On 06 May, 2012 responses were solicited to what was termed The Cryonics Intelligence Test which was posted here on Chronosphere (see: http://wp.me/p1sGcr-vV). Two people responded to this public request to “take the test” and provide input on possible solutions to the problems posed by the resource material that accompanied the test. The test consisted of the resource materials and the following  instructions:

Dear ______,

If you can figure out the scientific take home message for cryonics in what is to follow, you will have demonstrated extraordinary insight into “thinking in a cryonics-medical context.”

You will also have the tool to be able to understand why I believe that cryonics must, on a purely scientific-medical basis, be pursued in a fundamentally different way, both biomedically and socially.

The Test: The test resource materials are available for download at ___________, you will find a number of full text peer reviewed scientific papers. In addition, you will be sent several cryopatient case Hxs. Together, these resources contain data which should give a reasonably intelligent person with a properly prepared mind a fundamentally new insight into a major, indeed overwhelming flaw in how cryonics has been, and currently is practiced.

Your task is to:

a) identify the problem(s)

b) identify one or more possible solutions

You have 5 days to complete this task. Your response should be in the form of a succinct statement of the problem, and an itemization, and if you like, a discussion of possible solutions.

Thanks for your patience and cooperation.

Mike Darwin

Purposes

The reasons for  this exercise were as follows (in no particular order):

To answer the question posed to me by Alcor CEO on what was the most important research to be undertaking in cryonics at this time.

To determine if a representative cross section of people not actively employed in cryonics, or working in cryonics-related research, would independently reach the same or same similar conclusions about a heretofore not understood or appreciated major problem in cryonics and propose the same possible solutions (or novel ones) to said problem.

To evaluate the caliber of the intellects (who chose to participate) who read Chronosphere.

To attempt to determine the number of Chronosphere readers who were willing to accept the challenge of  exposing their judgment and intellectual performance to scrutiny, either by myself, publicly, or both.

To determine the approximate number of people who took the time and exerted the effort to at least peruse the article and download the Test Resource Materials.

To attempt to get a preliminary idea of the nature of the readers of Chronosphere and their interest in highly technical topics of serious relevance to cryonics.

To gauge the impact and reaction of both the leadership of the cryonics community, and the cryonics community itself, to the revelations that result from this exercise and the commentary that is to shortly follow it.

To solicit novel solutions to the central problem posed in the exercise.

To inform the community at large, both the cryonics community and the public, of this serious problem in the way human cryoprerservation is currently being pursued (e.g., informed consent).

Participants

Two people (Alexander McLin and Gerald Monroe ) responded to the public request on Chronosphere to take the test. Prior to publicly soliciting responses, fifteen individuals of diverse backgrounds in cryonics were privately asked to take the test. Of these, eleven agreed to do so and of those eleven, ten completed the test. Of the ten privately solicited respondents, three agreed to allow publication of their answers; two with the use of their names. One individual, a young academic pursuing advanced graduate degrees, asked for and was granted anonymity, due to the likelihood that open involvement in cryonics could prejudice his academic career.

Since it is not possible for the responses of those who chose not to allow publication to be evaluated here, I will not make any comment on them beyond noting that they exist and that they, along with those of the respondents who did allow publication, were material in making the decision to pursue an open solicitation here for additional respondents.

At this time, the answers of the respondents are being presented absent any biographical/background information, so as not to bias the reader as he reads and considers each response. At a later date, I will edit this post to add a brief (few sentences) background description on each of the participants in order to provide demographic data on the participants as a group (e.g., how many were biomedically sophisticated, laypersons, long-time cryonicists, novices, etc.).[1]

 Responses

Responses are presented in alphabetical order (by name of the respondent). The only editing that has been done is to to correct typographical errors.

Alexander McLin

After studying the test materials, I have come to the following conclusions about how cryonics is currently practiced today and the problem with its current standards of practice. The problem is that cryonics isn’t effectively managing ischemia, nor it doesn’t seem to be incorporating medical findings about how the brain is affected by hypotension, hypoventilation, and hyperventilation.

Moreover, research in determining a method to predict onset of cardiac death after life-saving treatments is withdrawn indicate that this is difficult to do so, this in conjunction with other papers, show that the brain damage begins almost as soon as a patient’s circulatory system begins to fail. This is problematic from the cryonics point of view, because long before cardiac death is declared, the brain may have already suffered irreversible ischemia damage preventing optimal cryonics suspension.

