A Visit to Alcor

 

“Are you interested in the whole body or the neuro? And would you like fries and a Coke with that?”


By Mike Darwin


Introduction


A short while ago, I hosted 3 visitors from the Russian cryonics organization KrioRus. During my visit with them in Moscow two and a half years previously, I had exhorted them to visit the US and see first-hand any hub of cryonics activity there, so that that they could see and learn for themselves what cryonics was really like, and how it was actually being pursued in the US. When I wrote to Alcor President and CEO Max More to try and schedule a visit on short notice, I jokingly included the aside that if I was not permitted to be on premises, I would go elsewhere… It was intended to be a humorous reference to a time in the not so distant past when I was not allowed into Alcor because my homosexuality was “unacceptable” to a former Alcor President (apparently being incompatible with his religious beliefs).

To my considerable surprise, Max took this remark seriously, and polled the Alcor Board on the matter. Surprise was replaced with shock when I subsequently learned that Alcor Director Saul Kent had expressed concerns that my visit to Alcor accompanying the Russians would be used as tool to “attack Alcor.” I still find this shocking, but depending upon how you define attack, maybe Saul was closer to the truth than I imagined possible. I’ve since been told that apparently there were speculations that “touring Russians” might be just an excuse of some kind to gain entry to Alcor.[1] Why this should be necessary is still a mystery to me, since as far as I knew I could visit by making by an appointment, presumably like anyone else.


Figure 1: The Alcor Mobile Advanced Rescue Cart (MARC), a portable extracorporeal support platform.

I saw quite a few unexpected things at Alcor, such as that the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by waist high PIB fabricated from stainless steel. All of which begs the point of why a hugely complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?


Figure 2: Left to right, Danila Medvedev, President of the Russian Transhumanist Association, Max More, Ph.D., President and CEO of Alcor and Valerija Pride, President of KrioRus. Photo by Stanislaw Lipin; courtesy of KrioRus.

A Long History of Serious Deficiencies in Patient Care

Shortly after he took office, I sent Max the 100+ plus page “Report of the Committee to Evaluate Alcor Procedures” which was presented to the Alcor Board of Directors on 04 April, 2002. This report came about because Saul Kent invited me over to his home in Woodcrest, California to view videotapes of two Alcor cases which troubled him – but he couldn’t quite put his finger on why this was so. What I saw shocked and disgusted me. Patients were being stabilized at a nearby hospice, transported to Alcor (~20 min away) and then CPS was discontinued, the patients were placed on the OR table and, without any ice on their heads, they were allowed to sit there at temperatures a little below normal body temperature for 1 to 1.5 hours, while burr holes were drilled, and the neck vessels were cannulated. Distilled water was being used to irrigate the brain and burr holes were done with a wood burr and electric drill with no cooling of the bone under the burr – smoke could be seen coming from the burr wound! Since the patient had no circulation to provide blood to carry away the enormous heat generated by the action of the burr on the bone, the temperature of the underlying bone (and brain) must have been high enough to literally cook an egg.

In one case, a patient’s head was removed in the field and, because they had failed to use a rectal plug, the patient had defecated in the PIB. The result was that feces had contaminated the neck wound, and Alcor personnel were seen pouring saline over the stump of the neck whilst holding the patient’s severed head over a bucket trying to wash the fecal matter off the stump. These are just a few of the grotesque problems I observed.

As a consequence, a “blue ribbon” Committee was put together to comprehensively review Alcor patient videos and records, and to make a field inspection of the Alcor facility. This Committee produced a comprehensive report and presented it to the Alcor Board. [Darwin, M., et al., Report of the Committee to Evaluate Alcor Procedures, Presented to the Alcor Board of Directors on April 4th, 2002.] Max More knew nothing of this until I sent him a copy after he was President for about one and a half months.

A Profound and Fundamental Error Unendingly Repeated

A short while later, Alcor published the first detailed case report since the A-1097 case report was published in 2006. A careful reading of this case report which is available at http://www.alcor.org/Library/pdfs/casereportA2435.pdf discloses that there is something terribly wrong that happens during this case, but unless you really understand cryonics as medicine, you are not likely to see it. The patient was pronounced at 6:58 PM and was transported to Alcor packed in ice while receiving CPS with the LUCAS. At ~ 8:42 PM, 1 hour and 42 minutes later, a median sternotomy is begun (excerpt from the case report, emphasis mine):

Continuation of CPS

Move to surgical table


7. Surgical Procedures


Manual CPS was continued on the patient while fresh ice was brought in from Alcor’s ice machine. The existing ice was removed from on top of the patient and she was pulled out of the ice bath and placed on the OR surgical table at 8:11 pm.


Testing of the sternal saw prior to the surgery revealed that the flexible shaft had frozen up. The problem was handed to Richard to deal with, and he had it unfrozen in a few minutes. The shaft was subsequently disassembled and lubricated.


The patient’s head was shaved to prep for the burr holes to be drilled. These are used to monitor the temperature of the patient’s brain as well as a way to visually watch for swelling. While the burr holes were being drilled using a craniotome perforator, Aaron prepped the patient’s sternum with Betadine, an antiseptic agent used topically to destroy microbes. Dr. McEachern cleaned each of the burr holes as they were completed. At 8:42 PM, she stood on a step stool to gain a higher position above the patient in order to perform a median sternotomy. This is a procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided to provide access to the heart for cannulation. Dr. McEachern cut through the skin of the chest with a scalpel. The guide of the saw blade was placed below the sternum. Richard operated the foot pedal on the floor as she guided the saw up the sternum. She talked through the procedure, step by step, to Aaron so he could gain additional training in its operation and application. After the sternum separation was completed, the chest was opened with Finochietto spreaders and the pericardial sac was exposed. Access to the heart was accomplished by cutting through the pericardium.


Dr. McEachern performed an arterial cannulation of the heart by sewing a purse-string suture into the wall of the aortic arch, puncturing the vessel within the purse-string, and advancing and securing the catheter. She then repeated this process for venous cannulation of the heart, going into the right atrium and advancing the cannula into the inferior vena cava. This process took approximately one hour and was completed at 9:48 PM. A thermocouple was placed under the dura through the burr hole at 3.0 hours post-arrest. Brain temperatures were taken under the dura and beneath the brain (nasopharyngeal).


Now the washout could begin. This process is used to replace the patient’s blood with cryoprotectant. The extracorporeal perfusion circuit had been primed with B1 base perfusate solution prior to the surgery and was being circulated through the bypass loop. When cannulation was complete, the circulation was transferred from the bypass loop into the cannulas. The circuit was switched from closed to open circulation and the blood was washed out of the patient’s vascular system, the visual blood concentration going from opaque to light pink.

The graph of below shows a typical patient’s cooling rate in the PIB.

Figure 3: The red-boxed areas of the two cooling curves above show the likely temperature range a patient would have cooled to during 1 hour and 44 minutes of closed chest cardiopulmonary supported external cooling using ■ ice bags or □ Portable Ice Bath (PIB) cooling.

Assuming the patient cooled at the rate that A-1169 did above, then the best that could be expected is that the patient was at ~ 22-24 deg C at 1 hour and 44 min post arrest. Examination of the graph below (Figure 4) shows that the “safe” circulatory arrest times for a “healthy” patient who has had no prior ischemic insult and who is fully oxygenated at various temperatures during cardiac or neurosurgery:

Figure 4: Probable safe circulatory arrest time vs. temperature for humans, as calculated using the Hypothermic Metabolic Index (HMI). [Ungerleider R, Gaynor,  JW.: The Boston Circulatory Arrest Study: An analysis. J Thorac Cardiovasc Surg 2004, 127:1256-1261.]

The reason these graphs are of relevance is that in order to do a median sternotomy you must, necessarily, stop CPR. So, yet again, Alcor took a patient with essentially uninterrupted CPS, brought them into the OR and then exposed her 1 hour and 42 minutes of ischemia! A few days before we went to Alcor, I had sent Max a letter pointing out that this had happened yet again, and that Aaron Drake’s report was badly flawed and that it was clear he was wholly inadequately trained to be doing cases unsupervised. I received no reply.

Our visit to Alcor was surreal – absolutely surreal. The first thing Max did when we entered was to show Danila Medvedev and Valerija Pride swatches of wall paper and explain that the office was he was occupying was “not his” and that it was to be redecorated. He then proceeded to do the same with me. Danila and I looked at each other as if to say, “Are you kidding us? Can this even be real?”

An Unkempt Kitchen in a 2-Star Hotel?

When we arrived at Alcor we were informed that a member was in need of Standby and very likely cryopreservation, and shortly after we entered the facility, the Remote Standby Team left with their equipment. I have been at Alcor only at brief intervals over the past 20 years, with the exception a stint for a month or so as subcontractor working for Suspended Animation, Inc. (SA) in 2002. I thus have mental “snapshots” of the state of the facilities separated by considerable intervals of time. This was the most disturbing snapshot I’ve seen so far. The operating room was unkempt. The floors were scuffed, stained, dirty, and had obviously not been waxed in a long time (Figure 5).

Figure 5: Scuffed and dirty floors, dusty shelves and a disorganized appearance are fair descriptors of the Alcor operating room. I wouldn’t consider medical treatment in a facility with this appearance – nor for that matter would I like to dine in a restaurant with a kitchen in such a state. Photo by Stanislaw Lipin; courtesy of KrioRus.

I inquired when preparation of the operating room would start for the patient who was to be perfused, presumably the next day, and I was told that they were “done.” When we entered the OR I observed tubing strung on the pumps of the heart lung machine console, and had assumed it was training tubing, since some of it was hanging down to the floor in front of the console inside a large, open ZipLoc bag (Figure 5).

Figure 5: Cryoprotective tubing dangling from pump console in a Ziploc bag; proper gas permeable sterilization wrapping (such as Kimlon™) was nowhere in evidence. Photo by Stanislaw Lipin; courtesy of KrioRus.

There were discarded tubing (ethylene oxide) sterilization caps lying around, and refuse, some of it apparently in place for some time, such as twist ties and paper backing from discarded sterilization pouches, lying covered in dust on the computer/instrumentation cart adjacent to the pump console (Figures 7 & 8).

Figure 6: Alcor operating room perfusion and data acquisition equipment. The refractometer heads used to continuously acquire cryoprotectant agent concentration to the left of the computer. Photo by Stanislaw Lipin; courtesy of KrioRus.

Figure 7: Dust covered lower shelf of the stainless steel data acquisition cart. The piece of sterilization packaging and the twist tie appeared to be covered in a film of dust, as well. Photo by Stanislaw Lipin; courtesy of KrioRus.

Figure 8: The recirculating reservoir perched precariously atop the magnetic stirring table used to mix cryoprotectant concentrate into the recirculating perfusate. Photo by Stanislaw Lipin; courtesy of KrioRus.

On the monitor shelf atop the pump console there was a spray bottle that had apparently been labeled “alcohol” (what kind? one wonders) with a Sharpie marker, and a laboratory wash bottle sitting next to it containing a liquid – but with no label (Figure 8).

Figure 9: At top, long view of the neuroperfusion enclosure and at bottom close up showing area of apparent blood contamination. Photo by Stanislaw Lipin; courtesy of KrioRus.

Disturbingly, the neuroperfusion enclosure had what appeared to be a residue of dried blood/perfusate in what appeared to be a defect in the adhesive seal where the waste diversion plate is cemented to the side wall of the enclosure (Figure 9). The drain line from the neuroperfusion enclosure (where biohazardous fluid will collect to be disposed of) was sitting unsecured in a ~20 L Costco Kirkland laundry detergent pail (Figure 10).

Figure 10: Costco laundry soap pail containing the unsecured biohazardous waste line from the neuroperfusion enclosure. Photo by Stanislaw Lipin; courtesy of KrioRus.

Figure 11: Alcor Operating room tableaux “fully readied” for a human neuropatient cryoprotective perfusion. Photo by Stanislaw Lipin; courtesy of KrioRus.

The recirculating reservoir was dangerously small making microbubble embolization of the patient during cryoprotective perfusion all but inevitable, since the cold, polymer-rich, viscous perfusate develops stable foam as a consequence of vortex formation and air entrapment from the action of the mixing magnetic stir-bar.

Figure 12: One possible scheme for achieving uniform mixing of cryoprotectant concentrate with the perfusate recirculating through the patient using a static mixer. A concentrate mixing pump continuously removes a large fraction of the recirculating perfusate from a cardiotomy or venous reservoir. This perfusate is then passed through a combination static mixer-heat exchanger where turbulent flow from inertia reversal and radial mixing uniformly blend the added cryoprotectant concentrate with the recirculating perfusate. The static mixer also serves as a heat exchanger. The blended and chilled perfusate then return to the venous reservoir.

Figure 13: At (A), a typical static mixer array. Static mixers allow thorough mixing of almost any kind of liquid or slurry without the introduction of air or the use of moving parts with the attendant seals. Because static mixers are of necessity a mixing element housed within a tube or cylinder, they make ideal heat exchangers since the fluid flowing inside the mixing tube elements is repeatedly thin-filmed and passed over the tube surface. It is thus possible to very efficiently combine mixing with heat exchange, as can be seen in the combination mixer-heat exchanger seen in B, above.

This has been a repeated problem in previous cases, and has been the subject of numerous advisory communications between Alcor Director Brian Wowk and me, among others. In fact, despite these repeated warnings (increase depth and volume of the recirculating reservoir, use a floating lid or replace the stir bar assembly with an in-line mixer: Figures 12 & 13), this same phenomenon was noted on during the cryoprotective perfusion of patient A-1097 in January of 2006. A detailed paper documenting this effect and demonstrating a simple way to eliminate it was first published in 1994. ( see: http://www.cryocare.org/index.cgi?subdir=bpi&url=tech5.txt)

I quote from this 1994 paper:

“A consequence of the stirring of the recirculating reservoir by the rapidly spinning magnetic stir bar is the generation of an air vortex in the recirculating perfusate. While this vortex is very effective at both rapidly and completely mixing the concentrate with the perfusate in the recirculating reservoir, it is also very effective at introducing air into the recirculating perfusate as well. At rates of rotation fast enough to achieve good mixing; the bottom of the vortex of air reaches the rapidly rotating stir bar. Air is thus turbulently mixed into the perfusate where it forms bubbles of widely varying size; the smallest of which are very stable. As the concentration of cryoprotectant rises, and the viscosity of the solution correspondingly increases, air bubbles generated by stirring in the recirculating reservoir become more and more stable and begin to saturate the recirculating perfusate creating large amounts of foam.”

And from A-1097’s case report:

“A differential vascular resistance check was done by clamping off and then unclamping the left and right carotid artery respectively. After clamping off the left carotid artery the pressure rose to 72 mm. After clamping off the right carotid artery the pressure rose to 140 mm. At 11:55 foaming was identified in the mixing reservoir, with worse foaming observed at 12:17.”

Figure 14: The recirculating reservoir sitting unsecured atop the mixing stir table. Note that the PVC tubing has not been adanced the requisite 3 barbs over the connector at the bottom (right) of the reservoir and that there is no cable tie in place to prevent accidental disconnection of the tubing. Photo by Stanislaw Lipin; courtesy of KrioRus.

It was also sitting akimbo on the magnetic stir table and the connections to and from it, including the critical withdrawal connection at the bottom was neither cable tied, nor pushed over the third barb of the tubing connector at the bottom of the reservoir (these are standard minimum practices for securing tubing against disconnection in extracorporeal medicine).

When I inquired as to how the recirculating reservoir would be secured during perfusion, I was told, “It’ll sit still when it has liquid in it.” If you can look at the picture above and concur with that answer, especially considering that Alcor has a history of pumping this small reservoir dry during perfusion and introducing air in the extracorporeal circuit, then you are a more courageous soul than me. Consider the recommendation made to Alcor by the formal Committee commissioned to evaluate and suggest corrective actions when Alcor’s cryopreservation procedures were found to be severely deficient in 2002:

4.13: Enlarge and alarm the recirculating reservoir.

The recirculating perfusate reservoir ran dry more than once during a recent case. The reservoir should be larger and should have an alarm system that is triggered by a low level of perfusate. At the least one specific person should be assigned the task of monitoring the reservoir.

Cargo Cult Security for Patients?

Then there was the lunacy of the “armored” patient care bay, which Max proudly showed us (Figure 15).

Figure 15: Blast resistant bullet proof window looking into the Alcor patient care bay. The hardened transparent window is backed up with a retractable steel curtain window cover. Photo by Stanislaw Lipin; courtesy of KrioRus.

I can’t even begin to imagine what all this cost (including reinforcing the perimeter walls). It looks very impressive, and no doubt has considerable “sales” value to the naive, or the foolish.

However, if anyone actually looks past the looking glass (which happens to be blast resistant, in this case) what they will see is the following reality.

Figure 16: View through the window into the patient care bay (PCB). A loose piece of the foil faced cardboard sheeting which covers the plywood roof decking and structural supports that comprise the roof of the PCB are highlighted by the red arrows. Photo by Stanislaw Lipin; courtesy of KrioRus.

The red arrows point to the foil-faced cardboard reflective “insulation” that covers the space between the perlins in the patient care bay. One piece has been left (un-anesthetically) loose adjacent to what appears to be a run of sprinkler pipe. What this told me was that roof of the PCB bay is a paper bag. It almost certainly consists of sheets of plywood or particle board decking covered with a layer of roofing felt, and finally the roofing material itself. Typically, this kind of construction can barely withstand the weight of a 250 lb man. Go up on the roof and walk around yourself, and you’ll immediately get a feel for what I’m talking about – the roof will give and spring back as you walk on it. It is minimally engineered for load bearing, and this fine, and a damn good thing in earthquake country, where tilt-up concrete industrial building construction was first developed.

