= 27d567bc2d48d9f40e9ccc20ea370b15)
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.
= b715d02e85f7b3b4ae65ca3d3e450868)
Subscribe to RSS Feed
= f037147d6e6c911a85753b9abdedda8d){kind=logo}
I enjoyed Down and Out in the Magic Kingdom quite a bit! I'm glad Kevin7 posted this link.
However, the insanity portrayed as being beneficial and desirable in The Metamorphosis is too egregious to ignore - even if the rest of the story had made good on its promise of providing an interesting look at a posthuman world. (It doesn't. We don't even get to see anything of it.) At first, I thought "oh, great; more cached-thought SF"... but it was worse than that. I forced myself to finish it just so I could be sure the following is accurate.
Worse than the already-irritating "death gives meaning to life!" reasoning replete in the work, we find either actual insanity or just a blithe disregard for self-contradiction:
Merits as a story? Well, at first, it's even a little exciting, as we are treated to a glimpse of a post-Singularity world (the only glimpse we get, as it turns out), and then some backstory on how the AI was created. That's cool; but after that, it's not worth reading, in this reader's humble opinion. It's very formulaic, the characters (all ~three of them) have no personality (unless you count angst), and any technical or imaginative details that might be interesting are... well, either not there at all, or waved away with the magic Correlation Effect Plot Device. (It's first used to explain one thing, then turns out to do, quite literally, everything.)
I would like to contrast this to John Wright's The Golden Age trilogy. That work is replete with interesting ideas and details about how a Far Future society might look and work; no magic one-size-fits-all Plotonium (to coin a term; I'm sure TVTropes already has one, though) here. In Metamorphosis, we aren't really given any glimpse at society, but what we do see is essentially Now Except With Magic Powers. In The Golden Age, it is immediately obvious we aren't in Kansas any more. Metamorphosis explores one idea - AI - and that, poorly; The Golden Age includes nanotech, simulation, self-modification, the problem of willpower (see: Werewolf Contracts), posthumans, post-posthumans, post-/trans-human art, and more. Check it out if you have transhumanist leanings... or just enjoy science fiction, come to that.
You may enjoy A Casino Odyssey in Cyberspace--it's based in part on the author's history of card-counting--but then, you might not, as the Casinos don't seem like a very Fun place to go.