internship), TOOLS to be used by and within that framework. If a man tells me he has the best glass cutting tool money can buy, but he doesn't know how to cut glass, well, I'm going to be underwhelmed.
Alcor patient case reports are disorganized, inconsistent and erratic narratives that make objective evaluation impossible. No great genius is required to consistently collect and organize the key data that define how well a case went - or didn't. The first cryonics case report was done by a 17 year old and a 22 year old graduate student:
http://www.lifepact.com/images/MTRV3N1.pdf
Examples of competently executed cases and case reports are available on Alcor's own web site and the data captured, reduced and presented in these case reports was achieved using a tiny fraction of the financial and personnel resources Alcor currently has available:
http://www.alcor.org/Library/html/casereport8511.html
http://alcor.org/Library/html/fried.html
http://alcor.org/Library/html/casereportC2150.htm
http://alcor.org/Library/html/casereport8504.html
LOOK AT THESE CARE REPORTS CAREFULLY and then look at those on the Alcor website from 1997 forward: http://www.alcor.org/Library/index.html#casereports
I'm not trying to be contrary, difficult, or unreasonable. What I am asking for is core competence, not perfection. There is nothing either exotic or impossible in that. For example, Alcor has a Novametrix CO2SMO capnograph and respiratory function analyzer. The device can effortlessly capture and write to disk over 60 different respiratory parameters and it measures the end-tidal expired carbon dioxide (EtCO2) in the patient's breath. The EtCO2 is the gold standard for determining how effective cardiopulmonary support (CPS) is. And if CPS is not effective, than that is both additional ischemic time the patient is experiencing and it is an opportunity to intervene and fix the situation. Or at worst, it offers the possibility of learning what caused inadequate CPS so that it might be avoided next time. The only skill required to use the device is to put the walnut sized sensor in line between the patient's airway and the ventilator on the LUCAS CPR machine: http://frankshospitalworkshop.com/equipment/documents/pulse_oximeter/user_manuals/Novametrix_8100_-_User_manual.pdf That should make it easily possible to produce graphic data like this:
http://i293.photobucket.com/albums/mm55/mikedarwin1967/EtCO2inCPSgraph.png
THAT kind of data speaks definitively to how that patient was stabilized and transported, and in aggregate it provides a statistical dataset that speaks to the overall performance of the organization. It should be accompanied with graphic data for the patient's TEMPERATURE, mean arterial pressure (until the time of arrest), the SpO2 (pulse ox) and other relevant data. This was done in the past by stressed out, sleep deprived, mostly volunteer people who were trained in-house. If that kind of data collection and accountability are considered "perfectionist," or some kind of golden past no longer to be achieved, then I restate my opinion that something is terribly wrong.
Paramedics are taught that the single most important and most critical indication of the efficacy, or lack thereof, of CPR is the EtCO2 of the patient over time. Where is this data???? This is only one of countless examples I could use - but it is especially relevant because it is simple data to collect, and I know from Alcor's recent case reports that they have a CO2SMO and they are actually using it on patients during the peri-arrest hospice period. Again, where is the data? That data is the ONLY way anyone has to evaluate the quality of cryonics cases because the patients cannot speak to us.
If you want to stop my criticisms, you need only show me the data and offer me and everyone else the opportunity to be reasonably certain it is valid and representative.
I think I'm missing something here. As I understand it, you (Mike Darwin) have a great deal of experience and expertise in the actual practice of cryonics, as well as a lot of actionable recommendations. The current staff at Alcor (e.g., Max More) seem to take you seriously.
Is it a silly question to ask why you're not working for Alcor?