The research materials furthermore show that hyperventilation when administrated for whatever reason actually makes things worse and that hypoventilation is preferred. With this in mind, do cryonics providers incorporate that finding when administrating oxygen to patients as part of the stabilization protocol?

To summarize, the conclusions I arrived at are that current cryonics providers are failing to manage ischemia, failing to research ways to predict the degree of severity of ischemia, failing to engage in proactive activities to minimize ischemia pre- and post-deanimation, and not incorporating medical findings in improving brain survivability in presence of hypotension and hypoventilation. In addition, there appear to be a lack of an attempt to maintain extensive database of patient medical history, collection of body fluids for pre and post-deanimation, and pre- and post-suspension which is essential for research intended to improve cryonics practices.

Here I will discuss solutions I have come up to address some of the conclusions I have arrived at. The biggest problem is the issue of ischemia and how likely it is to occur once oxygen is interrupted and also how sensitive the brain is to reperfusion injury. I would review the existing protocols to ensure whether they’re adequately taking the reperfusion injury into account, whether medicines need to be updated(add or remove medicines) with respect to the latest medical findings. It should be verified via meaningful actual research whether the cool-down equipment is really minimizing ischemia.

Finally, how can cryonics address the crucial issue of the existing medical-legal atmosphere that require patients to be declared dead according either to the cardiac or brain death definitions. Both which ensure that the brain will suffer ischemia damage before suspension occurs. How can cryonicists safely arrange for optimal cryonic suspension free of problematic legal implications? This suggests a need to engage in policy lobbying and pushing for legislation aimed towards changing the legal situation for the betterment of cryonics. To put it so bluntly, it appears that voluntary euthanasia is a cryonicist’s best friend, as distressing and stressful it may sound.

Lastly, cryonics providers need to establish a medical database and engage in much more data collection than they are doing at present. Some of the patient histories show recurrent problems with their collection equipment, do they need to be upgraded or replaced? Research in minimizing or preventing ischemia should be undertaken to determine how to optimize brain preservation prior to beginning suspension.

Mark Plus

Many cryonicists in hospice conditions currently deanimate and are pronounced after agonal periods similar to shock which result in prolonged hypoperfusion and hypoxia of the brain. These lead to significant compromises of the brain’s vasculature (e.g., the brain’s ability to self-regulate its blood flow to certain regions like the hypothalamus when the arterial pressure drops below 40 mm Hg) and interfere with cardiopulmonary support, washout and especially perfusion with cryoprotectants, not to mention the havoc they must cause to the brain’s fine structure.

Also, the trend towards harvesting organs from patients who are pronounced cardiac-dead after as little as two minutes of asystole is probably not a good thing for cryonicists, if the laws change to make it harder to opt out of such donations which will have the effect of ensuring thorough brain death.

My suggestions:

Use people with professional training in shock medicine and anesthesiology to perform the cardiopulmonary support after pronouncement. Monitor the level of brain perfusion with the proprietary bispectral index technology (which I had to look up and I’d like to read more about) to determine if brain hypoperfusion happens. Hypoventilate the patients.

Premedicate cryonicists before pronouncement with drugs like piracetam, arginine vasopressin and NO inhibitors, mentioned in the papers you sent me. You also wrote that Jerome White had attempted to premedicate himself with over the counter supplements until a few weeks before his suspension.

Cryonicists with terminal illnesses should consider moving to places where the laws allow assisted euthanasia so that they can go into arrest and undergo the suspension procedure well before their agonal decline.

Cryonics organizations need to gather a lot more data when they perform suspensions based on the current state of the medical art. The S-100B assay should be used along with other assays to measure brain injuries. These assays plus the bispectral index data can provide badly needed feedback on the effectiveness of brain perfusion procedures.

If the patient can’t deanimate at the time of his choosing, use some of the medical models developed by the DCD researchers to better estimate the patient’s time of cardiac death during standby.

