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.
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? :)