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.

The major problems at Alcor are truly abysmal management, for which the Alcor Board of Directors is to blame, and lack of a professional culture and staff to administer the front end of cryopreservation. The situation is almost identical to one that would exist if the board of directors of a hospital tried to deliver medical services without physicians and nurses, but rather hired "the best they could find" to do these professionals' jobs. Thus, there might be a veterinarian doing cardiac and neurosurgery, a chemist operating the heart lung machine, and so on. The absence of credentials, per se, is not the core issue here, because it is perfectly possible for such individuals to do these tasks and to do them "reasonably" well.

Because cryonics did not become a mainstream medical, industrial, or business activity, it necessarily is in the realm of very small "visionary enterprises," like the early days of flight or radio, or perhaps in the realm of the dedicated (professional) amateurs. A good example of the latter is amateur astronomy, where the people involved are fantastic - mostly level headed, focused, responsible and astonishingly capable. Amateur astronomers have made more brass tacks basic discoverers of heavenly bodies than their professional counterparts, and they have made major contributions to the fundamental science, as well. There are essentially no kooks, and their equipment and facilities are often spectacular and demonstrate fabulous innovation and engineering skill.

The barnstormers at the start of flight were "crazy," extreme personalities, but the fact that they had to fly and thus had to work with real machines which could CRASH and KILL them, kept them on track. However, a careful observer of their history will note that their mortality rate was terribly high. Those that survived barnstorming and doing air mail runs were, in effect, a "filtered product" who represented the best of practical skills, engineering ability, risk taking, and bad-ass courage. In that respect, Lindbergh and Fred Chamberlain had personalities that were extraordinarily similar.

I've had considerable contact with HAM radio clubs and amateur astronomers and there is simply no comparison to cryonicists. Ditto for the pioneering ultralight aircraft guys of 25 years ago. If you spend any time around these kinds of groups, you quickly see that they attract as many dysfunctional, narcissistic personalities, as does cryonics, but 99.9% of the time these people flake away, almost instantly. In the HAM groups it happens during the run up to getting your basic license. It doesn't matter how much physics you know, or how smart you are, most of the test is FCC regulations, proper jargon, and things that you must memorize. The loonies flee!

Having said that, it's been interesting to watch the quality of amateur radio enthusiasts plummet in recent years. This is because the equipment is now all solid state, it is much less expensive, and the days of building you own radios from parts are over. Also, the requirement for Morse code was dropped from the entry level licensing exam.

If you, or I, or anyone else looked at a TV set, or an MP3 player, or even a modern HAM radio and said, "I'm going to build one of those; I can do it just as well as Samsung and much less expensively," we'd likely all just laugh and figure the poor guy was crazy. Nobody tries to do that because it is stupid, just like no one in their right mind says, "My wife needs open heart surgery and those bastards at the Medical Center want $50K to do it! That's ridiculous, I've seen it done on TV and my brother in law is a veterinarian, so we're going to do it ourselves." The hubris required to take such an action, let alone the lack of commonsense, is just indescribable.

Now, if your wife needs surgery, you cannot possibly find a doctor to do it, and you think you can learn the craft well enough to give her fighting chance, well that's another matter - depending upon how you go at it! If you have 5-6 years to prepare, you're willing to do the work and you're willing to kill a LOT of dogs, you can indeed teach yourself the basics and perhaps have a 25% chance of pulling it off - providing it is a SIMPLE surgical procedure that she needs. You can actually do this from books, journals and lots of failed attempts in the "dog lab." When I was kid in the late 1960s, several teens a little older than me (15-16 years old) actually set up and did do cardiac surgery in their garages on dogs, and the animals survived! They built their own heart lung machines (HLMs). Today, such an action would be illegal and it is impossible to imagine teenagers building their own heart lung machines! But, in fact, this really happened.

The first practical HLM was built by the maverick surgeon C. Walton Lillehei, and a colleague, Richard Dewall . Lillihei was the archetype of the founder of almost any daring new profession (in this case, cardiac surgery): he was brilliant, courageous - just an incredible man. He started doing open heart surgery BEFORE the HLM by using another human being as the HLM in a technique called "cross circulation." He'd hook up a volunteer to the patient and use the volunteer's heart and lungs to support the patient while he operated. This was brutally controversial at the time and, of course, eventually one of the volunteers died due to a technical error in the OR! It was almost the end of Lillehei, and he barely escaped criminal prosecution. I mention Lillehei because his first HLM was built from a commercial "finger" tubing pump, with the oxygenator made from PVC beer tubing, a cheap glass frit, some stainless steel pot scratcher pads, and other odds and ends. Their total cost, excluding the pumps, was ~ $15.00: http://i293.photobucket.com/albums/mm55/mikedarwin1967/m8jpg.jpg

It worked brilliantly and was the design template for every HLM up until bubble oxygenators were replaced by membranes in the late 1980s. Now, if you look at the machine in that picture, it is something that anyone with a modicum of hand-skills could build. The pumps were standard, off the shelf industrial finger-pumps used in the food processing industry. So, a kid with some bucks really could build his own HLM - in fact, he could do it today. The difference is, as I previously pointed out, is that he'd be hauled off to jail if he tried to use it. And if you can't use it, why build it?