I can then go to Google Earth and quickly verify that, as of 11-2009, there were no structural or other evident reinforcements to the outside of the roof over the PCB. Maybe there are now (doubtful), but this is very easy to determine, either directly, for the cost of an aerial photograph ($300), or by checking with building and code enforcement to see if any structural permits were issued, and inspections subsequently done. Of course, the easiest way is just to climb up on the building and take a look. The single most important and most elementary security precaution any institution can take to increase the safety of its physical plant is to protect its perimeter. This is why sensitive and vulnerable government and corporate installations are surrounded by fences, patrolled by guards (and often dogs) and where feasible, protected by bollards against bomb bearing vehicular attack. Alcor’s perimeter is unsecured.

Figure 17: Google Earth view of the Alcor facility in 2009 shows no evidence of external (surface) reinforcing and no evidence of razor wire or other perimeter defenses on the roof of Alcor building in general, or the patient care bay in particular.

Figure 18: Metal lid covering bigfoot dewar at Alcor. Photo by Stanislaw Lipin; courtesy of KrioRus.

It is also evident that the dewars have no cladding, and that the softest spot is the top of the units where, in order to save both weight and money (again perfectly reasonable), the tops of the foam neck-plugs, as is the industry standard for cryogenic dewars, are fabricated from aluminum, or perhaps a tough plastic, such as ABS. However, in this case, no guessing is required; it is evident that the cover is metal and it is, judging from its thickness, aluminum.

Figure 19: Unsecured facility perimeter and roof of the patient care bay at the Alcor facility in Scottsdale, AZ. The blast and fire resistant neurovaults sit abandoned in the parking lot (red hash mark).

Google even shows me the long abandoned blast resistant neuro-vaults sitting in the parking lot (red hash mark), and confirms that the PCB roof is a standard wooden deck and asphalt configuration which will look structurally just about like this:

Figure 20: Type of roof construction used in the Alcor facility. The large composite wooden beams running from left to right are gluelams – machined pieces of wood glued together under high pressure. The gluelams are the primary load bearing elements of the roof. The single beam structural elements that connect the gluelams are the perlins. The perlins provide most of the structural support for the plywood or chipboard decking of the roof.

What is more, very few, if any people who want to do the patients harm will walk into Alcor on a tour. That’s almost ludicrous, especially when there are much more attractive alternatives. And the most attractive alternative is simply walk up to or drive by the building, and hurl a fragmentation-type explosive device, such as a pipe bomb, on the roof. A more serious and targeted approach would be to climb up on the roof and position heavy explosive charges exactly where they are deemed to do the most damage.

Figure 21: Historically, bollards made of wood, metal or concrete have been used to prevent accidental or deliberate vehicular intrusion into areas where unacceptable damage would result (above, top right).  More recently, concrete barriers such as the ones seen at top left have been used for this purpose. (Photos by Mike Darwin.) The use of concrete barriers, or K rails is, however, not only unaesthetic, it does not provide  protection against the intrusion of armed pedestrians, or 2-wheel vehicles such as bicycles and motorcycles. An effective alternative is the use of high impact and climb-over resistant fencing such as Ameristar Fence Products, Inc., (Tulsa, OK), Impasse™ high-security fencing system. With the company’s integrated cabling system, this product provides anti-ram defense against forced entry and ballistic attack, and is able to stop one 15,000 lb vehicle traveling 40 mph. This product meets Department of State’s K8/L1 and K8/L2 ratings.

So, in effect, the Alcor PCB is the equivalent of a Bugatti Verynon Sports car, which has excellent door locks and a great alarm system – all of which are of little utility in the event you leave the roof off!

Figure 22: The Bugatti Verynon features an excellent alarm system and a sporty, removable roof. The value of the alarm system is considerably diminished if the car is left parked with the roof off.

It is, of course, possible to really protect the patients against these kinds of threats, as well as radiation damage by placing the patient dewars in below ground silos as seen in Figure 23. But it isn’t pretty, although I guarantee you that this, or some variation of it, will be a whole lot more effective and less costly.

Figure 23: Truly effective blast, earthquake and radiation protection were achieved by CryoSpan in the late 1990s by the expedient of constructing in-ground steel reinforced concrete silos. At top, engineer Mark Connaughton works on the wooden support framing used to maintain the shape of the mold prior to pouring the concrete. While not offering “sexy” photo opportunities, such silos provide robust and affordable protection to cryonics patients. Photos by Charles Platt.


Subsequently, Max and I corresponded about these issues until it became clear that he was becoming angry with me. He denied that there was any current wastefulness at Alcor (including their 10 paid employees), challenging me to come up with line item examples; except, of course, I couldn’t do this because Alcor has published no financial reports in four years. In fact, such reports don’t exist (not yet, anyway). He did not respond to my query about why the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by a waist high PIB fabricated from stainless steel. All of which begs the question of why a complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?

Our correspondence pretty much ended with me telling him, “You may not agree with what my vision for Alcor was (in 1987) at this point in time, but the really unfortunate thing, for all involved, is that you probably have no idea what it was, nor why I am unhappy at the waste of millions of dollars of contributed member money[1] in the intervening decades. And Max, those millions were wasted.”

Every “criticism” I made he took as a personal challenge to his competence. Danila described it aptly as, “Horrible.” It now seems clear to me that nothing I can do from behind the scenes will change Alcor. I’ve been working quietly for over a decade now, and things just keep getting worse. I had planned for this contingency, and now I think it is time to proceed in creating an alternative organization and to providing some of the nocioception that Alcor has been spared these past 20 years. I like Max a great deal – we have been good friends for over 20 years.But this is business, serious life or death business.

I have been through at least 4 iterations of what amounted to effectively rebooting, or trying to be reboot cryonics organizations. It takes a long time to do that: ~5 years just to get some equilibrium and the core resources in place. Surprisingly, even throwing vast amounts of money into such efforts does nothing to accelerate the pace, and may even slow it. I’m old, and I am sickened at the thought of having to go through this exercise, even as a participant, let alone as a leader, yet again. Having said that, it is becoming clear with each passing year that this kind of effort was probably inevitable given our nearly complete lack of understanding of what was (and arguably still is) really required to do cryonics in a sustainable fashion. Certainly, there is no escape from this in most other endeavors – and especially not in fundamentally new ones. I rarely meet innovators or entrepreneurs on the “cutting edge” (an expression I loathe) who don’t have sad tales to tell about how many corporate entities they created and cycled through before they found a stable and durable platform (if they ever succeeded in doing so at all).

As to Alcor’s status and prospects, I don’t think Alcor is likely to fail in any kind of immediate or catastrophic way. It’s current and past deficiencies are primarily of a kind that, given cryonics’ fundamental lack of normal market feedback, will not be evident to cryonicists, let alone to the public, even if pointed out to them. The legacy of the Cryonics Society of California (CSC) is proof of that reality. So, that’s not what I’m saying.

The Stench of Impending Failure?

What I am saying is that there are certain infallible signs that an enterprise is in deep trouble, and while perhaps not in immediate danger of going under, is only going to continue to exist under highly favorable conditions. I’ll be quite specific in a moment, but I want to a spend few moments more on what is the really the more important point I have to make.

I’ve traveled the world and visited just about every kind of enterprise imaginable. Whether it is a restaurant Florence, a medical clinic in Hyderabad, or an ICU in Mumbai or Moscow, there is often this unmistakable gestalt (stench) of a profoundly dysfunctional business which is evident within minutes of being on the premises. Please note that I am not saying that all failing enterprises exhibit this aura, because I’m sure they don’t. Enron probably seemed in fine fettle until just before the end. But I am saying that when that ambience is present, the enterprise is in extremis. Under normal market conditions that would mean that you could reasonably (soon) expect the doors to be shuttered (or the floor to be removed, in the Middle East). The exceptions are small town businesses that constitute micro-monopolies, government operated facilities in the undeveloped world, and occasionally, religious orders or other institutions in terminal decline, but who have a trust fund or other stipend to sustain them.

Cryonics: A Product or an Unproven Experimental Procedure?

While in many important ways Alcor is the descendant of Cryonics Society of New York (CSNY) and the no-nonsense, tell like it is approach to cryonics of Curtis Henderson, this is not by any means the full picture. CSNY had perhaps half the paradigm right. The other half that came to constitute the “mature” Alcor approach of the 1980s was pioneered by Fred and Linda Chamberlain, and was one of the Alcor assets already in place, if dormant, when IABS and I arrived on the scene in 1981. That approach was a clear acknowledgement and understanding that cryonics was an experimental procedure, that Alcor was a mutual aid organization, and that recruiting members who were also experimental subjects, was not the same as selling cryonics to customers.

There was, in fact, a strong aversion to marketing cryonics as an ordinary product, or even as a “regular” medical treatment. A consequence of this attitude was that everyone who interfaced with the public, until shortly before I left, had an almost fanatical attitude about how signing up should be communicated to the member. The interesting, and indeed remarkable thing about this is that I do not ever recall doing any training or any scripting of how to handle callers who were prospective members, or who were gathering information for same. It was just something that was “organic” and a part of Alcor’s small, but very well defined corporate culture at that time.

A corollary or a logical extension of this “first contact” strategy was that we spent a lot of time and expended a lot of effort not only continuously educating already signed up members, but actively ensuring that their informed consent was maintained over time. The Cryonics Institute (CI) never had that paradigm and Alcor lost it, and as result, members got translated into customers. I believe this is a critical failure mode for a cryonics organization – any cryonics organization – because whatever else cryonics patients are, they are not customers, and neither are members customers before they become patients. The definition of customer is innocuous enough: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers. Superficially it would seem to fit the bill for cryonics. Unfortunately, it is not what is present in that definition that is problematic, it is what is missing.

By contrast, consider the definition of the word patient:

1. Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.

2. Marked by or exhibiting calm endurance of pain, difficulty, provocation, or annoyance.

3. Tolerant; understanding: an unfailingly patient leader and guide.

4. Persevering; constant: With patient industry, she revived the failing business and made it thrive.

5. Capable of calmly awaiting an outcome or result; not hasty or impulsive.

6. Capable of bearing or enduring pain, difficulty, provocation, or annoyance: “My uncle Toby was a man patient of injuries” (Laurence Sterne).


noun:


1. One who receives medical attention, care, or treatment.

2. Linguistics A noun or noun phrase identifying one that is acted upon or undergoes an action. Also called goal.

3. Archaic One who suffers.


The core of the definition of patient, which was the basis of the adoption of the word in medicine, is “one who demonstrates calm endurance of pain, difficulty, provocation, or annoyance.” Anyone involved in cryonics for very long will quickly come to know, viscerally, which of these terms best applies.


No law yet prohibits marketing cryonics as a consumer product, though some do exist prohibiting its marketing at all. One of the few advantages to age (especially if accompanied by global travel) is that you get to see how diverse societies handle certain classes of problematic services or undertakings – ones that are destabilizing to the social matrix, or which carry a high potential for fraud or exploitation of the individual, especially vulnerable individuals. While there is considerable variation in the details, the general approaches used are remarkably similar within societies that share the same basic values. So, while there is the sale of vital organs in places like India (something that is fast being regionally legislated against), you see either a complete absence of this practice, or the same limited workarounds, in virtually all of the West and Near East. As a relevant aside, it was fascinating to watch the arc of gambling in the Russian Republic, which went from ubiquitous, to exactly where it was in the US 20 years ago; mostly prohibited, except in special zones that are problematic to gain access to and which focus the predation on the wealthy (there is essentially no middle class in Russia). This change occurred in ~2 years!


The point here is that any enterprise operating as a low temperature mausoleum with the added benefit of prospective resurrection, and doing so on a razor thin margin of costs, is very likely headed for trouble. And precisely because they are primarily a customer service organization engaged in selling only the first half of the “product” (i.e., cryopreservation and storage) they will simply not “get it” when the second half of the product is neglected or threatened (i.e., stewardship and resuscitation). Reanimation is a matter for our friends in the future, and an inevitable consequence of this is that day-to-day things that impact its likelihood today are likely to be viewed as of little or no consequence. Indeed, they are not even likely to be perceived at all. I gained enormous respect for Melody Maxim’s ability to inflict harm[2] when she correctly perceived that CI (and thus ACS) had surrendered all practical control over their patients to the Michigan Cemetery Board by the “simple” act of submitting to state regulation.


That and (many) other insights aside, the one of most relevance to this discussion happened when I was dozing on the couch in the reception area (the Russians proved equally exhausting and rewarding to travel with). As I went in and out of consciousness, I could hear the phone being answered at Alcor, and the first thing that caught my attention and increased my level of alertness for the next call was that most of the incoming calls were from people who were apparently inquiring about cryonics services. Maybe I was just there on an unusually busy day, but I heard several calls – more than two and less than five, in the hour plus interval I intermittently slumbered. The side of the calls I could hear went very much like this: “Alcor Foundation,” silence “yes we offer that.” Silence “Are you interested in the whole body or the neuro. The whole body is $200,000 and the neuro is $80,000. Silence. “The whole body is your entire body, and the neuro is just your head.” Silence. “We’re located in the Scottsdale Airpark, which is just outside of Phoenix, and if you would like to arrange a tour we would be glad to show you through our facilities.” Silence. “Most people pay for it with life insurance, and if you like, I can refer to our life insurance representative.” Silence. “Well, if you are ever in the Phoenix metro area, please consider making arrangements to see our facilities.” Silence. “Thank you.”


As I sat there, semiconscious, I had two recurring thoughts that played tag with each other in my fogged brain:


1) Are you interested in the whole body or the neuro? And would like fries and a coke with that?


2) Please, please, let me be dreaming.


I told Max about this and he expressed some concern, informed me that the person handling the inquiries was not a signed up cryonicist, but was nevertheless “a very good employee and very loyal to cryonics.” He told me he would look into the matter (after all, I was dozing) and that he would see about scripting such encounters should it prove necessary. As I sit here in Dulwhich, London, and watch the heavy gray North Sea clouds parade across the fast darkening sky whilst spitting rain, I shudder at the thought of the theatre d’absurb that scipt will be written and performed in.


There is a large and very material difference between continuing to advertise for and accept guests if you are a hotel with fire code deficiencies (that is aware of this and working to fix them), versus being a hotel that is actually on fire. It is a peculiarity of certain kinds of institutions that they will, in fact, continue to solicit and escort new guests to their rooms, even as fire from an already engulfed kitchen, barrels up stairwells with no fire doors. Such behavior happens not infrequently in enterprises where there is any material separation of “operations” from “feedback” (as any number of the recent real estate and financial debacles demonstrate).


What Next?


In my opinion, Alcor is a hotel on fire, already seriously engulfed, and with no plan of any kind, let alone a detailed one, for extinguishing the blaze and rebuilding the infrastructure. A better analogy might be a sinking ship – because the passengers can’t just stroll over to the venue across the street – they are stuck where they are. I expect that most reading this will tell me that this is not so, that I am mistaken, or that I am excessively pessimistic, or even malicious…and that’s fine. I’m not about insisting that everyone share my opinions. I may in fact be wrong. However, what I am not wrong about is that Alcor is profoundly dysfunctional, and that many discrete and general problems can be objectively identified that will likely lead to its eventual failure or replacement. I can also say with a high degree of confidence that those members who are not customers, are either aware of this situation, or are very dissatisfied with Alcor’s performance (particularly its wastefulness and low quality of service).


Opinions aside, what I believe is necessary, which in this case is both an opinion and a fact, is some sort of detailed, credible acknowledgement and understanding of the problems, coupled with a realistic plan for fixing them. Preferably a plan that does not involve asking members for yet more money to hire yet more staff.


Footnotes


[1] Ironically, approximately $4 million of that money came from the Dick Jones estate; a bequest which I was instrumental in directing to the operating fund. For this advice I feel a great deal of humiliation and regret and will sincerely apologize to Dick if I ever get the chance.

[2] And conversely to do good by pointing out soft spots and likely failure modes.

 

A Visit to Alcor

“Are you interested in the whole body or the neuro? And would like fries and a coke with that?”

By Mike Darwin

A short while ago, I hosted 3 visitors from the Russian cryonics organization KrioRus. During my visit with them in Moscow two and a half years previously, I had exhorted them to visit the US and see first-hand any hub of cryonics activity there, so that that they could see and learn for themselves what cryonics was really like, and how it was actually being pursued in the US. When I wrote to Alcor President and CEO Max More to try and schedule a visit on short notice, I jokingly included the aside that if I was not permitted to be on premises, I would go elsewhere… It was intended to be a humorous reference to a time in the not so distant past when I was not allowed into Alcor because my homosexuality was “unacceptable” to a former Alcor President (apparently being incompatible with his religious beliefs).

To my considerable surprise, Max took this remark seriously, and polled the Alcor Board on the matter. Surprise was replaced with shock when I subsequently learned that Alcor Director Saul Kent had expressed concerns that my visit to Alcor accompanying the Russians would be used as tool to “attack Alcor.” I still find this shocking, but depending upon how you define attack, maybe Saul was closer to the truth than I imagined possible. I’ve since been told that apparently there were speculations that “touring Russians” might be just an excuse of some kind to gain entry to Alcor.[1] Why this should be necessary is still a mystery to me, since as far as I knew I could visit by making by an appointment, presumably like anyone else.

Figure 1: The Alcor Mobile Advanced Rescue Cart (MARC), a portable extracorporeal support platform.

I saw quite a few unexpected things at Alcor, such as that the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by waist high PIB fabricated from stainless steel. All of which begs the point of why a hugely complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?

Figure 2: Left to right, Danila, Medvedev, President of the Russian Transhumanist Association, Max More, Ph.D., President and CEO of Alcor and Valerija Pride, President of KrioRus.