I hope my answers and recommendations are not too off the mark, and I suspect I’ve misunderstand or failed to notice some key points. You gave me a lot of unfamiliar material to absorb in a short amount of time. After a few more weeks of study, I could probably understand it better. Some kind of primer would also help. A few years ago I speculated that based on actuarial considerations, the ideal candidate for cryosuspension would have to be a healthy ten year old who could walk into the lab and lie down on the table. That leaves the rest of us somewhere away from optimal candidacy for cryosuspension. But then, what can we do about it?

And I do plan to study this further, so thank you very much for the scientific background information, and feel free to send me additional papers.

Other observations:

I notice the contrast between the thorough reports you’ve written for the suspensions you’ve performed versus the ones written by Alcor’s “pod people,” which apparently includes Aaron Drake. Several things seem to go wrong with about every suspension Alcor has done lately, including basic preparations like not having the tray of all the necessary surgical tools ready for Dr. Nancy or the surgeon. I knew in a vague way that things had gotten bad, but you’ve given me some idea of how bad.

The scientific literature started to report the effects of shock and hypoperfusion decades ago, but you wouldn’t know that from the “official” cryonics propaganda. It seems like the cryonics movement should have incorporated this knowledge from the very beginning, but then physicians, surgeons and neuroscientists have mostly avoided cryonics and deprived us of their expertise. Dr. Ravin Jain, a neurologist, sits on Alcor’s board, and he should know this stuff, but I don’t get the impression that he’s done anything to incorporate his knowledge into Alcor’s suspension procedures. The neglect gives cryonics a reputation for “scienciness” and pseudoscience which it doesn’t necessarily have to have.

Gerald Monroe

a. The current techniques practiced for all the cryonics cases most likely result in long periods of ischemic hypoperfusion to the brain. Instruments now exist to detect this, combining the bispectral index with near infrared spectroscopy, and apparently even when top notch experts support cardiac surgeries on children, the hypoperfusion is common.

The ischemia and the hypoperfusion are very, very bad. Of course, so is the freezing. And the storage in liquid nitrogen where dissolved oxygen can reach the tissues and oxidize them. And the shoestring budget (compared to even a single hospital) the cryonics organizations have to do everything on.

b. It doesn’t sound like these problems are insoluble if there were real resources (compared to those spent to delay death from cancer by a few months, for instance) dedicated to the problem. Tomorrow, if cryonics had the resources of a single major metropolitan hospital, it could actually solve these problems in a systemic way.

There have to be experiments done on animals, where many different techniques* are attempted and evaluated. Evaluations should be done by preparing synapses of slices of the subject’s brain following the freezing. Also, rewarming and function tests (of slices), once the state of the art reaches the point that this is practical.

The human patients have to be part of this evaluation. If no one looks, the mistakes made will never be corrected. Somehow very small pieces need to be removed as samples from the human patients, following each cryonics procedure, small portions mostly taken from sections of the patient’s brain not thought to contain unique personality information.

And so on. Real improvements don’t come easily or cheaply – they come incrementally, with great effort, and honest evaluation of the results of each change. The last element is probably the most important of all.

The history of medicine is littered with many, many examples where something becomes common practice without honest testing of the results. Pretty much universally it fails.

With all that said, for those of us right here, alive in an era where cryonics does not have the resources it deserves, it is simply Pascal’s wager. No matter how dim the odds are, some chance of a form of survival is better than none. Information is probably duplicated inside the human brain many times over, and all of the decay processes that work against cryonics are things that happen according to predictable laws of physics. In a future world where a brain could be scanned at the molecular level, there is probably at least some recoverable memory and personality data for even the worst cryonics case.

For some, the prospective of saving even an incomplete fragment of yourself is better than the guaranteed destruction by rotting in the ground or burning in an incinerator.

Why it is like it is : the cryonics organizations don’t have any money. There’s probably a hundred new things that could be tried, and most of them are not better than what is being done now. Every dollar spent now is a buck less that could go to protecting the existing patients over many more decades.

Moreover, without any way to evaluate the current baseline : how effective is cryonics actually preserving the patients, right now? Making changes blindly is stupid. In the history of medicine, time and time again, it has been found that when a simple and dumb medical technique is compared honestly to a more expensive and advanced technique, almost universally the difference is minimal to none. A few examples : diuretics work as well as the far more expensive and specific beta blockers, film X-rays provide basically the same therapeutic improvement as the vastly more expensive CTs and MRIs, physical therapy works about as often as spine surgery, etc.