However, if you really want to master (simple) basic cardiac surgery, it will cost you a fortune in time, equipment, animals and supplies. The only way such a situation would make sense is if you were in a world where there were lots of doctors, medical supplies, equipment and so on, but you and your wife were banned from access to them. Your money wasn't any good and you had to "operate underground," literally. That's the situation cryonics was in and still is in, to a great degree.

The critical difference is that there is today in cryonics no perceived need to "get it right" with animals, or any other feedback-driven test system. It's like the guy I describe above who just decides he and vet brother in law will show up in the garage one day with whatever their idea of what is needed is, and they'll simply operate on his wife! But wait, what happens if they do that? Well, pretty clearly it will be a HORRIBLE MESS, not only will the wife die, but it will be a gruesome fuck up - just unimaginably bad - worse than if she were murdered with an ax. Then what happens? Well, they go to jail, there will be a huge outcry, it will be front page news. In short, they will get subjected to the CONSEQUENCES of their stupid and irresponsible acts.

However, if you are "freezing" your wife, well, who knows how it turned out? Who cares? She looks great! You feel real good about it! And if she does thaw out and rot, well, she was dead anyway, right? So, no harm and no foul. Certainly there are no social or legal consequences for any errors, oversights or failures. There isn't even any way to KNOW that such things might have (or indeed did happen).

THAT IS CRYONICS.

And when good quality people do come along, or people who sincerely want to put their money into cryonics, there is always some damned fool who will tell them how easy it is, how much more quickly THEY will show them results, and on and on and on. If you were doing anything else; running a dog food company, or making women's' handbags, you couldn't get away with that, because the product wouldn't sell and you might even be in court for killing peoples' pets with tainted food. But, not so with cryonics...

Cryonics came reasonably close to crossing the threshold into professionalism with Alcor in the 1980s, but that effort imploded. Jerry Leaf was cryopreserved and I left to pursue more conventional biomedical research (a terrible mistake, in hindsight). Absent a well defined and well established culture of professionalism that included self-correcting feedback mechanisms, Alcor fell back to become something broadly similar to CI. Instead of functioning as a hospital board of directors does, Alcor's Directors became de facto managers - arbiters of the technical details of care, by default. This has been a disaster, not only for those receiving such care, but because Alcor (much more than CI) now serves as a spolier to professionalism. The high tech veneer and the appearance of biomedical competence short circuit any perception that something is seriously wrong, and that things were once, and could again be, much better.

Dr. Wowk wrote: "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."

CATASTROPHIC? EXTREME DAMAGE? I am curious why Alcor insists on bringing the temperature during cryopreservation down to -196 degrees C (liquid nitrogen temperature) when fractures are occurring below -130 degrees C. Glass transition is already completed at -90 to -130 degrees. It seems that going below -130 degrees is not only useless for purpose of long term preservation, but it also ensures apparently catastrophic and irreversible damages, as you admitted. Granted it might take more effort and it might be a little more expensive to maintain the temperature in the -90 to -130 degrees, but the catastrophic micro-fracture damage does not occur in any meaningful degree. I do not believe Alcor ever provided satisfactory answer to this.

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

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

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

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

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

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

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

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

That field case report is here.

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

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

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

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

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

I 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.

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

Only accepting criticisms from true believers is a common cult failure mode, which I would strongly warn you against. It seems like someone on the cryonics side ought to double-check a few of her specific claims; does a case report she claims suggest incompetence contain the text she says it does? Do independent medical experts (just email twenty professors at universities, you ought to get at least one response) agree with a simplified version of the claim?

Yes. 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 ("it's just motivated cognition", "she has no plans to sign up") which really obviously dodges actually addressing the claims. Which are natural human reactions, but that doesn't make them good ideas.

Honestly, the fact that she's not signed up makes her far more credible in my eyes. Has no one here heard of consistency bias? Dr. Wowk has stated that he needs cryonics to work, and so it provides me no information that he thinks cryonics works. For someone without a horse in the race to look at cryonics and have a low opinion of it does provide me information.

Honestly, the fact that she's not signed up makes her far more credible in my eyes. Has no one here heard of consistency bias? Dr. Wowk has stated that he needs cryonics to work, and so it provides me no information that he thinks cryonics works. For someone without a horse in the race to look at cryonics and have a low opinion of it does provide me information.