Shortly after he took office, I sent Max the 100+ plus page “Report of the Committee to Evaluate Alcor Procedures” which was presented to the Alcor Board of Directors on 04 April, 2002. This report came about because Saul Kent invited me over to view videotapes of two Alcor cases which troubled him – but he couldn’t quite put his finger on why this was so. What I saw shocked and disguste. Patients were being stabilized at a nearby hospice, transported to Alcor (~20 min away) and then CPS was discontinued, the patients were placed on the OR table and, without any ice on their heads, they were allowed to sit there at a temperatures a little below normal body temperature for 1 to 1.5 hours, while burr holes were drilled and the neck vessels were cannulated. Distilled water was being used to irrigate the brain and burr holes were done with a wood burr and electric drill with no cooling of the bone under the burr – smoke could be seen coming from the burr wound! Since the patient had no circulation to provide blood to carry away the enormous heat generated by the action of the burr on the bone, the temperature of the underlying bone must have been high enough to literally cook an egg.

In one case, a patient’s head was cut off in the field and, because they had failed to use a rectal plug, he had defecated in the PIB. The result was that feces had contaminated the neck wound, and Alcor personnel were seen pouring saline over the stump of the neck whilst holding the patient’s severed head over a bucket trying to wash the fecal matter off the stump! These are just a few of the grotesque problems I saw.

As a consequence, a “blue ribbon” Committee was put together to comprehensively review Alcor patient videos and records, and to make a field inspection of the Alcor facility. This Committee produced a comprehensive report and presented it to the Alcor Board. Max More knew nothing of this until I sent him a copy after he was President for about 1.5 months. A short while later, Alcor published the first detailed case report since the A-1169 case report was published in 2006. A careful reading of this case report which is available at http://www.alcor.org/Library/pdfs/casereportA2435.pdf and discloses that there is something terribly wrong that happens during this case, but unless you really understand cryonics as medicine, you are not likely to see it. The patient was pronounced at 6:58 PM and was transported to Alcor packed in ice while receiving CPS with the LUCAS. At ~ 8:42 PM, 1 hour and 42 minutes later, a median sternotomy is begun (excerpt from the case report, emphasis mine):

Continuation of CPS

Move to surgical table

7. Surgical Procedures

Manual CPS was continued on the patient while fresh ice was brought in from Alcor’s ice machine. The existing ice was removed from on top of the patient and she was pulled out of the ice bath and placed on the OR surgical table at 8:11 pm.

Testing of the sternal saw prior to the surgery revealed that the flexible shaft had frozen up. The problem was handed to Richard to deal with, and he had it unfrozen in a few minutes. The shaft was subsequently disassembled and lubricated. 15

The patient’s head was shaved to prep for the burr holes to be drilled. These are used to monitor the temperature of the patient’s brain as well as a way to visually watch for swelling. While the burr holes were being drilled using a craniotome perforator, Aaron prepped the patient’s sternum with Betadine, an antiseptic agent used topically to destroy microbes. Dr. McEachern cleaned each of the burr holes as they were completed. At 8:42 PM, she stood on a step stool to gain a higher position above the patient in order to perform a median sternotomy. This is a procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided to provide access to the heart for cannulation. Dr. McEachern cut through the skin of the chest with a scalpel. The guide of the saw blade was placed below the sternum. Richard operated the foot pedal on the floor as she guided the saw up the sternum. She talked through the procedure, step by step, to Aaron so he could gain additional training in its operation and application. After the sternum separation was completed, the chest was opened with Finochietto spreaders and the pericardial sac was exposed. Access to the heart was accomplished by cutting through the pericardium.

Dr. McEachern performed an arterial cannulation of the heart by sewing a purse-string suture into the wall of the aortic arch, puncturing the vessel within the purse-string, and advancing and securing the catheter. She then repeated this process for venous cannulation of the heart, going into the right atrium and advancing the cannula into the inferior vena cava. This process took approximately one hour and was completed at 9:48 PM. A thermocouple was placed under the dura through the burr hole at 3.0 hours post-arrest. Brain temperatures were taken under the dura and beneath the brain (nasopharyngeal).

Now the washout could begin. This process is used to replace the patient’s blood with cryoprotectant. The extracorporeal perfusion circuit had been primed with B1 base perfusate solution prior to the surgery and was being circulated through the bypass loop. When cannulation was complete, the circulation was transferred from the bypass loop into the cannulas. The circuit was switched from closed to open circulation and the blood was washed out of the patient’s vascular system, the visual blood concentration going from opaque to light pink.

The graph of below shows a typical patient’s cooling rate in the PIB:

Figure 3: The red-boxed areas of the two cooling curves above show the likely temperature range a patient would have cooled to during 1 hour and 44 minutes of closed chest cardiopulmonary supported external cooling using ■ ice bags or □ Portable Ice Bath (PIB) cooling.

Assuming the patient cooled at the rate that A-1169 did above, then the best that could be expected is that the patient was at ~ 22-24 deg C at 1 hour and 44 min post arrest. If you look at the graph below you see the “safe” circulatory arrest times for a “healthy” patient who has had no prior ischemic insult and who is fully oxygenated at various temperatures during cardiac or neurosurgery:

Figure 4: Probable safe circulatory arrest time vs. temperature for humans, as calculated using the Hypothermic Metabolic Index (HMI).

The reason these graphs are of relevance is that in order to do a median sternotomy you must, necessarily, stop CPR. So, yet again, Alcor took a patient with essentially uninterrupted CPS, brought them into the OR and then exposed her 1 hour and 42 minutes of ischemia! A few days before we went to Alcor, I had sent Max a letter pointing out that this had happened yet again, and that Aaron Drake’s report was badly flawed and that it was clear he was wholly inadequately trained to be doing cases unsupervised. I received no reply. Our visit to Alcor was surreal – absolutely surreal. The first thing Max did when we entered was to show Danila Medvedev and Valerija Pride swatches of wall paper and explain that the office was he was occupying was “not his” and that it was to be redecorated. He then proceeded to do the same with me. Danila and I looked at each other as if to say, “Are you kidding us? Can this even be real?”

When we arrived at Alcor we were informed that member was in need of Standby and very likely cryopreservation, and shortly after we entered the facility, the Remote Standby Team left with their equipment. I have been at Alcor only at brief intervals over the past 20 years, with the exception a stint for a month or so as subcontractor working for Suspended Animation, Inc. (SA) in 2002. I thus have mental “snapshots” of the state of the facilities separated by considerable intervals of time. This was the most disturbing snapshot I’ve seen so far. The operating room was unkempt. The floors were scuffed, stained, dirty, and had obviously not been waxed in a long time.

Figure 5: Scuffed and dirty floors, dusty shelves and a disorganized appearance are fair descriptors of the Alcor operating room. I wouldn’t consider medical treatment in a facility with this appearance – nor for that matter would I like to dine in a restaurant with a kitchen in such a state.

I inquired when preparation of the operating room would start for the patient who was to be perfused, presumably the next day, and I was told that they were “done.” When we entered the OR I observed tubing strung on the pumps of the heat lung machine console, and had assumed it was training tubing, since some of it was hanging down to the floor in front of the console inside a large, open ZipLoc bag.

Figure 5: Cryoprotective tubing dangling from pump console in a Ziploc bag; proper gas permeable sterilization wrapping (such as Kimlon™) was nowhere in evidence.

There were discarded tubing (ethylene oxide) sterilization caps lying around, and refuse, some of it apparently in place for some time, such as twist ties and paper backing from discarded sterilization pouches, lying covered in dust on the computer/instrumentation cart adjacent to the pump console.

Figure 6: Alcor operating room perfusion and data acquisition equipment. The refractometer heads used to continuously acquire cryoprotectant agent concentration to the left of the computer.

Figure 7: Dust covered lower shelf of the stainless steel data acquisition cart. The piece of sterilization packaging and the twist tie appeared to be covered in a film of dust, as well.

Figure 8: The recirculating reservoir perched precariously atop the magnetic stirring table used to mix cryoprotectant concentrate into the recirculating perfusate.

On the monitor shelf atop the pump console there was a spray bottle that had apparently been labeled “alcohol” (what kind? one wonders) with a Sharpie marker, and a laboratory wash bottle sitting next to it containing a liquid – but with no label.

Figure 9: At top, long view of the neuroperfusion enclosure and at bottom close up showing area of apparent blood contamination.

Disturbingly, the neuroperfusion enclosure had what appeared to be a residue of dried blood/perfusate in what appeared a defect in the adhesive seal where the waste diversion plate is cemented to the side wall of the enclosure. The drain line from the neuroperfusion enclosure (where biohazardous fluid will collect to be disposed of) was sitting unsecured in a ~20 L Costco Kirkland laundry detergent pail.

Figure 10: Costco laundry soap pail containing the unsecured biohazardous waste line from the neuroperfusion enclosure.

Figure 11: Alcor Operating room tableaux “fully readied” for a human neuropatient cryoprotective perfusion.

The recirculating reservoir was dangerously small making microbubble embolization of the patient during cryoprotective perfusion all but inevitable, since the cold, polymer-rich, viscous perfusate develops stable foam as a consequence of vortex formation and air entrapment from the action of the mixing magnetic stir-bar.

Figure 12: One possible scheme for achieving uniform mixing of cryoprotectant concentrate with the perfusate recirculating through the patient using a static mixer. A concentrate mixing pump continuously removes a large fraction of the recirculating perfusate from a cardiotomy or venous reservoir. This perfusate is then passed through a combination static mixer-heat exchanger where turbulent flow from inertia reversal and radial mixing uniformly blend the added cryoprotectant concentrate with the recirculating perfusate. The static mixer also serves as a heat exchanger. The blended and chilled perfusate then return to the venous reservoir.

Figure 13: At (A), a typical static mixer array. Static mixers allow thorough mixing of almost any kind of liquid or slurry without the introduction of air or the use of moving parts with the attendant seals. Because static mixers are of necessity a mixing element housed within a tube or cylinder, they make ideal heat exchangers since the fluid flowing inside the mixing tube elements is repeatedly thin-filmed and passed over the tube surface. It is thus possible to very efficiently combine mixing with heat exchange, as can be seen in the combination mixer-heat exchanger seen in B, above.

This has been a repeated problem in previous cases, and has been the subject of numerous advisory communications between Alcor Director Brian Wowk and me, among others. In fact, despite these repeated warnings (increase depth and volume of the recirculating reservoir, use a floating lid or replace the stir bar assembly with an in-line mixer), this same phenomenon was noted on during the cryoprotective perfusion of patient A-1097 in January of 2006. A detailed paper documenting this effect and demonstrating a simple way to eliminate it was first published in 1994. ( see: http://www.cryocare.org/index.cgi?subdir=bpi&url=tech5.txt)

I quote from our 1994 paper:

“A consequence of the stirring of the recirculating reservoir by the rapidly spinning magnetic stir bar is the generation of an air vortex in the recirculating perfusate. While this vortex is very effective at both rapidly and completely mixing the concentrate with the perfusate in the recirculating reservoir, it is also very effective at introducing air into the recirculating perfusate as well. At rates of rotation fast enough to achieve good mixing; the bottom of the vortex of air reaches the rapidly rotating stir bar. Air is thus turbulently mixed into the perfusate where it forms bubbles of widely varying size; the smallest of which are very stable. As the concentration of cryoprotectant rises, and the viscosity of the solution correspondingly increases, air bubbles generated by stirring in the recirculating reservoir become more and more stable and begin to saturate the recirculating perfusate creating large amounts of foam.”

And from A-1097’s case report:

“A differential vascular resistance check was done by clamping off and then unclamping the left and right carotid artery respectively. After clamping off the left carotid artery the pressure rose to 72 mm. After clamping off the right carotid artery the pressure rose to 140 mm. At 11:55 foaming was identified in the mixing reservoir, with worse foaming observed at 12:17.”

Figure 14: The recirculating reservoir sitting unsecured atop the mixing stir table. Note that the PVC tubing has not been advanced the requisite 3 barbs over the connector at the bottom (right) of the reservoir and that there is no cable tie in place to prevent accidental disconnection of the tubing.

It was also sitting akimbo on the magnetic stir table and the connections to and from it, including the critical withdrawal connection at the bottom was neither cable tied, nor pushed over the third barb of the tubing connector at the bottom of the reservoir (these are standard minimum practices for securing tubing against disconnection in extracorporeal medicine).

When I inquired as to how the recirculating reservoir would be secured during perfusion, I was told, “It’ll sit still when it has liquid in it.” If you can look at the picture above and concur with that answer, especially considering that Alcor has a history of pumping this small reservoir dry during perfusion and introducing air in the extracorporeal circuit, then you are more courageous soul than me. Consider the recommendation made to Alcor by a formal Committee commissioned to evaluate and suggest corrective actions when Alcor’s cryopreservation procedures were found to be severely deficient in 2002:

4.13: Enlarge and alarm the recirculating reservoir.

The recirculating perfusate reservoir ran dry more than once during a recent case. The reservoir should be larger and should have an alarm system that is triggered by a low level of perfusate. At the least one specific person should be assigned the task of monitoring the reservoir.

Then there was the lunacy of the “armored” patient care bay, which Max proudly showed off.:

Figure 15: Blast resistant bullet proof window looking into the Alcor patient care bay. The hardened transparent window is backed up with a retractable steel curtain window cover.

I can’t even begin to imagine what all this cost (including reinforcing the perimeter walls). It looks very impressive, and no doubt has considerable “sales” value to the naive, or the foolish.

However, if anyone actually looks past the looking glass (which happens to be blast resistant, in this case) what they will see is the following reality.

Figure 16: View through the window into the patient care bay (PCB). A loose piece of the foil faced cardboard sheeting which covers the plywood roof decking and structural supports that comprise the roof of the PCB are highlighted by the red arrows.

The red arrows point to the foil-faced cardboard reflective “insulation” that covers the space between the perlins in the patient care bay. One piece has been left (un-anesthetically) loose adjacent to what appears to a run of sprinkler pipe. What this told me was that roof of the PCB bay is a paper bag. It almost certainly consists of a sheet of plywood or particle board decking covered with a layer of roofing felt, and finally the roofing material itself. Typically, this kind of construction can barely withstand the weight of a 250 lb man. Go up on the roof and walk around yourself, and you’ll immediately get a feel for what I’m talking about – the roof will give and spring back as you walk on it. It is minimally engineered for load bearing, and this fine, and a damn good thing in earthquake country, where tilt-up construction was first developed.

I can then go to Google Earth and quickly verify that, as of 11-2009, there were no structural or other evident reinforcements to the outside of the roof over the PCB. Maybe there are now (doubtful), but this is very easy to determine, either directly, for the cost of an aerial photograph ($300), or by checking with building and code enforcement to see if any structural permits were issued, and inspections subsequently done. Of course, the easiest way is just to climb up on the building and take a look. The single most important and most elementary security precaution any institution can take to increase the safety of its physical plant is to protect its perimeter. This why sensitive and vulnerable government and corporate installations are surrounded by fences, patrolled by guards (and often dogs) and where feasible, protected by bollards against bomb bearing vehicular attack. Alcor’s perimeter is unsecured.

Figure 17: Google Earth view of the Alcor facility in 2009 shows no evidence of external (surface) reinforcing and no evidence of razor wire or other perimeter defenses on the roof of Alcor building in general, or the patient care bay in particular.

Figure 18: Metal lid covering bigfoot dewar at Alcor.

It is also evident that the dewars have no cladding, and that the softest spot is the top of the units where, in order to save both weight and money (again perfectly reasonable), the tops of the foam neck-plugs, as is the industry standard for cryogenic dewars, are fabricated from aluminum, or perhaps a tough plastic, such as ABS. However, in this case, no guessing is required; it is evident that the cover is metal and it judging from its thickness, aluminum.

Figure 19: Unsecured facility perimeter and roof of the patient care bay at the Alcor facility in Scottsdale, AZ. The blast and fire resistant neurovaults sit abandoned in the parking lot (red hash mark).

Google even shows me the neuro-vaults sitting in the parking lot (red hash mark), and confirms that the PCB roof is a standard wooden deck and asphalt configuration which will look structurally just about like this:

Figure 20: Type of roof construction used in the Alcor facility. The large composite wooden beams running from left to right are gluelams – machined pieces of wood glued together under high pressure. The gluelams are the primary load bearing elements of the roof. The single beam structural elements that connect the gluelams are the perlins. The perlins provide most of the structural support for the plywood or chipboard decking of the roof.

What is more, very few, if any people who want to do the patients harm will walk into Alcor on a tour. That’s almost ludicrous, especially when there are much more attractive alternatives. And the most attractive alternative is simply walk up to or drive by the building, and hurl a fragmentation-type explosive device, such as a pipe bomb, on the roof. A more serious and targeted approach would be to climb up on the roof and position a heavy explosive charge exactly where they are deemed to do the most damage.

So, in effect, the Alcor PCB is the equivalent of a Bugatti Verynon Sports car, which has excellent door locks and a great alarm system – all of which are of little utility in the event you leave the roof off!

Figure 21: The Bugatti Verynon features an excellent alarm system and a sporty, removable roof. The value of the alarm system is considerably diminished if the car is left parked with the roof off.

It is, of course, possible to really protect the patients against these kinds of threats, as well as radiation damage. But it isn’t pretty, although I guarantee you that this, or some variation of it, will be a whole lot more effective and less costly.

Figure 22: Truly effective blast, earthquake and radiation protection were achieved by CryoSpan in the late 1990s by the expedient of constructing in-ground steel reinforced concrete silos. At top, engineer Mark Connaughton works on the wooden support framing used to maintain the shape of the mold prior to pouring the concrete. While not offering “sexy” photo opportunities, such silos provide robust and affordable protection to cryonics patients.

Subsequently, Max and I corresponded about these issues until it became clear that he was becoming angry with me. He denied that there was any current wastefulness at Alcor (including their 10 paid employees), challenging me to come up with line item examples; except, of course I couldn’t do this because Alcor has published no financial reports in four years. In fact, they don’t exist (not yet, anyway). He did not respond to my query about why the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by a waist high PIB fabricated from stainless steel. All of which begs the question of why a complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?