This is why in countries with socialized medicine, with outdated equipment and techniques and long wait lists, the patients live almost as long. (and the population lives years longer due to better lifestyles)

* A few ideas that might or might not work :
1. More rapid cooling by exposing the brain to coolant with burr holes and connecting pumps directly to cerebral perfusion
2. Drugs to prevent the cerebral arterioles from closing when exposed to cold perfusate.
3. Calcium blockers to prevent apoptotic pathways from triggering
4. Oscillating magnets like the Japanese claim work for transplanting teeth
5. Skipping cryonics entirely and plastinating the brain

Jordan Sparks, DMD

Well, I’ve read all the papers. I’ve attached the notes I made. I know you said I could skim them a little more quickly, but I was having trouble understanding and remembering. I needed to use a more aggressive approach this time. I did the references to help me get organized, and if I had to do that again I would do it without listing out all the names. Anyway, this is where I’m at.

I have a tentative answer which I may refine later. I’m continuing to think about it. You only gave me one cryopatient case Hx. I notice that it’s rich with hematology and chemistry data. Repeated samples were taken and charted over time. Both the TBW circuit and the cryoprotective perfusion circuit are well documented. Pressures and flow rates are nicely charted. Also, glycerol, blood gas, and pH were monitored during cryoprotective perfusion. The lab samples, in particular, are notable because that is not the current practice of Alcor or CI. It would take me some time to look back through case reports to see when was the last time this was done.

a) Cryonics providers are currently disregarding complexity associated with the biochemical milieu. I’m not quite sure how to state it, but all of the 22 papers treated their problems as a complex interplay of the mechanical issues as well as the biochemistry. Reading current Alcor and CI reports, on the other hand, there is a total disregard for the role of biochemistry.

That’s my first stab at it. I wish I could state it better, and I might try to rewrite it. I might wait for feedback from you before I go much further in case I’ve missed your point.

1.  Fast recovery from shock used vasopressor combined with hypertonic saline starch.  Slow recovery used fluid resuscitation.  Propofol and Hb concentrations were comparable in both groups.  The fast recovery resulted in better cerebral perfusion and a higher BIS that was likely due to the better perfusion.  CPP =MAP−ICP.

2.  Three resuscitation protocols: 1=FR (fluid resuscitation), 2=NA/HS (noradrenaline/ hypertonic starch), and 3=AVP/ HS (arginine vasopressin/HS).  The AVP/HS group had faster and higher increase in MAP and CCP as well as better survival.  Also, ICP was lower.

3.  After significant hypervolemia, cerebral circulation decompensation occured.  There were significant regional variations in cerebral blood flow.  The redistribution favored the areas related to cardiovascular control.

4.  Patients in shock can have normal physiological, hematological, fluid, and electrolyte balance but still die due to metabolic abnormalities.

5.  In spite of mechanisms for preferential shunting of blood to the brain, low MAP will result in poor perfusion.  This results in inadequate oxygenation as well as inadequate lactate washout.  Decreased perfusion leads to ischemic damage.

6.  Hemorrhagic hypotension was induced in dogs which was still above the lower limit of cerebral autoregulation.  This resulted in an increased turnover of free fatty acids in the CSF.

7.  Moderate reduction of MAP in anesthetized cats resulted in no significant EEG changes.  Below 40 mm Hg, cortical rhythms slowed and then stopped.  Cell damage was only found below 40 mm Hg.

8.  Baboons were pretreated with Phenoxybenzamine (PBZ) before hypovolemic shock, and it prevented the fall in cerebral blood flow.  EEG does not normally return after reinfusion.

9.  Bispectral index (BIS) dropped to 0 during cerebral hypoperfusion.

10.  For donation after cardiac death (DCD) kidneys, prolonged severe hypotension was a good predictor of subsequent organ function.  Donor age also correlated with worse outcome.

11.  Dogs anesthetized and hypovolemic shock induced for 2 hours.  NMR used to monitor phosphate metabolism.  Upon fluid resuscitation, phosphate pools quickly returned to near baseline values, but intracellular acidosis persisted.