Our correspondence pretty much ended with me telling him, “You may not agree with what my vision for Alcor was (in 1987) at this point in time, but the really unfortunate thing, for all involved, is that you probably have no idea what it was, nor why I am unhappy at the waste of millions of dollars of contributed member money[2] in the intervening decades. And Max, those millions were wasted.”

Every “criticism” I made he took as a personal challenge to his competence. Danila described it aptly as, “Horrible.” It now seems clear to me that nothing I can do from behind the scenes will change Alcor. I’ve been working quietly for over a decade now, and things just keep getting worse. I had planned for this contingency, and now I think it is time to proceed in creating an alternative organization and to providing some of the nocioception that Alcor has been spared these past 20 years. I like a Max a great deal – we have been good friends for over 20 years.

I have been through at least 4 iterations of what amounted to effectively rebooting, or trying to be reboot cryonics organizations. It takes a long time to do that: ~5 years just to get some equilibrium and the basic resources in place. Surprisingly, even throwing vast amounts of money into such efforts does nothing to accelerate the pace, and may even slow it. I’m old, and I am sickened at the thought of having to go through this exercise, even as a participant, let alone a leader, yet again. Having said that, it is becoming clear with each passing year that this kind of effort was probably inevitable given our nearly complete lack of understanding of what was (and arguably still is) really required to do cryonics in a sustainable fashion. Certainly, there is no escape from this in most other endeavors – and especially not in fundamentally new ones. I rarely meet innovators or entrepreneurs on the “cutting edge” (an expression I loathe) who don’t have sad tales to tell about how many corporate entities they created and cycled through, before they found a stable and durable platform (if they ever succeeded in doing so at all).

As to Alcor’s status and prospects, I don’t think Alcor is likely to fail in any kind of immediate or catastrophic way. It’s current and past deficiencies are primarily of a kind that, given cryonics’ fundamental lack of normal market feedback, will not be evident to cryonicists, let alone to the public, even if pointed out to them. The legacy of the Cryonics Society of California (CSC) is proof of that reality. So, that’s not what I’m saying.

What I am saying is that there are certain infallible signs that an enterprise is in deep trouble, and while perhaps not in immediate danger of going under, is only going to continue to exist under highly favorable conditions. I’ll be quite specific in a moment, but I want to a spend few moments more on what is the really the more important point I have to make.

I’ve traveled the world and visited just about every kind of enterprise imaginable. Whether it is a restaurant Florence, a medical clinic in Hyderabad, or an ICU in Mumbai or Moscow, there is often this unmistakable gestalt (stench) of a profoundly dysfunctional business which is evident within minutes of being on the premises. Please note that I am not saying that all failing enterprises exhibit this aura, because I’m sure they don’t. Enron probably seemed in fine fettle until just before the end. But I am saying that when that ambience is present, the enterprise is in extremis. Under normal market conditions that would mean that you could reasonably (soon) expect the doors to be shuttered (or the floor to be removed, in the Middle East). The exceptions are small town businesses that constitute micro-monopolies, government operated facilities in the undeveloped world, and occasionally, religious orders or other institutions in terminal decline, but who have a trust fund or other stipend to sustain them.

While in many important ways Alcor is the descendant of Cryonics Society of New York (CSNY) and the no-nonsense, tell like it is approach to cryonics of Curtis Henderson, this is not by any means the full picture. CSNY had perhaps half the paradigm right. The other half that came to constitute the “mature” Alcor approach of the 1980s was pioneered by Fred and Linda Chamberlain, and was one of the Alcor assets already in place, if dormant, when IABS and I arrived on the scene in 1981. That approach was a clear acknowledgement and understanding that cryonics was an experimental procedure, that Alcor was a mutual aid organization, and that recruiting members who were also experimental subjects, was not the same as selling cryonics to customers.

There was, in fact, a strong aversion to marketing cryonics as an ordinary product, or even as a “regular” medical treatment. A consequence of this attitude was that everyone who interfaced with the public, until shortly before I left, had an almost fanatical attitude about how signing up should be communicated to the member. The interesting, and indeed remarkable thing about this is that I do not ever recall doing any training or any scripting of how to handle callers who were prospective members, or who were gathering information for same. It was just something that was “organic” and a part of Alcor’s small, but very well defined corporate culture.

A corollary or a logical extension of this “first contact” strategy was that we spent a lot of time and expended a lot of effort not only continuously educating already signed up members, but actively ensuring that their informed consent was maintained over time. The Cryonics Institute (CI) never had that paradigm and Alcor lost it, and as result, members got translated into customers. I believe this is a critical failure mode for a cryonics organization – any cryonics organization – because whatever else cryonics patients are, they are not customers, and neither are members customers before they become patients. The definition of customer is innocuous enough: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers. Superficially it would seem to fit the bill for cryonics. Unfortunately, it is not what is present in that definition that is problematic, it is what is missing.

By contrast, consider the definition of the word patient:

1. Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.

2. Marked by or exhibiting calm endurance of pain, difficulty, provocation, or annoyance.

3. Tolerant; understanding: an unfailingly patient leader and guide.

4. Persevering; constant: With patient industry, she revived the failing business and made it thrive.

5. Capable of calmly awaiting an outcome or result; not hasty or impulsive.

6. Capable of bearing or enduring pain, difficulty, provocation, or annoyance: “My uncle Toby was a man patient of injuries” (Laurence Sterne).

n.

1. One who receives medical attention, care, or treatment.

2. Linguistics A noun or noun phrase identifying one that is acted upon or undergoes an action. Also called goal.

3. Archaic One who suffers.

The core of the definition of patient, which was the basis of the adoption of the word in medicine, is “one who demonstrates calm endurance of pain, difficulty, provocation, or annoyance Anyone involved in cryonics for very long will quickly come to know, viscerally, which of these terms best applies.

No law yet prohibits marketing cryonics as a consumer product, though some do exist prohibiting its marketing at all. One of the few advantages to age (especially if accompanied by global travel) is that you get to see how diverse societies handle certain classes of problematic services or undertakings – ones that are destabilizing to the social matrix, or which carry a high potential for fraud or exploitation of the individual. While there is considerable variation in the details, the general approaches used are remarkably similar within societies with the same basic values. So, while there is the sale of vital organs in places like India (something that is fast being regionally legislated against), you see either a complete absence of this practice, or the same limited workarounds, in virtually all of the West and Near East. As a relevant aside, it was fascinating to watch the arc of gambling in the Russian Republic, which went from ubiquitous, to exactly where it was in the US 20 years ago; mostly prohibited, except in special zones that are problematic to gain access to and which focus the predation on the wealthy (there is essentially no middle class in Russia). This change occurred in ~2 years!

The point here is that any enterprise operating as a low temperature mausoleum with the added benefit of prospective resurrection, and doing so on a razor thin margin of costs, is very likely headed for trouble. And precisely because they are primarily a customer service organization engaged in selling only the first half of the “product” (i.e., cryopreservation and storage) they will simply not “get it” when the second half of the product is neglected or threatened (i.e., stewardship and resuscitation). Reanimation is a matter for our friends in the future, and an inevitable consequence of this is that day-to-day things that impact its likelihood now are likely to be viewed as of little or no consequence. Indeed, they are not even likely to be perceived at all. I gained enormous respect for Melody Maxim’s ability to inflict harm[3] when she correctly perceived that CI (and thus ACS) had surrendered all practical control over their patients to the Michigan Cemetery Board by the “simple” act of submitting to state regulation.

That and (many) other insights aside, the one of most relevance to this discussion happened when I was dozing on the couch in the reception area (the Russians proved equally exhausting and rewarding to travel with). As I went in and out of consciousness, I could hear the phone being answered at Alcor, and the first thing that caught my attention and increased my level of alertness for the next call was that most of the incoming calls were from people who were apparently inquiring about cryonics services. Maybe I was just there on an unusually busy day, but I heard several calls – more than two and less than five, in the hour plus interval I intermittently slumbered. The side of the calls I could hear went very much like this: “Alcor Foundation,” silence “yes we offer that.” Silence “Are you interested in the whole body or the neuro. The whole body is $200,000 and the neuro is $80,000. Silence. “The whole body is your entire body, and the neuro is just your head.” Silence. “We’re located in the Scottsdale Airpark, which is just outside of Phoenix, and if you would like to arrange a tour we would be glad to show you through our facilities.” Silence. “Most people pay for it with life insurance, and if you like, I can refer to our life insurance representative.” Silence. “Well, if you are ever in the Phoenix metro area, please consider making arrangements to see our facilities.” Silence. “Thank you.”

As I sat there, semiconscious, I had two recurring thoughts that played tag with each other in my fogged brain:

1) Are you interested in the whole body or the neuro? And would like fries and a coke with that?

2) Please, please, let me be dreaming.

I told Max about this and he expressed some concern, informed me that the person handling the inquiries was not a signed up cryonicist, but was nevertheless “a very good employee and very loyal to cryonics.” He told me he would look into the matter (after all, I was dozing) and that he would see about scripting such encounters should it prove necessary. As I sit here in Dulwhich outside London, and watch the heavy gray North Sea clouds parade across the fast darkening sky whilst spitting rain, I shudder at the thought of the theatre d’absurb that scipt will be written and performed in.

There is a large and very material difference between continuing to advertise for and to accept guests, if you are a hotel with fire code deficiencies (that is aware of this and working to fix them), and a hotel that is actually on fire. It is a peculiarity of certain kinds of institutions that they will, in fact, continue to solicit and escort new guests to their rooms, even as fire from an already engulfed kitchen, barrels up stairwells with no fire doors. Such behavior happens not infrequently in enterprises where there is any material separation of “operations” from “feedback” (as any number of the recent real estate and financial debacles demonstrate).

In my opinion, Alcor is a hotel on fire, already seriously engulfed, and with no plan of any kind, let alone a detailed one, for extinguishing the blaze and rebuilding the infrastructure. A better analogy might be a sinking ship – because the passengers can’t just stroll over to the venue across the street – they are stuck where they are. I expect that most reading this will tell me that this is not so, that I am mistaken, or that I am excessively pessimistic, or even malicious…and that’s fine. I’m not about insisting that everyone share my opinions. I may in fact be wrong. However, what I am not wrong about is that Alcor is profoundly dysfunctional, and that many discrete and general problems can be objectively identified that will likely lead to its eventual failure or replacement. I can also say with a high degree of confidence that those members who are not customers, are either aware of this situation, or are very dissatisfied with Alcor’s performance (particularly its wastefulness and low quality of service).

A Visit to Alcor

“Are you interested in the whole body or the neuro? And would like fries and a coke with that?”

By Mike Darwin

A short while ago, I hosted 3 visitors from the Russian cryonics organization KrioRus. During my visit with them in Moscow two and a half years previously, I had exhorted them to visit the US and see first-hand any hub of cryonics activity there, so that that they could see and learn for themselves what cryonics was really like, and how it was actually being pursued in the US. When I wrote to Alcor President and CEO Max More to try and schedule a visit on short notice, I jokingly included the aside that if I was not permitted to be on premises, I would go elsewhere… It was intended to be a humorous reference to a time in the not so distant past when I was not allowed into Alcor because my homosexuality was “unacceptable” to a former Alcor President (apparently being incompatible with his religious beliefs).

To my considerable surprise, Max took this remark seriously, and polled the Alcor Board on the matter. Surprise was replaced with shock when I subsequently learned that Alcor Director Saul Kent had expressed concerns that my visit to Alcor accompanying the Russians would be used as tool to “attack Alcor.” I still find this shocking, but depending upon how you define attack, maybe Saul was closer to the truth than I imagined possible. I’ve since been told that apparently there were speculations that “touring Russians” might be just an excuse of some kind to gain entry to Alcor.[1] Why this should be necessary is still a mystery to me, since as far as I knew I could visit by making by an appointment, presumably like anyone else.

Figure 1: The Alcor Mobile Advanced Rescue Cart (MARC), a portable extracorporeal support platform.

I saw quite a few unexpected things at Alcor, such as that the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by waist high PIB fabricated from stainless steel. All of which begs the point of why a hugely complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?

Figure 2: Left to right, Danila, Medvedev, President of the Russian Transhumanist Association, Max More, Ph.D., President and CEO of Alcor and Valerija Pride, President of KrioRus.

Shortly after he took office, I sent Max the 100+ plus page “Report of the Committee to Evaluate Alcor Procedures” which was presented to the Alcor Board of Directors on 04 April, 2002. This report came about because Saul Kent invited me over to view videotapes of two Alcor cases which troubled him – but he couldn’t quite put his finger on why this was so. What I saw shocked and disguste. Patients were being stabilized at a nearby hospice, transported to Alcor (~20 min away) and then CPS was discontinued, the patients were placed on the OR table and, without any ice on their heads, they were allowed to sit there at a temperatures a little below normal body temperature for 1 to 1.5 hours, while burr holes were drilled and the neck vessels were cannulated. Distilled water was being used to irrigate the brain and burr holes were done with a wood burr and electric drill with no cooling of the bone under the burr – smoke could be seen coming from the burr wound! Since the patient had no circulation to provide blood to carry away the enormous heat generated by the action of the burr on the bone, the temperature of the underlying bone must have been high enough to literally cook an egg.

In one case, a patient’s head was cut off in the field and, because they had failed to use a rectal plug, he had defecated in the PIB. The result was that feces had contaminated the neck wound, and Alcor personnel were seen pouring saline over the stump of the neck whilst holding the patient’s severed head over a bucket trying to wash the fecal matter off the stump! These are just a few of the grotesque problems I saw.

As a consequence, a “blue ribbon” Committee was put together to comprehensively review Alcor patient videos and records, and to make a field inspection of the Alcor facility. This Committee produced a comprehensive report and presented it to the Alcor Board. Max More knew nothing of this until I sent him a copy after he was President for about 1.5 months. A short while later, Alcor published the first detailed case report since the A-1169 case report was published in 2006. A careful reading of this case report which is available at http://www.alcor.org/Library/pdfs/casereportA2435.pdf and discloses that there is something terribly wrong that happens during this case, but unless you really understand cryonics as medicine, you are not likely to see it. The patient was pronounced at 6:58 PM and was transported to Alcor packed in ice while receiving CPS with the LUCAS. At ~ 8:42 PM, 1 hour and 42 minutes later, a median sternotomy is begun (excerpt from the case report, emphasis mine):

Continuation of CPS

Move to surgical table

7. Surgical Procedures

Manual CPS was continued on the patient while fresh ice was brought in from Alcor’s ice machine. The existing ice was removed from on top of the patient and she was pulled out of the ice bath and placed on the OR surgical table at 8:11 pm.

Testing of the sternal saw prior to the surgery revealed that the flexible shaft had frozen up. The problem was handed to Richard to deal with, and he had it unfrozen in a few minutes. The shaft was subsequently disassembled and lubricated. 15

The patient’s head was shaved to prep for the burr holes to be drilled. These are used to monitor the temperature of the patient’s brain as well as a way to visually watch for swelling. While the burr holes were being drilled using a craniotome perforator, Aaron prepped the patient’s sternum with Betadine, an antiseptic agent used topically to destroy microbes. Dr. McEachern cleaned each of the burr holes as they were completed. At 8:42 PM, she stood on a step stool to gain a higher position above the patient in order to perform a median sternotomy. This is a procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided to provide access to the heart for cannulation. Dr. McEachern cut through the skin of the chest with a scalpel. The guide of the saw blade was placed below the sternum. Richard operated the foot pedal on the floor as she guided the saw up the sternum. She talked through the procedure, step by step, to Aaron so he could gain additional training in its operation and application. After the sternum separation was completed, the chest was opened with Finochietto spreaders and the pericardial sac was exposed. Access to the heart was accomplished by cutting through the pericardium.

Dr. McEachern performed an arterial cannulation of the heart by sewing a purse-string suture into the wall of the aortic arch, puncturing the vessel within the purse-string, and advancing and securing the catheter. She then repeated this process for venous cannulation of the heart, going into the right atrium and advancing the cannula into the inferior vena cava. This process took approximately one hour and was completed at 9:48 PM. A thermocouple was placed under the dura through the burr hole at 3.0 hours post-arrest. Brain temperatures were taken under the dura and beneath the brain (nasopharyngeal).

Now the washout could begin. This process is used to replace the patient’s blood with cryoprotectant. The extracorporeal perfusion circuit had been primed with B1 base perfusate solution prior to the surgery and was being circulated through the bypass loop. When cannulation was complete, the circulation was transferred from the bypass loop into the cannulas. The circuit was switched from closed to open circulation and the blood was washed out of the patient’s vascular system, the visual blood concentration going from opaque to light pink.

The graph of below shows a typical patient’s cooling rate in the PIB:

Figure 3: The red-boxed areas of the two cooling curves above show the likely temperature range a patient would have cooled to during 1 hour and 44 minutes of closed chest cardiopulmonary supported external cooling using ■ ice bags or □ Portable Ice Bath (PIB) cooling.

Assuming the patient cooled at the rate that A-1169 did above, then the best that could be expected is that the patient was at ~ 22-24 deg C at 1 hour and 44 min post arrest. If you look at the graph below you see the “safe” circulatory arrest times for a “healthy” patient who has had no prior ischemic insult and who is fully oxygenated at various temperatures during cardiac or neurosurgery:

Figure 4: Probable safe circulatory arrest time vs. temperature for humans, as calculated using the Hypothermic Metabolic Index (HMI).

The reason these graphs are of relevance is that in order to do a median sternotomy you must, necessarily, stop CPR. So, yet again, Alcor took a patient with essentially uninterrupted CPS, brought them into the OR and then exposed her 1 hour and 42 minutes of ischemia! A few days before we went to Alcor, I had sent Max a letter pointing out that this had happened yet again, and that Aaron Drake’s report was badly flawed and that it was clear he was wholly inadequately trained to be doing cases unsupervised. I received no reply. Our visit to Alcor was surreal – absolutely surreal. The first thing Max did when we entered was to show Danila Medvedev and Valerija Pride swatches of wall paper and explain that the office was he was occupying was “not his” and that it was to be redecorated. He then proceeded to do the same with me. Danila and I looked at each other as if to say, “Are you kidding us? Can this even be real?”

When we arrived at Alcor we were informed that member was in need of Standby and very likely cryopreservation, and shortly after we entered the facility, the Remote Standby Team left with their equipment. I have been at Alcor only at brief intervals over the past 20 years, with the exception a stint for a month or so as subcontractor working for Suspended Animation, Inc. (SA) in 2002. I thus have mental “snapshots” of the state of the facilities separated by considerable intervals of time. This was the most disturbing snapshot I’ve seen so far. The operating room was unkempt. The floors were scuffed, stained, dirty, and had obviously not been waxed in a long time.

Figure 5: Scuffed and dirty floors, dusty shelves and a disorganized appearance are fair descriptors of the Alcor operating room. I wouldn’t consider medical treatment in a facility with this appearance – nor for that matter would I like to dine in a restaurant with a kitchen in such a state.

I inquired when preparation of the operating room would start for the patient who was to be perfused, presumably the next day, and I was told that they were “done.” When we entered the OR I observed tubing strung on the pumps of the heat lung machine console, and had assumed it was training tubing, since some of it was hanging down to the floor in front of the console inside a large, open ZipLoc bag.

Figure 5: Cryoprotective tubing dangling from pump console in a Ziploc bag; proper gas permeable sterilization wrapping (such as Kimlon™) was nowhere in evidence.

There were discarded tubing (ethylene oxide) sterilization caps lying around, and refuse, some of it apparently in place for some time, such as twist ties and paper backing from discarded sterilization pouches, lying covered in dust on the computer/instrumentation cart adjacent to the pump console.

Figure 6: Alcor operating room perfusion and data acquisition equipment. The refractometer heads used to continuously acquire cryoprotectant agent concentration to the left of the computer.

Figure 7: Dust covered lower shelf of the stainless steel data acquisition cart. The piece of sterilization packaging and the twist tie appeared to be covered in a film of dust, as well.

Figure 8: The recirculating reservoir perched precariously atop the magnetic stirring table used to mix cryoprotectant concentrate into the recirculating perfusate.

On the monitor shelf atop the pump console there was a spray bottle that had apparently been labeled “alcohol” (what kind? one wonders) with a Sharpie marker, and a laboratory wash bottle sitting next to it containing a liquid – but with no label.

Figure 9: At top, long view of the neuroperfusion enclosure and at bottom close up showing area of apparent blood contamination.

Disturbingly, the neuroperfusion enclosure had what appeared to be a residue of dried blood/perfusate in what appeared a defect in the adhesive seal where the waste diversion plate is cemented to the side wall of the enclosure. The drain line from the neuroperfusion enclosure (where biohazardous fluid will collect to be disposed of) was sitting unsecured in a ~20 L Costco Kirkland laundry detergent pail.

Figure 10: Costco laundry soap pail containing the unsecured biohazardous waste line from the neuroperfusion enclosure.

Figure 11: Alcor Operating room tableaux “fully readied” for a human neuropatient cryoprotective perfusion.

The recirculating reservoir was dangerously small making microbubble embolization of the patient during cryoprotective perfusion all but inevitable, since the cold, polymer-rich, viscous perfusate develops stable foam as a consequence of vortex formation and air entrapment from the action of the mixing magnetic stir-bar.

Figure 12: One possible scheme for achieving uniform mixing of cryoprotectant concentrate with the perfusate recirculating through the patient using a static mixer. A concentrate mixing pump continuously removes a large fraction of the recirculating perfusate from a cardiotomy or venous reservoir. This perfusate is then passed through a combination static mixer-heat exchanger where turbulent flow from inertia reversal and radial mixing uniformly blend the added cryoprotectant concentrate with the recirculating perfusate. The static mixer also serves as a heat exchanger. The blended and chilled perfusate then return to the venous reservoir.

Figure 13: At (A), a typical static mixer array. Static mixers allow thorough mixing of almost any kind of liquid or slurry without the introduction of air or the use of moving parts with the attendant seals. Because static mixers are of necessity a mixing element housed within a tube or cylinder, they make ideal heat exchangers since the fluid flowing inside the mixing tube elements is repeatedly thin-filmed and passed over the tube surface. It is thus possible to very efficiently combine mixing with heat exchange, as can be seen in the combination mixer-heat exchanger seen in B, above.

This has been a repeated problem in previous cases, and has been the subject of numerous advisory communications between Alcor Director Brian Wowk and me, among others. In fact, despite these repeated warnings (increase depth and volume of the recirculating reservoir, use a floating lid or replace the stir bar assembly with an in-line mixer), this same phenomenon was noted on during the cryoprotective perfusion of patient A-1097 in January of 2006. A detailed paper documenting this effect and demonstrating a simple way to eliminate it was first published in 1994. ( see: http://www.cryocare.org/index.cgi?subdir=bpi&url=tech5.txt)

I quote from our 1994 paper:

“A consequence of the stirring of the recirculating reservoir by the rapidly spinning magnetic stir bar is the generation of an air vortex in the recirculating perfusate. While this vortex is very effective at both rapidly and completely mixing the concentrate with the perfusate in the recirculating reservoir, it is also very effective at introducing air into the recirculating perfusate as well. At rates of rotation fast enough to achieve good mixing; the bottom of the vortex of air reaches the rapidly rotating stir bar. Air is thus turbulently mixed into the perfusate where it forms bubbles of widely varying size; the smallest of which are very stable. As the concentration of cryoprotectant rises, and the viscosity of the solution correspondingly increases, air bubbles generated by stirring in the recirculating reservoir become more and more stable and begin to saturate the recirculating perfusate creating large amounts of foam.”

And from A-1097’s case report:

“A differential vascular resistance check was done by clamping off and then unclamping the left and right carotid artery respectively. After clamping off the left carotid artery the pressure rose to 72 mm. After clamping off the right carotid artery the pressure rose to 140 mm. At 11:55 foaming was identified in the mixing reservoir, with worse foaming observed at 12:17.”

Figure 14: The recirculating reservoir sitting unsecured atop the mixing stir table. Note that the PVC tubing has not been advanced the requisite 3 barbs over the connector at the bottom (right) of the reservoir and that there is no cable tie in place to prevent accidental disconnection of the tubing.

It was also sitting akimbo on the magnetic stir table and the connections to and from it, including the critical withdrawal connection at the bottom was neither cable tied, nor pushed over the third barb of the tubing connector at the bottom of the reservoir (these are standard minimum practices for securing tubing against disconnection in extracorporeal medicine).

When I inquired as to how the recirculating reservoir would be secured during perfusion, I was told, “It’ll sit still when it has liquid in it.” If you can look at the picture above and concur with that answer, especially considering that Alcor has a history of pumping this small reservoir dry during perfusion and introducing air in the extracorporeal circuit, then you are more courageous soul than me. Consider the recommendation made to Alcor by a formal Committee commissioned to evaluate and suggest corrective actions when Alcor’s cryopreservation procedures were found to be severely deficient in 2002:

4.13: Enlarge and alarm the recirculating reservoir.

The recirculating perfusate reservoir ran dry more than once during a recent case. The reservoir should be larger and should have an alarm system that is triggered by a low level of perfusate. At the least one specific person should be assigned the task of monitoring the reservoir.

Then there was the lunacy of the “armored” patient care bay, which Max proudly showed off.:

Figure 15: Blast resistant bullet proof window looking into the Alcor patient care bay. The hardened transparent window is backed up with a retractable steel curtain window cover.

I can’t even begin to imagine what all this cost (including reinforcing the perimeter walls). It looks very impressive, and no doubt has considerable “sales” value to the naive, or the foolish.

However, if anyone actually looks past the looking glass (which happens to be blast resistant, in this case) what they will see is the following reality.

Figure 16: View through the window into the patient care bay (PCB). A loose piece of the foil faced cardboard sheeting which covers the plywood roof decking and structural supports that comprise the roof of the PCB are highlighted by the red arrows.

The red arrows point to the foil-faced cardboard reflective “insulation” that covers the space between the perlins in the patient care bay. One piece has been left (un-anesthetically) loose adjacent to what appears to a run of sprinkler pipe. What this told me was that roof of the PCB bay is a paper bag. It almost certainly consists of a sheet of plywood or particle board decking covered with a layer of roofing felt, and finally the roofing material itself. Typically, this kind of construction can barely withstand the weight of a 250 lb man. Go up on the roof and walk around yourself, and you’ll immediately get a feel for what I’m talking about – the roof will give and spring back as you walk on it. It is minimally engineered for load bearing, and this fine, and a damn good thing in earthquake country, where tilt-up construction was first developed.

I can then go to Google Earth and quickly verify that, as of 11-2009, there were no structural or other evident reinforcements to the outside of the roof over the PCB. Maybe there are now (doubtful), but this is very easy to determine, either directly, for the cost of an aerial photograph ($300), or by checking with building and code enforcement to see if any structural permits were issued, and inspections subsequently done. Of course, the easiest way is just to climb up on the building and take a look. The single most important and most elementary security precaution any institution can take to increase the safety of its physical plant is to protect its perimeter. This why sensitive and vulnerable government and corporate installations are surrounded by fences, patrolled by guards (and often dogs) and where feasible, protected by bollards against bomb bearing vehicular attack. Alcor’s perimeter is unsecured.

Figure 17: Google Earth view of the Alcor facility in 2009 shows no evidence of external (surface) reinforcing and no evidence of razor wire or other perimeter defenses on the roof of Alcor building in general, or the patient care bay in particular.

Figure 18: Metal lid covering bigfoot dewar at Alcor.

It is also evident that the dewars have no cladding, and that the softest spot is the top of the units where, in order to save both weight and money (again perfectly reasonable), the tops of the foam neck-plugs, as is the industry standard for cryogenic dewars, are fabricated from aluminum, or perhaps a tough plastic, such as ABS. However, in this case, no guessing is required; it is evident that the cover is metal and it judging from its thickness, aluminum.

Figure 19: Unsecured facility perimeter and roof of the patient care bay at the Alcor facility in Scottsdale, AZ. The blast and fire resistant neurovaults sit abandoned in the parking lot (red hash mark).

Google even shows me the neuro-vaults sitting in the parking lot (red hash mark), and confirms that the PCB roof is a standard wooden deck and asphalt configuration which will look structurally just about like this:

Figure 20: Type of roof construction used in the Alcor facility. The large composite wooden beams running from left to right are gluelams – machined pieces of wood glued together under high pressure. The gluelams are the primary load bearing elements of the roof. The single beam structural elements that connect the gluelams are the perlins. The perlins provide most of the structural support for the plywood or chipboard decking of the roof.

What is more, very few, if any people who want to do the patients harm will walk into Alcor on a tour. That’s almost ludicrous, especially when there are much more attractive alternatives. And the most attractive alternative is simply walk up to or drive by the building, and hurl a fragmentation-type explosive device, such as a pipe bomb, on the roof. A more serious and targeted approach would be to climb up on the roof and position a heavy explosive charge exactly where they are deemed to do the most damage.

So, in effect, the Alcor PCB is the equivalent of a Bugatti Verynon Sports car, which has excellent door locks and a great alarm system – all of which are of little utility in the event you leave the roof off!

Figure 21: The Bugatti Verynon features an excellent alarm system and a sporty, removable roof. The value of the alarm system is considerably diminished if the car is left parked with the roof off.

It is, of course, possible to really protect the patients against these kinds of threats, as well as radiation damage. But it isn’t pretty, although I guarantee you that this, or some variation of it, will be a whole lot more effective and less costly.

Figure 22: Truly effective blast, earthquake and radiation protection were achieved by CryoSpan in the late 1990s by the expedient of constructing in-ground steel reinforced concrete silos. At top, engineer Mark Connaughton works on the wooden support framing used to maintain the shape of the mold prior to pouring the concrete. While not offering “sexy” photo opportunities, such silos provide robust and affordable protection to cryonics patients.

Subsequently, Max and I corresponded about these issues until it became clear that he was becoming angry with me. He denied that there was any current wastefulness at Alcor (including their 10 paid employees), challenging me to come up with line item examples; except, of course I couldn’t do this because Alcor has published no financial reports in four years. In fact, they don’t exist (not yet, anyway). He did not respond to my query about why the MARC is no longer in use and lies covered in dust (not even tarped) and laden with ‘junk’ in the ambulance bay; it has been replaced by a waist high PIB fabricated from stainless steel. All of which begs the question of why a complex and costly technological platform, in the form of a mobile operating room was developed, if it isn’t going to be used for extracorporeal support?

Our correspondence pretty much ended with me telling him, “You may not agree with what my vision for Alcor was (in 1987) at this point in time, but the really unfortunate thing, for all involved, is that you probably have no idea what it was, nor why I am unhappy at the waste of millions of dollars of contributed member money[2] in the intervening decades. And Max, those millions were wasted.”

Every “criticism” I made he took as a personal challenge to his competence. Danila described it aptly as, “Horrible.” It now seems clear to me that nothing I can do from behind the scenes will change Alcor. I’ve been working quietly for over a decade now, and things just keep getting worse. I had planned for this contingency, and now I think it is time to proceed in creating an alternative organization and to providing some of the nocioception that Alcor has been spared these past 20 years. I like a Max a great deal – we have been good friends for over 20 years.

I have been through at least 4 iterations of what amounted to effectively rebooting, or trying to be reboot cryonics organizations. It takes a long time to do that: ~5 years just to get some equilibrium and the basic resources in place. Surprisingly, even throwing vast amounts of money into such efforts does nothing to accelerate the pace, and may even slow it. I’m old, and I am sickened at the thought of having to go through this exercise, even as a participant, let alone a leader, yet again. Having said that, it is becoming clear with each passing year that this kind of effort was probably inevitable given our nearly complete lack of understanding of what was (and arguably still is) really required to do cryonics in a sustainable fashion. Certainly, there is no escape from this in most other endeavors – and especially not in fundamentally new ones. I rarely meet innovators or entrepreneurs on the “cutting edge” (an expression I loathe) who don’t have sad tales to tell about how many corporate entities they created and cycled through, before they found a stable and durable platform (if they ever succeeded in doing so at all).

As to Alcor’s status and prospects, I don’t think Alcor is likely to fail in any kind of immediate or catastrophic way. It’s current and past deficiencies are primarily of a kind that, given cryonics’ fundamental lack of normal market feedback, will not be evident to cryonicists, let alone to the public, even if pointed out to them. The legacy of the Cryonics Society of California (CSC) is proof of that reality. So, that’s not what I’m saying.

What I am saying is that there are certain infallible signs that an enterprise is in deep trouble, and while perhaps not in immediate danger of going under, is only going to continue to exist under highly favorable conditions. I’ll be quite specific in a moment, but I want to a spend few moments more on what is the really the more important point I have to make.

I’ve traveled the world and visited just about every kind of enterprise imaginable. Whether it is a restaurant Florence, a medical clinic in Hyderabad, or an ICU in Mumbai or Moscow, there is often this unmistakable gestalt (stench) of a profoundly dysfunctional business which is evident within minutes of being on the premises. Please note that I am not saying that all failing enterprises exhibit this aura, because I’m sure they don’t. Enron probably seemed in fine fettle until just before the end. But I am saying that when that ambience is present, the enterprise is in extremis. Under normal market conditions that would mean that you could reasonably (soon) expect the doors to be shuttered (or the floor to be removed, in the Middle East). The exceptions are small town businesses that constitute micro-monopolies, government operated facilities in the undeveloped world, and occasionally, religious orders or other institutions in terminal decline, but who have a trust fund or other stipend to sustain them.

While in many important ways Alcor is the descendant of Cryonics Society of New York (CSNY) and the no-nonsense, tell like it is approach to cryonics of Curtis Henderson, this is not by any means the full picture. CSNY had perhaps half the paradigm right. The other half that came to constitute the “mature” Alcor approach of the 1980s was pioneered by Fred and Linda Chamberlain, and was one of the Alcor assets already in place, if dormant, when IABS and I arrived on the scene in 1981. That approach was a clear acknowledgement and understanding that cryonics was an experimental procedure, that Alcor was a mutual aid organization, and that recruiting members who were also experimental subjects, was not the same as selling cryonics to customers.

There was, in fact, a strong aversion to marketing cryonics as an ordinary product, or even as a “regular” medical treatment. A consequence of this attitude was that everyone who interfaced with the public, until shortly before I left, had an almost fanatical attitude about how signing up should be communicated to the member. The interesting, and indeed remarkable thing about this is that I do not ever recall doing any training or any scripting of how to handle callers who were prospective members, or who were gathering information for same. It was just something that was “organic” and a part of Alcor’s small, but very well defined corporate culture.

A corollary or a logical extension of this “first contact” strategy was that we spent a lot of time and expended a lot of effort not only continuously educating already signed up members, but actively ensuring that their informed consent was maintained over time. The Cryonics Institute (CI) never had that paradigm and Alcor lost it, and as result, members got translated into customers. I believe this is a critical failure mode for a cryonics organization – any cryonics organization – because whatever else cryonics patients are, they are not customers, and neither are members customers before they become patients. The definition of customer is innocuous enough: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers. Superficially it would seem to fit the bill for cryonics. Unfortunately, it is not what is present in that definition that is problematic, it is what is missing.

By contrast, consider the definition of the word patient:

1. Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.