12.  Hemorrhagic shock combined with increased ICP is particularly damaging.  Increased ICP leads to cerebral ischemia which causes release of thromboxane A2 (TxA2), a potent vasoconstrictor and hypertenstive agent.  The increase in TxA2 persists for at least two hours after reperfusion and results in further cerebral hypoperfusion.  Pretreatment with COX inhibitor ibuprofen decreases TxA2 levels and improves total cerebral blood flow after global cerebral ischemia.

13.  Brain is vulnerable during hypotension and shock, especially long-lasting shock.  Patchy areas of ischemia developed through sludge formation and persisted even after hyperperfusion, indicating the role of local factors.  Phenoxybenzamine pretreatment significantly reduced rCBF changes during shock.

14.  DCD livers result in inferior graft survival compared to donation after brain death (DBD).  A DCD risk index was developed.  The lowest risk is with donor age <= 45 years,  warm ischemia time (DWIT) <= 15 minutes, and cold ischemia time (CIT) <= 10 hours.

15.  CNS activity was measured during hemorrhagic shock under light central anesthesia.  After reinfusion, if neurons failed to recover electrical activity, this was an early indication of eventual irreversibility.  There is a relationship between irreversibility and cumulative oxygen debt and excess lactate.

16.  Rats were subjected to hypoxia and hypotension followed by resuscitation.  Rather than the no reflow that the authors were expecting, they observed hyperemia in some areas for at least two hours.  They concluded that therapy aimed at increasing cerebral blood flow and oxygenation would be insufficient.

17.  Guidelines for controlled DCD are given.  DBD is superior.

18.  DCD score system is described.  Kidneys may benefit from therapeutic interventions before transplantation.

19.  Average values for basal respiratory functions in adolescents and adults.

20.  Severe hypotension causes brain damage.  Microvascular damage results in hemorrhage upon reinfusion.

21.  Prolonged agonal time did not influence kidney transplantation outcome when other variables were closely considered instead.  For example, elderly donors were not included.

22.  During hypovolemic shock, electrical activity and ICP was minimally altered.  The authors interpret this as a lessening of the role of the brain in the genesis and perpetuation of irreversible shock.

References

1: Cavus E, Meybohm P, Doerges V, Hoecker J, Betz M, Hanss R, Steinfath M, Bein B.  Effects of cerebral hypoperfusion on bispectral index: A randomized, controlled animal experiment during haemorrhagic shock.  Resuscitation.  2010;81:1183-1189.

2: Cavus E, Meybohm P, Doerges V, Hugo HH, Steinfath M, Nordstroem J, Scholz J, Bein B.  Cerebral effects of three resuscitation protocols in uncontrolled haemorrhagic shock: a randomized controlled experimental study.  Resuscitation.  2009;80:567-572.

3: Chen RY, Fan FC, Schuessler GB, Simchon S, Kim S, Chien S.  Regional cerebral blood flow and oxygen consumption of the canine brain during hemorrhagic hypotension.  Stroke.  1984;15:343-350.

4: Cowley RA, Attar S, LaBrosse E, McLaughlin J, Scanlan E, Wheeler S, Hanashiro P, Grumberg I, Vitek V, Mansberger A, Firminger H.  Some significant biochemical parameters found in 300 shock patients.  J Trauma.  1960;9:926-938.

5: Feldman RA, Yashon D, Locke GE, Hunt WE.  Cerebral tissue lactate in experimental oligemic shock.  J Neurosurg.  1971;34:774-778.

6: Fritschka E, Ferguson JL, Spitzer JJ.  Increased free fatty acid turnover in CSF during hypotension in dogs.  Am J Physiol.  1979;236(6):H802-H807.

7: Gregory PC, McGeorge AP, Fitch W, Graham DI, MacKensie ET, Harper AM.  Effects of hemorrhagic hypotension on the cerebral circulation.  II.  Electricocortical function.  Stroke.  1979;10:719-723.

8: Hamar J, Kovach AGB, Reivich M, Nyary I, Durity F.  Effect of phenoxybenzamine on cerebral blood flow and metabolism in the baboon during hemorrhagic shock.  Stroke.  1979;10:401-407.

9: Hemmerling TM, Olivier JF, Basile F, Le N, Prieto I.  Bispectral index as an indicator of cerebral hypoperfusion during off-pump coronary artery bypass grafting.  Anesth Analg.  2005;100:354-6.