2. Marked by or exhibiting calm endurance of pain, difficulty, provocation, or annoyance.

3. Tolerant; understanding: an unfailingly patient leader and guide.

4. Persevering; constant: With patient industry, she revived the failing business and made it thrive.

5. Capable of calmly awaiting an outcome or result; not hasty or impulsive.

6. Capable of bearing or enduring pain, difficulty, provocation, or annoyance: “My uncle Toby was a man patient of injuries” (Laurence Sterne).

n.

1. One who receives medical attention, care, or treatment.

2. Linguistics A noun or noun phrase identifying one that is acted upon or undergoes an action. Also called goal.

3. Archaic One who suffers.

The core of the definition of patient, which was the basis of the adoption of the word in medicine, is “one who demonstrates calm endurance of pain, difficulty, provocation, or annoyance Anyone involved in cryonics for very long will quickly come to know, viscerally, which of these terms best applies.

No law yet prohibits marketing cryonics as a consumer product, though some do exist prohibiting its marketing at all. One of the few advantages to age (especially if accompanied by global travel) is that you get to see how diverse societies handle certain classes of problematic services or undertakings – ones that are destabilizing to the social matrix, or which carry a high potential for fraud or exploitation of the individual. While there is considerable variation in the details, the general approaches used are remarkably similar within societies with the same basic values. So, while there is the sale of vital organs in places like India (something that is fast being regionally legislated against), you see either a complete absence of this practice, or the same limited workarounds, in virtually all of the West and Near East. As a relevant aside, it was fascinating to watch the arc of gambling in the Russian Republic, which went from ubiquitous, to exactly where it was in the US 20 years ago; mostly prohibited, except in special zones that are problematic to gain access to and which focus the predation on the wealthy (there is essentially no middle class in Russia). This change occurred in ~2 years!

The point here is that any enterprise operating as a low temperature mausoleum with the added benefit of prospective resurrection, and doing so on a razor thin margin of costs, is very likely headed for trouble. And precisely because they are primarily a customer service organization engaged in selling only the first half of the “product” (i.e., cryopreservation and storage) they will simply not “get it” when the second half of the product is neglected or threatened (i.e., stewardship and resuscitation). Reanimation is a matter for our friends in the future, and an inevitable consequence of this is that day-to-day things that impact its likelihood now are likely to be viewed as of little or no consequence. Indeed, they are not even likely to be perceived at all. I gained enormous respect for Melody Maxim’s ability to inflict harm[3] when she correctly perceived that CI (and thus ACS) had surrendered all practical control over their patients to the Michigan Cemetery Board by the “simple” act of submitting to state regulation.

That and (many) other insights aside, the one of most relevance to this discussion happened when I was dozing on the couch in the reception area (the Russians proved equally exhausting and rewarding to travel with). As I went in and out of consciousness, I could hear the phone being answered at Alcor, and the first thing that caught my attention and increased my level of alertness for the next call was that most of the incoming calls were from people who were apparently inquiring about cryonics services. Maybe I was just there on an unusually busy day, but I heard several calls – more than two and less than five, in the hour plus interval I intermittently slumbered. The side of the calls I could hear went very much like this: “Alcor Foundation,” silence “yes we offer that.” Silence “Are you interested in the whole body or the neuro. The whole body is $200,000 and the neuro is $80,000. Silence. “The whole body is your entire body, and the neuro is just your head.” Silence. “We’re located in the Scottsdale Airpark, which is just outside of Phoenix, and if you would like to arrange a tour we would be glad to show you through our facilities.” Silence. “Most people pay for it with life insurance, and if you like, I can refer to our life insurance representative.” Silence. “Well, if you are ever in the Phoenix metro area, please consider making arrangements to see our facilities.” Silence. “Thank you.”

As I sat there, semiconscious, I had two recurring thoughts that played tag with each other in my fogged brain:

1) Are you interested in the whole body or the neuro? And would like fries and a coke with that?

2) Please, please, let me be dreaming.

I told Max about this and he expressed some concern, informed me that the person handling the inquiries was not a signed up cryonicist, but was nevertheless “a very good employee and very loyal to cryonics.” He told me he would look into the matter (after all, I was dozing) and that he would see about scripting such encounters should it prove necessary. As I sit here in Dulwhich outside London, and watch the heavy gray North Sea clouds parade across the fast darkening sky whilst spitting rain, I shudder at the thought of the theatre d’absurb that scipt will be written and performed in.

There is a large and very material difference between continuing to advertise for and to accept guests, if you are a hotel with fire code deficiencies (that is aware of this and working to fix them), and a hotel that is actually on fire. It is a peculiarity of certain kinds of institutions that they will, in fact, continue to solicit and escort new guests to their rooms, even as fire from an already engulfed kitchen, barrels up stairwells with no fire doors. Such behavior happens not infrequently in enterprises where there is any material separation of “operations” from “feedback” (as any number of the recent real estate and financial debacles demonstrate).

In my opinion, Alcor is a hotel on fire, already seriously engulfed, and with no plan of any kind, let alone a detailed one, for extinguishing the blaze and rebuilding the infrastructure. A better analogy might be a sinking ship – because the passengers can’t just stroll over to the venue across the street – they are stuck where they are. I expect that most reading this will tell me that this is not so, that I am mistaken, or that I am excessively pessimistic, or even malicious…and that’s fine. I’m not about insisting that everyone share my opinions. I may in fact be wrong. However, what I am not wrong about is that Alcor is profoundly dysfunctional, and that many discrete and general problems can be objectively identified that will likely lead to its eventual failure or replacement. I can also say with a high degree of confidence that those members who are not customers, are either aware of this situation, or are very dissatisfied with Alcor’s performance (particularly its wastefulness and low quality of service).

Opinions aside, what I believe is necessary, which in this case is both an opinion and a fact, is some sort of detailed, credible acknowledgement and understanding of the problems, coupled with a realistic plan for fixing them. Preferably a plan that does not involve asking members for yet more money to hire yet more staff.


[1] Even more amusingly, I’ve subsequently learned that there was at least some belief that I was a Russian agent; that I had been converted to work for KrioRus, and presumably was on a mission to steal Alcor’s secrets.

 

 

[2] Ironically, approximately $4 million of that money came from the Dick Jones estate; a bequest which I was instrumental in directing to the operating fund. For this advice I feel a great deal of humiliation and regret and will sincerely apologize to Dick if I ever get the chance.

[3] And conversely to good by pointing out soft spots and likely failure modes.

Opinions aside, what I believe is necessary, which in this case is both an opinion and a fact, is some sort of detailed, credible acknowledgement and understanding of the problems, coupled with a realistic plan for fixing them. Preferably a plan that does not involve asking members for yet more money to hire yet more staff.


[1] Even more amusingly, I’ve subsequently learned that there was at least some belief that I was a Russian agent; that I had been converted to work for KrioRus, and presumably was on a mission to steal Alcor’s secrets.

 

 

[2] Ironically, approximately $4 million of that money came from the Dick Jones estate; a bequest which I was instrumental in directing to the operating fund. For this advice I feel a great deal of humiliation and regret and will sincerely apologize to Dick if I ever get the chance.

[3] And conversely to good by pointing out soft spots and likely failure modes.

This entry was posted in Cryonics Technology (General), Ischemia-Reperfusion Injury. Bookmark the permalink.

41 Responses to A Visit to Alcor

  1. Abelard Lindsey says:

    Why does Alcor have 10 paid employees? This is incredible!

    I believe the suspension team consists of 5 or less people and sometimes includes volunteers. Whatever administrative work (including cleaning the surgical bay and making sure all inventories are complete) can be done by the same people between suspensions. It seems to me Alcor would operate fine on 5 employees. Perhaps Alcor is turning into a bureaucracy.

    That the Alcor facility is part of a larger building (is it leased, or do they own their portion of the building) may limit the structural improvements to increased security. If the building is leased, then landlord approval is necessary for any such improvements.

    Alcor has not published any financial statements in 5 years? This is also incredible. However, as Saul Kent is the director, he can insist on proper financial statements and financial management. I’m surprised he is not doing this. Perhaps he is receiving them privately. Or maybe Saul has his fingers in too many pies and is too preoccupied with, say, Suspended Animation or 21cm in order to stay on top of Alcor.

    I don’t know the details of proper suspension protocol, but I do remember that each and every suspension used to be well-documented in the Cryonics magazine. I felt this was necessary to keep the membership informed as well as to build confidence in Alcor. As the creator of Extropy, Max should understand the importance of these activities with regards to a membership organization such as Alcor.

    • admin says:

      That’s a good question, and one I’ve asked repeatedly, often in the context of WHAT DO ALL THOSE PEOPLE DO ALL DAY LONG EVERY DAY??? I can justifiably ask this question, because I’ve been President of Alcor, and run other cryonics businesses as well. I would also add that Alcor is looking to add an 11th employee: http://www.alcor.org/jobs.html, something called a MEMBER COMMUNICATIONS DIRECTOR!

      Sometime before I visited Alcor I scanned in all the photos of the Alcor facility in Riverside, as well as relevant photos showing the nature and scope of the work that was underway at that time, and during the year before and after we occupied the new building. I then generated an employee vs. workload vs. work product analysis. Unfortunately, I did not have all of Alcor the financial reports for the years ending 1984-1987. These would be necessary to complete the picture and demonstrate the approximate ratio of productivity to cash expended and labor, goods or services contributed (i.e., income). This has been a long planned article – originally I was going to try submitting it to Cryonics (now that Aschwin deWolf is the Editor) and later, failing that, to publish it here. When I visited Alcor with the KrioRus people, I asked Alcor’s Finance Director, Bonnie Magee, if she would be kind enough to obtain copies of the financial statements for those years and forward them to me. She said that she would (sic) “look around and see if she could find them.” Apparently she didn’t find them, because I never received them. I found this appalling – the idea that an organization entrusted with millions of dollars of member/patient money doesn’t have (or doesn’t care enough) to provide a member with yearly financial reports that were openly published and distributed to every subscriber of Cryonics magazine was mind boggling.

      However, I was in for an even bigger surprise, because that set Danila Medvedev off on a mini-sermon about the last 4 years of Alcor annual financial reports. You could have knocked me over with a feather when I learned that Danila had discovered that there had been no Alcor financials in 4 years, and that he had been trying to prise these out of Bonnie Magee for quite sometime! Bear in mind, that when Alcor had only TWO paid employees (Hugh Hixon and I) financial reports were prepared MONTHLY; each and every month, without fail. When we returned to Southern California, I went through my Alcor meeting minutes from 1982 to 1990 and showed an incredulous Danila the detailed financial reports, Board meeting minutes, agendas, and the mass of internal memorandums that constituted only a tiny fraction of the work product of Alcor at that time.

      Over the past few days, I’ve been told by several sources that I am now considered the devil incarnate by Max More, and that he and others in Alcor consider the above post to be malicious distortions and lies. So, if this is true, I guess it is fair to assume I won’t be getting the annual financial reports from ’84-’87. — Mike Darwin

      • Luke Parrish says:

        More info about the staff is available at:
        http://www.alcor.org/AboutAlcor/meetalcorstaff.html

        Personally, I think you are overreacting. I had the chance to attend an Alcor-sponsored training recently, and the impression I got was that they are working hard to train and equip the various regions. As more of the existing patients become senile, they will need more diligent follow-up, which will doubtless involve more staff.

        As to your criticism that they are embracing a “customer” service oriented model — well, so what? Selling stuff is that makes our economy work. We don’t rely on volunteers to clean the roads, drive the ambulances, or even to perform surgery. Paying people to do things is what gets things done.

        That’s not to say you don’t raise legitimate concerns. Financial statements should be made available on a consistent basis. I don’t think much of what you cite is Max’s fault though; it seems to predate him significantly. (E.g. the patient case you cite is from 2006.)

        • admin says:

          Contrary to popular belief, I’m not a tyrant, and you not only get to, you are encouraged to form your own opinions. As I always say, you pays your money and you takes your chances; especially if you are, or choose to be, a customer (and often even if you don’t!).

          There are a number of ways to evaluate a cryonics organization: technically, financially, philosophically and perhaps even ideologically. Your areas of interest and expertise will usually largely determine which of these areas you are most sensitive to. In fact, they often determine whether you can even perceive problems or excellence in a given domain. Financial people will almost invariably hone in on financial matters, technical people on technical matters, and so on. This is natural and to be expected. What integrates these things in the everyday world of feedback-driven institutional activity is the global feedback that comes from the organization’s performance. This feedback is typically both robust and rapid in the case of things like consumer products – especially highly competitive, high turn-over goods, like clothing or consumer electronics. It becomes more problematic in operations like mission-oriented charitable organizations, such the AHA, the ACS, the Red Cross, and so on. Despite its large infrastructure and huge cash flow, the AHA has done little to affect morbidity and mortality from heart disease. And it is quite easy to see that they have absolutely no sense of urgency about doing so. They are not chomping at the bit the way the ACT-UP people were vis a vis AIDS – this despite the fact that heart disease is a much more tractable illness. So, in my estimation, the AHA has not been much of a success. BTW, similarly, they were (and are) almost completely insensitive to really improving outcome from CPR; they were quite content to just go along using CPR algorithms that basically didn’t work – decade after decade.

          So when you say, “I had the chance to attend an Alcor-sponsored training recently, and the impression I got was that they are working hard to train and equip the various regions.” I guess I would ask, “What are they doing, and what is their evidence that it is really effective, or likely to be so?” Similarly, speaking as a technical person with considerable experience in the area, when I see CPS interrupted for in excess of an hour in patients, thus exposing them to serious ischemia-reperfusion injury for no discernible reason, I know at that point there are serious systemic problems with the biomedical/technical capability of the organization that cannot be addressed by simply pointing out the error and saying, “Please, don’t do that again.” My certainty about this approaches 100% when I see a technical report of patient care that includes no meaningful (let alone) comprehensive data, including time-temperature data, and many, many other parameters critical to good (or even barely adequate patient care). When I see a case report that is a short story told from the view of a person who cannot sort out relevant from irrelevant detail and who does not know (or perhaps understand) the critical events in Transport and CPA perfusion, and that person is in charge of some or all of those operations, then there is essentially no doubt in my mind that technical care will be grossly substandard, no matter how good it looks superficially, no matter how much expensive equipment is used, and no matter how diligently, energetically and frequently the procedures employed are being taught.

          Nor is there anything new in this. Here in the UK, surgeons are still called Mister (Mr.) not Doctor (Dr.) because they were once at the bottom of the professional/social ranking hierarchy. Surgery was not only a dirty and dangerous manual skill, it was also barbaric, and most often grotesquely ineffective. This had been the case since the dawn of civilization. Literally for thousands of years surgery remained surprisingly unchanged – and shockingly ineffective. And yet people still turned to surgeons when they had no other hope of cure. In fact, that was the ONLY time they turned to them. Amputations, couching of cataracts, and cutting for bladder stones were just about the only surgeries that worked at all, and in the latter two, the mortality and complications were horrible – and remained more or less constant over centuries. Nevertheless, becoming a surgeon involved arduous and dangerous training, and it required substantial skill, albeit skill at delivering very poor remedies. Nothing much changed until Ambroise Paré pioneered the treatment of gunshot wounds circa 1545, followed next by the creation of scientific (feedback driven) surgery by John Hunter (1728 – 1793). Pare’ had a very hard time of it because of his (evidence based) insistence that hot oil or red hot irons not be put into battlefield wounds to cauterize them. John Hunter was the model used by Robert Louis Stevenson for his novella, the “Strange Case of Dr. Jekyll and Mr. Hyde.” So, that should give you an idea of how well Hunter was received. These two cases, followed by others such as Semmelweiss, Pasteur, Morton and Lister served to illustrate that even when you HAVE the data and even when you KNOW what you are doing, bad practice may not only continue – it can thrive, and as in the case of Semmelweiss, triumph. Hunter had to found his own private teaching school, create his own private anatomical collection, and develop his own personal curriculum completely independent of the Royal College of Surgeons (RCS) and despite fierce opposition from the Universities and the existing medical establishment. That fraction of Hunter’s anatomical collection, which he called his “books of surgery” that was not destroyed by Nazi bombing of London during WWII, is now a great treasure of the very RCS that so once eschewed him, and the Hunterian Collection is now on public display. It is an amazing thing to see: http://www.rcseng.ac.uk/about/virtual_tours/museum.html. Once again, the problem is getting feedback, knowing how to evaluate it, and being willing or even ABLE to appreciate it, when you do.

          You write: “As to your criticism that they are embracing a “customer” service oriented model — well, so what? Selling stuff is that makes our economy work. We don’t rely on volunteers to clean the roads, drive the ambulances, or even to perform surgery. Paying people to do things is what gets things done.”

          First, I would point out that I said nothing about relying on volunteers. And for the record, I think that is a terrible idea.

          Beyond that, we come to what appears to be a fundamental philosophical difference about cryonics. I most emphatically do not see cryonics as a product akin to toasters, computers, or even medical or surgical treatment. It cannot be regarded in this light, or treated so because it lacks a number of the essential features of developed products such as, to name but a few:

          1) There is no straightforward and reliable way to evaluate the quality or the outcome in any normal human time scale.
          2) No chronologically determined endpoint for results; the care of cryonics patients is, by definition, open-ended and indefinite. This makes all kinds of definitive planning, including financial planning, not merely problematic, but impossible.
          3) No robust competitive marketplace for consumers to choose from.
          4) Socially and medically ostracized.
          5) Completely unregulated, internally or externally (this is unprecedented in almost any technologically advanced society where large amounts of money and life or death issues are involved).

          I could go on and on… A mistake I believe we are making is too look to the existing marketplace of institutional mechanisms and feel we must choose from that menu. I don’t think that will work.

          Finally,and very importantly, I not only didn’t say that most of these things are Max’s fault, the reality is that I don’t believe that to be the case; and in fact it is objectively NOT the case. What I said was that Max reacted to my comments and criticisms as if they were his personal doing, and not just his newly acquired responsibility to fix. Obviously, there is a large and material difference between these two situations. It is certainly true that I found it incredible that he would assert, as he did, that there is currently virtually no wasteful spending at Alcor, that he is “fortunate to have come into Alcor with such uniformly excellent employees,” and that, presumably, all ten of them were indispensable – including one who is the Financial Director, but cannot either produce current (or past) financial reports, or alternatively, offer a cogent and compelling explanation of why this should be the case. THAT creeped me out completely. But again, your mileage may differ. – Mike Darwin

          • Mark Plus says:

            Time to put that extropian theory into practice?

            http://video.google.com/videoplay?docid=5883182560901699665#

          • admin says:

            Sorry, my dongle modem bandwidth doesn’t allow me to watch videos effectively. I will say, that as a sobered Danila Medvedev and I made our way to Salem Oregon by car and continued our discussion about Alcor, Danila noted grimly that he felt Alcor would be the perfect test for Max’s idea of Dynamic Optimism (http://www.maxmore.com/optimism.htm). My response was to propose the founding of a new school of philosophical thought more appropriate to the task, which I promptly christened Dynamic Pessimism. As the weeks have wore on, I’ve begun to think it might need to be rechristened Massive Dynamic Pessimism. — Mike Darwin

          • Luke Parrish says:

            Thanks for the clarifications, Mike. You make some good points.

            My ideal is for cryonics to overcome the social (and medical) ostracism as quickly as possible. Making sure organizations like Alcor are minding their P’s and Q’s is important to that.

          • unperson says:

            Mike, I thank you for taking all the time and effort to report on your visit and put up these photos etc. Fascinating report. Nothing else like it online. As a cryoblogger, you stand alone.

            Further, you have really done a lot for cryonics over the years, and this latest effort here is yet another chapter in your work for cryonics.

            However, I have to agree with Luke that you are overreacting here. The facility doesn’t look that bad.

            I somewhat agree with your concerns about financial statements and the hiring of excess personnel, and also with the idea of paid employees versus volunteer cryonicists. Again, it seems to me that we have had SIGNIFICANT problems with MOST of the non-cryonicists who have ever worked at alcor. I imagine I do not need to go over the actual names here. I realize, however, that there are other concerns that may make hiring outsiders necessary.

            As for max more, I don’t think that he is the right person to head alcor, but then again my ideas about the direction cryonics needs to take are vastly different from those expressed by any other cryonicist online.

            In the photo of max more above, it would appear as if he has some reservations about you.

            I definitely think Alcor could use your help. Unfortunately, they don’t seem to want you. And I can see why–from what I can tell from what you write online, you seem to have some emotional/psychological “issues.” You would appear to be easily the most knowledgeable person in the world when it comes to cryonics, but that package comes bundled with your emotional/psychological “baggage” that may make it difficult for other cryos to work with you. And I realize that I am saying this without ever having even met you in person. This is my evaluation of you from your writings here and your responses in the comments and from the history of cryonics as written in the cryonet archives.

            Not much to go on, but that is just my take on it.

          • admin says:

            Since you are ignoring the various elephants in the room, I will, too…

            When you write: “In the photo of max more above, it would appear as if he has some reservations about you.” I find that fascinating, I guess because it presumes that I’m the one at whom Max is looking. I’m not. In fact, I declined to be in any of the photos, and I took none of the pictures. I think I was munching on strawberries elsewhere when those photos were taken. The photographer was a member of the KrioRus crew, Stas Lipin. Max was having what by anyone’s standards would be a very stressful day. He had a high level of concern about the KR people, he had a member going down, and he had many other matters to attend to. I thought it was gracious of him to permit the tour, given the unexpected turn of events, and even more gracious to spend the amount of time he did.

            As for my “emotional/psychological “issues,” well, I’ll just post this quote, and leave it at that ;-)

            “They think I’m crazy, … But trust me, I’m 100 percent there.”
            - Marilyn Monroe

            –Mike Darwin

          • unperson says:

            admin wrote:
            “Since you are ignoring the various elephants in the room, I will, too… ”
            ———-

            What are you referring to?

          • admin says:

            One of the people who reviewed “A Visit to Alcor” before its publication suggested that I include a table in the text listing all of the problems and deficiencies mentioned in the article, because “it will make it more difficult for the readers to ignore these problems or dismiss them.” I thought that was a good idea and in fact, I did just that, but decided not to include it at the last minute because it might seem like overkill. Your initial letter on this topic made mention of the following issues in your response:

            1) You overreacting here. The facility doesn’t look that bad.
            2) You don’t think that Max More is the right person to head Alcor.
            3) Max appears (from a photo) to have some reservations about me.
            4) Alcor could use my help. Unfortunately, they don’t seem to want me and you can see why–from what you can tell from what I write online, I seem to have some emotional/psychological “issues.”

            Fair enough; this is obviously your honest reaction and I not only think it likely one shared by many other readers, I genuinely value it for its honesty and for the feedback it provides about the effectiveness (or lack thereof) of what I’ve written.

            However, what it doesn’t address are the numerous objective (and presumably objectively verifiable) issues, that are raised in the article; some of which of are very, very serious problems, elephant sized problems, if indeed they are correct. This is critically important because these “problems” do not depend upon my psychological state, neuropsychiatric condition, or emotional timber. I recently visited a 999 (911) call center and I was impressed that usually the more serious the incoming emergency call, the crazier the caller sounds. Not infrequently they are hysterical, and it becomes the job of the call-taker to separate and extract life or death factual information from irrelevant detail, emotional vocalizations, and hysteria-driven disorganization of thought. Sometimes callers are genuinely crazy, but to make matters more difficult, are actually reporting a genuine emergency. My point here is that it is a dangerous red herring to dismiss discrete and well articulated “matters of fact” as irrelevant because the person making them is rumored to have “emotional/psychological “issues,’” (or even does have such problems).

            So, having said that, let’s take a look at some of those elephants:

            1) Since the late 1980s the optimum way to transport cryonics patients with very little ischemic time is to initiate extracorporeal support with a blood pump, membrane oxygenator and heat exchanger, followed by blood washout and cooling to ~ 10 deg c with extracorporeal support continuing through transport to the cryonics organization facility and the start of cryoprotective perfusion (in the case of patients who arrest locally or within ~ 6-8 hours drive time to the facility). To the best of my knowledge, there has been no change to this scenario as best practice treatment. Alcor spent tens of thousands of dollars on a sophisticated mobile operating room (MOR) to support exactly this technological option. And yet, the Mobile Advanced Rescue Cart (MARC) sat is disrepair, covered with dust, its batteries sitting with corrosion caked terminals on the floor in front it. In the MARC’s place in the MOR is a very pricey, beautifully fabricated PIB made from stainless steel. I could go further and comment on the many deficiencies in the design of this PIB, but this isn’t the place and I don’t believe it would do any good. So, elephant #1 is that the MARC, and apparently the use of extracorporeally assisted transport via femoral-femoral bypass, has been abandoned at Alcor; and this has been done without any apparent notification of the membership that there has been such a profound change in treatment. When I reacted with amazement at the state of the MARC, Hugh Hixon responded by noting with apparent sarcasm or disdain, “That was one of Regina Pancake’s ideas.”

            2) Patients who had received prompt cardiopulmonary support (CPS) were subsequently exposed to ischemia at temperatures a little below normal body temperature for 1 to 1.5 hours, while burr holes were drilled, and the neck vessels were cannulated, for no apparently rational reason. Despite bringing this matter to Alcor’s attention, this absolutely staggering error was repeated yet again with case A-2435 which was carried out by substantially the same technical and biomedical personnel staffing Alcor today. Even amongst the lay persons reading this, who would imagine it even remotely acceptable to simply interrupt CPR for over an hour so that cannulae could be placed, or burr holes made? Burr holes are a monitoring tool, an important one, but in no way trump CPS. If femoral-femoral (groin vascular access) is used to provide CPS after closed chest CPS is started, there is no need to interrupt CPS to cannulate the great vessels in the chest, or the internal carotid arteries in the neck. This is common sense. When contrary behavior is observed, such as has repeatedly occurred at Alcor, it is a sign that something is deeply, systemically wrong.

            3) Alcor case reports are narratives where one “heroic action” after another is required to save the save the day. Patients almost don’t get perfused in the field because some essential item is missing, a piece of equipment malfunctions…and the day is saved only when some “clever” work around or fix that is required to save the day (except in those cases when it doesn’t) materializes. This is totally contrary to how medical, surgical, technical, or even professionally executed home plumbing repair procedures proceed. They are remarkable not for their drama, but for their boredom. There are no frantic requests for missing instruments, tubing connectors or supplies; and if something breaks or malfunctions, a backup part is readily at hand for all critical components. One of the most difficult things to get cryonicists to do is to actually watch an entire unedited video of a human cryonics case done well. This is because other than a few minutes at the start of Transport, there is no drama. It is just hour after hour after hour of quiet, nonplussed work. There are few if any “emergencies.” Absence of this kind of procession of case work, and of the large amounts of data (which can only be gathered by an organized and well oiled team working under good conditions with a high level of knowledge and good leadership), there is nothing but evidence of incompetence an trouble..

            4) My impression and opinion of what the organizational and housekeeping state of the Alcor OR imply for patient care are unquestionably subjective. The reader is free to look at the photos and accept or reject them as they choose.

            5) The recirculating reservoir was dangerously small making microbubble embolization of the patient during cryoprotective perfusion all but inevitable, since the cold, polymer-rich, viscous perfusate develops stable foam as a consequence of vortex formation and air entrapment from the action of the mixing magnetic stir-bar. A detailed paper documenting this effect and demonstrating a simple way to eliminate it was first published in 1994. ( see: http://www.cryocare.org/index.cgi?subdir=bpi&url=tech5.txt) and yet the problem persists through the present. Easy and inexpensive to implement solutions were given over a decade ago. They have not been implemented.

            6) Alcor has expended substantial sums on protecting the patients against terrorist attack. The likelihood of such attack may be open to debate, but what is not is that the first and most fundamental element of protection for BOTH patients and staff is perimeter security. Isolating assets (personnel, patients or infrastructure) from potential threat is the most cost effective and the most important step for security. This is best accomplished by a fence, bollards, and perhaps other more sophisticated perimeter defenses. To leave a building and its personnel undefended while expending large sums of money to provide ineffective protection to patients (again, because of lack of stand-off from street access) makes no sense. And to then, to insist that this is not money misspent, makes even less sense. Years ago, Alcor made a conscious decision to remove neuro dewars from vaults, not proceed with plans to similarly protect whole body patients, and to expend ~1K per whole body dewar to electropolish them. These things were done, and in particular electropolishing (which provides a mirror bright finish) in large measure because it made the storage facility attractive to the media. Photographs of gleaming whole body dewars look impressive and are “media-genic.”

            7) Alcor has moved from promoting cryonics as an experimental procedure, wherein Alcor functioned as a mutual aid organization that recruiting members who were also experimental subjects to selling cryonics to customers; to a marketing-based approach to promoting cryonics which views members and patients as customers.

            Those are some of the unmentioned elephants in the room. – Mike Darwin

        • Fundie says:

          There is nothing inherently wrong with selling. But selling is a more workable model when you have a commoditizable product. Cryonics is new, unique, and experimental. (Okay, maybe it’s not so new, but given where we are it is still far from commoditized.)

          It is clear to me that people who desire to survive cryopreservation ought to be massively involved in it. The people who simply phone Alcor and “purchase the product” stand a good chance of not making it for any of a hundred or more reasons. The level of seriousness required to get a good cryopreservation far exceeds the level that required of a mere “customer,” and for this reason I think a mutual aid society is an organization model with much greater chances of success.

          • admin says:

            This is a succinctly and brilliantly articulated statement of the problem. Many years ago, when consumer electronics were very expensive, a company called Heathkit sold things like color televisions, shortwave and HAM radios, and lots of other electronics in PIECES – literally as kits, which the “customer” had to put together. Of course, Healrhkit didn’t really have customers, they had hobbyists and electronics geeks who wanted the pleasure (and frustration) of getting hands on experience with actually building these devices. A few years ago, I was in a Pub in Soho, talking with some friends, when the topic of Mac vs. PC came up. As it turned out, one of the guys in the conversation had been a telephone order taker and counselor for Heathkit! I asked him about that job, and just about the first point he made was that the company was very careful to make sure that every potential customer was thoroughly apprised that he was not about to get a 10-step snap together kit in the mail, but rather thousands of parts requiring soldering AND a basic understanding of electronic circuitry. And still they had a lot of grief from pissed off customers who expected to get a TV without hundreds of hours of intense effort. I immediately thought of cryonics. Mike Darwin

          • Fundie says:

            I’ve heard of Heathkit. It sounds like they make a great example of a company that wanted to serve one particular market niche and not others. Such a company (or organization) has to invest some work to actively turn away people who are not in the niche they wish to serve. I’ve seen a lot of areas of thought where people cannot comprehend an organization not trying to cater to literally everybody, and read a lot of conversations where people have gotten very disrespectful as they explain how “wrong” an institution is for engaging in actions that are likely to drive people away.

            Applied to cryonics, if a cryo org wants to try to be a company catering to customers, more power to them, but I am definitely of the thought that this is not going to be viable for a long period of time, and people who are seriously interested in survival have every reason to support an organization that is actively turning away people who are not in its niche. I’ve read a lot of writing from multiple writers suggesting that Alcor’s policies have resulted in accepting patients that have been a net drain (“summing” up a lot of factors that are not all financial, or even numeric). The people who have commented on this are not irrational, and they are not damaging cryonics if they want to take a different approach and seek a more limited niche of people to be involved.

          • unperson says:

            but in this real world, people have to make a living.

      • Abelard Lindsey says:

        Proper financial reporting is necessary to establish trust of the organization with the membership, which is especially important for something “far out” like cryonics. One of the most common forms of organizational failure is improper financial management. I’ve seen too many businesses fail because of this (both here and in Asia). They must have some kind of budget that they work with. I suspect they do, but they do not want to share it with you because their monthly burn rate is way too high.

        What I don’t understand is where Saul Kent is in all of this. He is the leading director and should be on top of all of this. If I was Saul, I would insist on financial and employee activity reports monthly. Perhaps he is too busy with Suspended Animation as well as the LEF itself although I hear Bill Faloon does the day to day management of LEF.

        Unless Alcor routinely does two suspensions simultaneously, I cannot imagine why they need 10 people on payroll.

      • Fundie says:

        “people have to make a living” is completely tangential to what I am saying.

        Yes, people have to make a living. It does not follow from this that every institution and organization should attempt to attract every single human on the earth.

  2. Fundie says:

    Footnote 2:

    I gained enormous respect for Melody Maxim’s ability to inflict harm (And conversely to do good by pointing out soft spots and likely failure modes.)

    I caught that down at the bottom and wondered how many others did.

    I definitely appreciate your much more effective (and much more respectful) way of seeking to accomplish the same potential good.

    It’s interesting that Maxim has gone all silent.

  3. Mark Plus says:

    Speaking of extropianism, advocates of alleged technological acceleration have some explaining to do. The Foresight Institute’s quarter century reunion later this month intends to focus on “the future of nanotech,” even though in 2011 we live in the time of a previously envisioned “future of nanotech” many of these dead-enders speculated about 20-25 years ago; at this rate they’ll eventually have to push “the future of nanotech” off to the 22nd century. We also live in “the future of cryonics” from the vantage points of previous years going back to 1964, with underwhelming results.

    By contrast, people who started careers in the 1980′s and 1990′s in fields like neuroscience, computing, biotechnology, medical imaging and even battery technologies have something to show for their efforts in 2011.

    • Abelard Lindsey says:

      I recently re-read my old (signed) copy of “Engines of Creation”. Drexler’s original timeline is not that much different than what we expect today. The chapter of the book on cell repair machines, he mentioned 2030 as to the first simple anti-aging therapies and 2050 when we would get the good stuff. This is not that different than Mike’s timeline above. Also, I remember from the 1980′s that we all thought that the early 22nd century (I always thought between 2100 and 2150) was when we would come out, assuming that cryonics even worked in the first place, which we were not at all certain would be the case.

      • admin says:

        I’ve always personally liked and respected Drexler, and I never had a problem with his highly qualified “technological forecasting.” However, it is important to separate Drexler from The Foresight Institute, which was and is primarily the work of Chis Peterson. Notably absent from the Reunion Conference lineup is Eric Drexler. — Mike Darwin

        • Abelard Lindsey says:

          Nanotechnology as depicted in “Engines” is vaguely biological-like. This is because Drexler wrote much of it in 1984 and 1985. The ideas about nano-mechanical nanotechnology first came around just as “Engines” was first published in spring of 1986. It was exclusively some early successes of SPM (scanning probe microscopy) and STM, in particular, that lead others to believe that “nano-mechanical” technology was possible, most notably Ralph Merkel. SPM’s make good analytical instruments. I have sold them myself and am familiar with their capabilities. However, they will not lead to nanotechnology in the manner that the Foresight people expect them to.

          These days, Eric Drexler seems to be focused on biologically-based nanotechnology, which I think will work, even within the timelines cited in the original version of “Engines”.

          I’ve never met Chris Peterson and have never been to any Foresight institute event. So, I don’t know much about her or the group. My impression is that Foresight institute is rather passe these days as the Bay Area “transhumanists” seem to obsess over “uploading” and AI more than anything else. I’ve never met, in person, any of the Bay Area transhumanists either.

          Nano-mechanical approach is an open question. There is a researcher in the U.K., Philip Moarity, who has a 5 million pound grant to answer the question. He has said in an interview that he does not believe nano-mechanical technology is scalable. The biological stuff seems to be progressing in its incremental fashion.