10: Ho KJ, Owens CD, Johnson SR, Khwaja K, Curry MP, Pavlakis M, Mandelbrot D, Pomposelli JJ, Shah SA, Saidi RF, Ko DSC, Malek S, Belcher J, Hull D, Tullius SG, Freeman RB, Pomfret EA, Whiting JF, Hanto DW, Karp SJ.  Donor postextubation hypotension and age correlate with outcome after donation after cardiac death transplantation.  Transplantation.  2008;85:1588-1594.

11: Horton JW, McDonald G.  Heart and brain nucleotide pools during hemorrhage and resuscitation.  Am J Physiol.  1990;259:H1781-H1788.

12: Kong DL, Prough DS, Whitley JM, Taylor C, Vines S, Deal DD, DeWitt DS.  Hemorrhage and intracranial hypertension in combination incresae cerebral production of thromboxane A2.  Critical Care Medicine.  1991;19:532-538.

13: Kovach A, Sandor P.  Cerebral blood flow and brain function during hypotension and shock.  Ann Rev Physiol.  1976;38:571-596.

14: Lee KW, Simplins CE, Montgomery RA, Locke JE, Segev DL, Maley WR.  Factors affecting graft survival after liver transplantation from donation after cardiac death donors.  Transplantation.  2006;82:1683-1688.

15: Peterson CG, Haugen FP.  Hemorrhagic shock and the nervous system.  1. Spinal cord reflex activity and brain stem reticular formation.  Annals Surgery.  1965;485-496.

16: Proctor HJ, Wood JJ, Palladino W, Woodley C.  Effects of hypoxia and hypotension on oxygen delivery in the brain.  J Trauma.  1979;19:682-685.

17: Reich DJ, Mulligan DC, Abt PL, Pruett TL, Abecassis MMI, D’Alessandro A, Pomfret EA, Freeman RB, Markmann JF, Hanto DW, Matas AJ, Roberts JP, Merion RM, Klintmalm GBG.  A J Transplant. 2009;9:2004-2011.

18: Plata-Munoz JJ, Vazques-Montes M, Friend PJ, Fuggle SV.  The deceased donor score system in kidney transplants from deceased donors after cardiac death.  European Society Organ Transplant.  2010;23:131-139.

19: Shock NW, Soley MH.  Average values for basal respiratory functions in adolescents and adults.  J Nutrition.  1939;143-153.

20: Tamura H, Witoszka MM, Hopkins RW, Simeone FA.  The nervous system in experimental hemorrhagic shock: morphology of the brain.  J Trauma.  1972;12:869-875.

21: van Heurn LWE.  Prolonged agonal time–not a contraindication for transplantation.  Nat Rev Nephrol.  2011;7:432-433.

22: Yashon D, Locke GE, Bingham WG, Wiederholt WC, Hunt WE.  Cerebral function during profound oligemic hypotension in the dog.  J Neurosurg.  1971;34:494-499.

“Synaptic”

As you wrote in 1994, the three sources of damage to cryopatients are 1) the underlying disease process, 2) shock and global and trickle flow ischemia secondary to dying and cardiac arrest, and 3) cryoprotectant toxicity and cryoinjury from freezing. This, as far as I can tell, has not changed. So, a flaw in how cryonics is practiced would have to mean that providers are not minimizing the damage from these processes as well as they could be. #1 is out as that is not the primary mission of cryo providers, although I agree with the arguments on your blog that they could add some value here too. #3 is also basically out, because gains over M22 seem unlikely to come in the near future, at least outside of 21CM.

That leaves #2. A number of the papers you sent me study animal models of hemorrhagic shock, and the results are not pretty for preservation of cellular structure. For example, the amount of necrotic cells in Ozkan et al’s paper is pretty high–up to 50% necrotic in the temporal lobe, after just 3 hours. The natural question is: if a cell undergoes necrosis, has it irretrievably lost the information coded in its cellular state? The answer is unclear. On one hand, it may be possible to reverse engineer the process of cell degradation from the surviving clues and thus recover the position of crucial membrane receptors and/or neurites. On the other hand, if the degradation process is random enough, that may not be the case. Probably it depends on the specifics — “cell necrosis” is a broad class.