  4. Luke Parrish says:

    Cryonics has been a “dedicated hobbyist” concern for a LONG TIME now. I don’t support making it even more so unless there is no alternative.

    The dedicated cryonicist can improve their odds significantly (on average) by exercising control over where they deanimate, making sure they have sympathetic caregivers, and so forth. Those who choose to be casual consumers are certainly going to (on average) pay a price — perhaps the ultimate price, perhaps not. Those who do not consume the product at all are paying the ultimate price by default.

    As it stands, even the most casual consumer of cryonics is an early adopter. They are doing something almost nobody else is doing. Like any “new” product, it is inferior to what it would be if everyone was doing it, and costs a lot more. (The first cell phones are a case in point.) I want to live to see cryonics mature as a market, and to become widely seen as something that normal people can and do sign up for.

    • admin says:

      Luke, you are certainly right that cryonics isn’t a hobby, and shouldn’t be one. I’d go further, and say that a lot of harm has come from treating it as such. The Heathkit analogy wasn’t meant to suggest that as a model for cryonics. In fact, cryonics is in a MUCH worse position than a product such as a hobby electronics kit, or for that matter, a cranky new technology like personal computers were in the mid to late 1970s. Those products WORKED – if not all of the time, then some of the time. In fairness, a good fraction of Heathkit sales were not to hobbyists, but rather were to people who knew, or could learn how to solder, and wanted test, radio, or stereo equipment that would otherwise have been unaffordable. My Uncle Thurmam Meyers, had a fantastic stereo system in the very early 1960s, that used a lot of Heathkit components. He was no hobbyist – just a guy who wanted consumer goods he couldn’t otherwise afford. Similarly, I saw Heathkit oscilloscopes and test equipment in labs and businesses when I was a kid. In short, it was was WORKING PRODUCT. Heathkit also had competition, and it was possible to determine outcome and product quality with every kit sold by any of the kit manufacturers.

      Cryonics is not even operational to that standard, so that’s an added level of difficulty. The important thing about the Heathkit analogy was that it was essential for the company and the customer to know what to expect from each other. That’s true in any business relationship, but usually the company has little burden or obligation to do much explaining to the customer beyond telling him how to use the product, and only recently, how it might injure or kill him. Thirty years ago, when you bought a chain saw or shotgun, all parties involved assumed you knew these things could maim and kill – easily. Nobody picked up a chain saw in 1960 and expected that if they foolishly (or even carefully) cut their leg off with it that they could sue the manufacturer. A good part of the reason why that was so was because chain saws cost a lot of money in 1960, and almost exclusively they were used by people who knew how to use them and what the hazards were. That isn’t the case today – chainsaws are vastly cheaper, and now, Every Joe thinks he can use one.

      Cryonics is worse still than chainsaws, because ultimately it is going to impinge directly on the most sensitive areas of medicine. This has a lot of potential for harm, even if it is handled very skillfully. The bite-back from failing to treat cryonics as what it is, a highly speculative, experimental, and unproven procedure (which nevertheless represents our only realistic shot at survival) will not be good, and may well be disastrous. Even in the 1970s, Heathkit would have been out of business if they didn’t market their product honestly and responsibly, which in their case meant exerting a lot of additional effort to inform their customers that their participation in assembling the product would require many hours of work, the ability to follow instructions, and a LOT of patience. Cryonics has an even higher bar to meet; and it MUST develop surrogate quality feedback mechanisms and ensure its customers are educated in their use. And here’s the interesting thing, once those things are done, they will result in more members, not less. — Mike Darwin

  5. Abelard Lindsey says:

    Mike,

    Your desciptions of the “elephants” in the room at Alcor is good. However, I don’t think they can do much about the perimeter security unless they move to a different location. I visited Alcor in Scottsdale about 10 years ago. Assuming they are still in the same location, that facility is part of a larger building with other tenants and businesses. I don’t see how the perimeter fence you suggest can be built without troubling the other tenant/owners in the same structure.

    To put up the kind of perimeter defense you suggest would require them to buy and move into a stand-alone building of their own (this is actually a good idea if they can afford it). They would also have to buy, not lease, the building so that they can make the perimeter and structural changes that you recommend without having to get landlord approval. Better yet, have a building built to their specifications. Since real estate and construction industry is in a funk right now, particularly in Arizona (one of the four “sand” states) where the bubble got totally out of hand, they should be able to find a good contractor that can design and build such a structure at reasonable cost.

    About the MARC, I have no idea why they are not using it. Does the MOR have the same instrumentation and technical capabilities as the MARC? If not, why not?
    I notice from Alcor’s website that Regina Pancake is no longer with Alcor. If the changes she implemented do not make sense, why don’t they reverse them since she is no longer there to defend them?

    • admin says:

      As you say, it’s been a decade since you toured the Alcor facility – a lot has changed. Alcor has been through a number of regimen changes in the past decade (honestly, I’ve lost count) and each has had its own set of schemes and dreams, which resulted in Alcor absorbing more and more of the Acoma Drive building. I won’t give the whole depressing history, but suffice it to say that they now occupy most of the building. They had some un-leased space when we were there, and are now down to one tenant (one who does not do retail business, if I recall correctly). Thus, it would seem possible for them to put perimeter security in place if they believe it is necessary. With a remotely operated gate, both staff and tenant(s) could come and go at will, albeit with some inconvenience. This is why a fundamental criterion of an owned cryonics facility is (or ought to be) that it be freestanding.

      It should also be pointed out that Alcor does not own the building, the Patient Care Trust (PCT) does. Since the PCT’s first duty is to the welfare of the patients, it would seem that the only obstacle to perimeter security for Alcor would be financial, providing that such security is deemed necessary. I presume someone at Alcor believes extraordinary security is necessary, or they would not have expended the considerable resources they did to harden the patient care bay (whilst also leaving it fundamentally unprotected). Decision making at Alcor appears to go in the dark, and at far remove from member knowledge or input. Cryonics “magazine” deals only with generalities, not with the brass tacks (financial, technical, or clinical) of Alcor’s operations. How decisions are taken at Alcor is a complete mystery to me – and I’ve been trying to keep informed and aware. I was really surprised to see the blast-resistant glass and personnel door. Having said that, if the threat justifies such security, so be it (as long as it isn’t a Potemkin effort, or simply ineffective). I have heard that Alcor has had gunfire into the facility and vandalism – possibly as a result of the Ted Williams case. I used the security expenditures not because I perceive them as particularly pressing (CI has no such security, and does not even lock its cryostats), but because it was an example of lunatic spending; throwing money at a problem to great cosmetic effect, but with little practical benefit.

      The issue of how and to what degree Alcor (or any cryonics facility) should be secured is a different matter altogether. It’s a complex one and is beyond the scope of detailed commentary here. Suffice it to say, as I already have, that THE first step in security is to secure your perimeter. I suggested some ways that might be achieved (expediently and otherwise), but that’s only the tip of the iceberg.

      The mobile operating room was designed to support the MARC, or more generally, to facilitate in-field cardiopulmonary bypass. If you aren’t going to do that, you can use a much simpler operating platform. If you like, I can answer your questions in more detail and visually with a “formal” post where I can use photographs. — Mike Darwin

      • Mark Plus says:

        I wonder if a product like X-FLEX applied to the ceiling could provide some protection from a roof bomb until Alcor can find a better solution:

        http://xflexsystem.com/

        • admin says:

          Mark, this looks like an extraordinarily useful product, depending upon how much it costs. Even if it is cost prohibitive to use it to protect the entire ceiling of the PCB, it should be affordable to use it to cover the lids of the dewars (neck-plug covers), and possibly to clad the dewars (with an appropriate spacer material). By spacer material, I mean something to absorb the shock waves and the impact energy of fragments striking the surface of the dewar in order to protect the outer can from becoming dented or deformed. Gypsum might work, or for that matter, the right density of closed cell polymer foam – something along the line of closed cell polyethylene – the material used to make swimming flotation sticks for children, and those interdigitating anti-fatigue floor mats. Anything that will provide a buffer and prevent denting of the outer can should work. [I confess that testing to find what does work sounds like an awful lot of fun.] The attractive thing about materials like gypsum are that they provide safe burn time. Each 1/2″ of fire rated gypsum wall board gives about 20 minutes of burn-through time. The outer can of stainless steel cryogenic dewars can withstand ambient temperatures up to ~ 400 deg F, more or less indefinitely (not so the lid/neck-plug or the casters).

          Whether or not Alcor uses this material in the future, thank you VERY much for bringing it to my attention. This is a really useful product, because it accomplishes with lightweight and compact material what would have required at least 4 inches of steel reinforced concrete to achieve in the past. Certainly, it is ideal for cladding the surface of dewars to add enormous protection in the event the primary blast barrier is breached. This is the kind of useful and eye-opening suggestion you get only when you open and outward looking, rather than inward looking and closed. — Mike Darwin

          • Anon says:

            Concerning the serious problems you’ve described, security doesn’t even seem to rank on a 30-point priority list, nor warrant any kind of serious discussion at this point.

            Who in this world got an interest to assassinate a bunch of dead frozen nerds with a bomb? In the long term a certain security standard is obviously sensible, but blast-proof walls and ceilings at this point in time… come on! At the current stage of cryonics I’m much more likely to be accidentally and irreversibly killed by incompetent Alcor staff than by crazy anti-futurists or religious nuts.

          • admin says:

            In general, I agree with you. The risk of a major assault on any cryonics organization’s patients (or staff) at this time is very, very low; arguably vanishingly small. And again, given the other problems specified, it can be argued that such risk (and thus precautions against it) don’t even appear on the event horizon of “must do” action items at this time. However, it is also prudent to consider that the long term nature of cryonics operations means that risk is cumulative and thus that small risks at any given time will eventually likely result in disaster. So, a prudent thing to do is to address those risks in a rational and incremental way by planning for, and ultimately creating a super-hardened facility for patient storage. I’ve spent a fair bit of time specifying such a facility (starting in the mid-1980s) and there is no question, at least in my mind, that such a facility could have been put in place some years ago, with even a small fraction of the bequest money that Alcor has spent to no apparent benefit over the past 20 years. This will probably be the subject of a detailed article here on Chronosphere in the future.

            The creation of such a hardened facility with grid-independent cryogenic refrigeration capability is really just common sense. For instance, most of the world’s largest corporations, and all of the world’s largest nation-states have super-hardened facilities for storage of their most critical data; tax records, financial records, intellectual property, etc. A quick look at the unexpected weather related flooding, tornado and seismic damage to infrastructure around the world (and especially in the US) shows the wisdom of such a strategy – even in the case of human enterprises that have comparatively short timescales of operation: i.e., on the order of a 100 to 200 years at most, for corporations.

            Finally, as the Ted Williams case illustrates (and Dora Kent, as well), patient security can go from a negligible risk position to a very high risk position in a matter of days or weeks, with virtually no warning. All that would be necessary is for Alcor, CI, or any other cryonics organization to cryopreserve an individual who touches off intense hostility on the part of some of the public, or in some special interest group. For instance, while I was very dubious about the Ted Williams cryopreservation, it never even remotely occurred to me that it would launch a micro-movement of zealous nut-cases who would, in fact, threaten Alcor. Given the inherent ability of cryonics to provoke strong emotional reactions in some people if they perceive it at as threatening, it is not unreasonable to create a secure environment for the patients, and also for the staff (who are arguably more likely to be primary targets of vengeance or revenge). Of course such a threat does not obviate the need for RATIONAL planning and execution of security precautions in a cost effective way. — Mike Darwin

          • Fundie says:

            grid-independent cryogenic refrigeration capability

            As in on-site LN2 production?

          • admin says:

            Yes. This has been practical for at least 20 years using one kind of technology or another. The economics and mechanics of on-site cryogenic refrigeration were first rigorously explored by Greg Fahy in the mid to late 1980s. Greg proposed using “cold finger” technology, essentially a small Joule-Thompson helium refrigerator to cool a single bigfoot dewar. Cold finger’s were developed primarily for applications in electron microscopy and experimental physics where it was uneconomical to use LN2, or where an arbitrary temperature was needed which did not correspond to the boiling point of any of the commonly available refrigerant cryogenic gases. Greg demonstrated mathematically that it was possible to use a cold finger to achieve zero boil off cryogenic refrigeration with a bigfoot. It would have been considerably more expensive than refrigeration with delivered LN2, but would have been useful as a stopgap in an emergency.

            Since that time, there have been truly enormous advances in molecular sieving technology and cryogenic refrigeration. It is now possible to use polymer membranes to selectively remove nitrogen from the air and deliver it to a highly efficient low maintenance cryogenic refrigerator, or gas liquifier. This has eliminated the need for separation towers on small scale nitrogen liquification facilities, which were a major headache in terms of both maintenance and nitrogen gas purity. Advances in helium refrigerators have reduced maintenance to a series of simple, straightforward parts change outs, dramatically increased reliability, and virtually eliminated significant downtime. They have also reduced the cost of such systems dramatically.

            Concurrent advances in solar power technology have made it feasible to provide sufficient kilowattage to reliably power such small-scale LN2 production plants in a place such as central or southern Arizona. Low or no sun days can be compensated for by storing LN2 liquified on sunny days (easily feasible in central Arizona). Thus, in the event of a ball-busting emergency, the procedure would be to convert all patients to neuro and place them in bigfoot dewars. At this time, 2 bigfoot dewars would be required for Alcor. You would, at a minimum, also need the following: a single 150 kW Solar Power Plant: $605,800, 2 x LN2 Plants: $144,000, Food, Water, Medical Supplies: $15,000, 2K gallons Diesel Fuel: $5,000, Miscellaneous: $10,000, Hardened Storage Facility: $1,367,640 (ECD-60), $ 290,300 (CAT-12) at a Total cost of ~ $2, 447,750. This rough estimate is based on specific cost and energy use estimates made by Eugen Leitl and I a couple of years ago and would allow 1-year grid independent survival of patients and staff (I’m sure costs have risen substantially since then). The diesel fuel is necessary as a buffer for any prolonged period without sunlight, and to supply HVAC and lighting for personnel during the night under some foreseeable conditions. The entire facility would be underground and would use off the shelf technology in this implementation. This was, in fact, to be Part 4 of my Failure Analysis Lectures, but alas, I didn’t finish it, since Parts 1-3 seemed to be of no interest and to have no practical effect. As you may now be guessing, this is where I am heading with the “The Latter Day Laputas” articles; so you now know the ending ;-0. BTW, the slides and some of the text for this proposal were submitted to Alcor awhile ago. My guess is that they haven’t stopped laughing yet, if they paid them any serious attention at all. — Mike Darwin

          • Fundie says:

            Wonderful, Mike. I am glad you are sharing part 4 with the world. I have no doubt that we would all be delighted to see a detailed Alcor rebuttal.

  6. Fundie says:

    I wonder what the odds are of Alcor giving up the MARC to another group that would want to make use of it.

    • admin says:

      IMHO, none. You could of course ask them yourself – the definitive approach. Historically Alcor has had large amounts of “obsolete” equipment, such as PIPs, Thumpers, and many other items used in Transport. Prior to 1991 this equipment was put into the the field with nascent start-up groups, mostly overseas where the local groups had very little money. In at least 2 cases I know of, this equipment was used to help stabilize patients who otherwise would have gotten much poorer care. Since 1991, I know of no cases where this has been done. Alcor has supported some Alcor groups overseas, such as Alcor UK, but my understanding is that they charge for such support. Again, you would do best to ask Alcor – that’s the advice I’ve given others with similar questions. — Mike Darwin

    • admin says:

      Mark, this is interesting, but not surprising. As of 11/19/2007 no annual financial reports or shareholders’ reports had been filed for 21st Century Medicine since at least 2001. As recently as a few months ago, I had two 21CM shareholders contact me asking if I had, or had received annual financial reports and/or shareholders’ reports for 21CM. These inquiries were made because these individuals, both 21CM shareholders, had not received such reports in over 10 years. My response was that I had not received any communications whatsoever from 21CM in terms of annual reports or shareholders reports, and had no knowledge of any shareholders’ meetings being held since the last one I attended in Ontario, CA sometime around 1999 or 2000.

      Annual financial reports and (at least) annual shareholders meetings are legal requirements for maintaining corporate integrity in California, and most US states. 21CM is a California corporation, and as such it must allow shareholders to vote, hold an annual meeting of shareholders, permit a shareholder to inspect records after a written demand and provide an annual report to shareholders (http://ag.ca.gov/consumers/general/corporate_shareholders.php). I know of two shareholders who have requested some or all of the above, and did not received a response from 21CM, despite the passage of several years since the requests were made. I have not made such requests, so I cannot speak to whether these complaints of noncompliance are valid, or not.

      It would be interesting to know if the various corporate entities associated with and/or funded by LEF have filed the required state and federal financial reports, or otherwise complied with state and federal laws that preserve their corporate shield and/or their tax exempt status — Mike Darwin

      • Abelard Lindsey says:

        Having shareholders meetings, issuing financial reports, and what not are a part of “acting” like a corporation, which is necessary for the legal and liability protections of a corporation. Not acting like a corporation can result in the removal of the corporate “shield” and exposing the principles to personal liability in the case of lawsuit or other legal action. If these issues are true, Bill and Saul could be exposing themselves to personal liability. I thought they were more careful than this.

  7. gwern says:

    > It is minimally engineered for load bearing, and this fine, and a damn good thing in earthquake country, where tilt-up concrete industrial building construction was first developed.

    ?

  8. KBart says:

    I have to say, I’m deeply disappointed and disturbed after reading through your post and the comments – it’s just horrifying to see how bad things have gotten at Alcor. I’ve been interested in cryonics for quite a few years now and I was actually planning on signing up for neuropreservation with Alcor within the next few months. Considering the above, would you have any suggestions for a different, more reliable cryopreservation organization?

    Thanks!

Leave a Reply to admin Cancel reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>