A number of the other papers look at the acceptability of donors who died of cardiac death. It seems that kidneys can last up to 4 hr’s of warm ischemia with similar function post-transplant, while lungs following can hardly withstand 15 mins of warm ischemia time and still offer good function post-transplant. Meanwhile, it is practically common knowledge that the organ which is least able to survive following ischemic time is the brain. Finally, there is regional susceptibility variation within the brain, and there are reasons to think that regions like CA1 that may be especially important for identity (i.e., memory) are especially vulnerable to ischemia.

To me, this emphasized how quick the interventions must be and how essential it is to maximize the time period during which oxygen perfusion in the brain is high. There’s no reason why neurons have to be able to withstand lack of oxygen for long before randomly decaying — evolution has little reason to select for it. It is a bias of operating on human timescales to think that not much can happen within five minutes, but molecular timescales unfold much faster.

You also sent a few papers that evaluated measures to query brain activity via EEG. You seem to have a particular interest in one EEG-derived algorithm called the Bispectral Index, which in a few fascinating cases actually went to zero in the absence of cerebral blood flow during surgery. These are interesting in part because they could potentially be used to monitor CBF in cryo patients.

Which brings me to the major problem that we see in many of the case reports you sent me. That is, we have good reason to believe that all of them had already experienced a very low brain oxygen perfusion prior to clinical death. The signs of this are many, and include the hyperventilation of A2435 and A2361, the terrible peripheral perfusion of A1556, the hypotension and fluid loss of A1614, ACS9577′s poor perfusion and very low coma scale score, and the long periods of apnea and low blood pressure of A2420. One of the papers that you sent me called the period after removal from life support and cardiac death the “agonal phase”, and this phrase has been aptly used in cryonics to describe the period during which a patient is known to be eminently terminal but has not yet reached cardiac death.

One key question is whether these patients are ever in fact technically brain dead, meaning no neural activity at all, as measured by EEG or CT. If they are, then it is possible that clinical death could be pronounced and preservation techniques could be started much sooner. When I first thought of this, I was hopeful that I had discovered your “problem.” But on further contemplation I’m not so sure, in part because it seems like people would have thought of this. So, I am going with the more obvious, and indeed in some senses more troubling, problem that many or most cryonics patients experience torrents of brain damage during their agonal period.

What to do about this?

1) Somehow establish, in the US, legal recognition of the rights of cryo patients to initiate procedures to preserve brain-encoded identity when the patient is diagnosed by independent physicians to be terminal, in a similar way that organ transplants are.

2) Use a workaround by going to a country like Switzerland that already allows assisted suicide in such cases, perform the cryopreservation there, and then ship the patients back on dry ice to the US.

3) #2, except establish a new storage facility in the foreign country.

4) Develop, drawing off of the “normal” biomedical literature, substantially improved methods for preserving brain oxygen perfusion in agonal cryonics patients, and implement these on a routine basis.

One of the interesting things about this problem is that it is not specific to cryopreservation but would also apply to plastination, and may even be more pronounced there. So this is one area where progress, if any is made on either front, would certainly be synergistic.

A meta thought of mine about this assignment is that I didn’t like the assumption that I would be able to diagnose problems and suggest solutions so quickly to a problem that many people have spent lots of time thinking about. I doubt that what I have written above is at all novel.

Still, I did find it to be a very worthwhile exercise to learn about some details of cryopreservation and its associated medical concepts, and for that, I thank you for offering it to me.

——————————————————————————————————

I want to extend a sincere thank you to all who participated in this exercise, and especially to Alexander McLin, Mark Plus, Gerald Monroe, Jordan Sparks, DMD, and “Synaptic” for publicly participating. It takes an enormous amount of courage to undertake such an exercise on the Internet, where it both is and will remain open to public scrutiny, more or less indefinitely. Congratulations gentlemen, you have my unreserved admiration for your courage and for your willingness to take a personal risk in pursuit of the truth. — MD

Footnote

Steven B. Harris, M.D.

In September of 1988, Steve Harris, M.D., published an essay entitled The Day the Earth Stood Still: Cryonics and the Resurrection of the Mythic Hero. It was one of his best in a formidable roster of insightful articles that he wrote dealing with the likely cultural requirements and cognitive limitations that inform humanity’s acceptance, or lack thereof, of cryonics.  I strongly recommend cryonicists read it. Steve’s articles had a great deal of influence on my thinking,  and both Steve and I were, in turn,  influenced by  the philosopher-mythologist-historian Joseph Campbell. I don’t know how Steve was introduced to him, but I first heard of Campbell as a result of the PBS series THE POWER OF MYTH WILL BILL MOYERS, (downloadable here)  which aired in the late 1980s.

I remember breaking out in goose bumps (I have them now) many times during Campbell’s program and, subsequently, when reading his books. His book of the same title as the series is an excellent introduction to his work. I had the same reaction when reading  Steve Harris’ brilliantly insightful articles dealing with issues critical to human perception of, and reaction to cryonics when I read them for the first time in manuscript form, before they were published in Cryonics And I had it again when I read them in “in print” as the final, published product. These works bear reading and rereading and reading again.

The Dead Ant Heap & Our Mechanical Society: http://www.alcor.org/Library/html/DeadAntHeap.html

The Return of the Krell Machine: http://www.grg.org/charter/Krell2.htm

Will Cryonics Work?: http://www.alcor.org/Library/html/probability.html

The Society for the Recovery of Persons Apparently Dead: http://www.alcor.org/Library/html/PersonsApparentlyDead.htm

Many are Cold But Few Are Frozen: http://www.cryocare.org/index.cgi?subdir=&url=humanist.html

Frankenstein and the Fear of Science (Lecture), VHS tape: http://www.worldcat.org/title/frankenstein-and-the-fear-of-science/oclc/043933281

There are very powerful ideas and insights in these essays which should be a source of influence and inspiration to many more cryonicists, than to those relatively few who have read them, to date.

One of my central points about the reason for the continued “failure” of cryonics, and for its very slow growth, both absolutely and relatively,  is the near total lack of any kind of memory of what has gone before, let alone a sorting out of what part of that history is vitally important to be remembered. It’s as if most cryonicists live only in the present, looking forward to a future exclusively of their own imagining, with just a dim halo of memory extending, perhaps 5 years back, at most.

A few days ago, I had my nth practical example of that. I was contacted by some people interested in establishing cryonics Elsewhere. One of the interesting (and depressing) things they had been told by “cryonics people in the US,” was that it was a “good idea to establish companion for profit and non-profit organizations” to carry out the various functions of the cryonics undertaking with minimal liability.

Really?

Maybe that is the best system, but if it is, there is no evidence I know of to support it, and substantial empirical evidence to refute it.

This is an edited version of my response t0 that recommendation:

“I can only tell you what I have observed here over and over again. Maybe you can figure a way around it, or maybe you won’t have the same problems in the first place, owing to cultural differences. I just don’t know.

You will notice that all of the cryonics organizations in the US consist of fully integrated providers. Suspended Animation is the (recent) exception. What’s remarkable about this situation is that it is the polar opposite of what all of us intended when we started cryonics operations here (myself included). There were always paired for profit and not for profit companies, and for just the reasons you’ve stated. CSNY & Cryo-Span, CSC & Cryonic Interment, BACS & Trans Time, IABS & Soma, Cryovita, Manrise & Alcor… And yet there are only single entities around today. Why?

I do not know about your local law, but in the US, it is forbidden for non-profit organizations (NPOs) and for-profit corporations (FPCs) to have interlocking directorates. In fact, it is generally prohibited for corporations related to, or doing business with each other to have interlocking directorates, unless one is mostly or wholly owned by the other, regardless of their status as FPCs, or NPOs. The reasons for this are many and are deeply rooted in corporate law, but mostly can they be reduced to “conflict of interest” issues. In the early days of cryonics, this ban on interlocking directorates was flagrantly disregarded. The inevitable result was that the FPCs completely dominated the NPOs. In fact, FPCs used the NPOs as a convenient shill for doing all the things that were unprofitable, risky, or otherwise not desirable, such as being stuck with the open-ended custody of the patient!

While the initial reason for this was the use of the Uniform Anatomical Gift Act (UAGA) to accept the patients, the eventual reason for it became (obviously), proprietary interest. People in the FPCs got paid for their work (usually in shares in the FPC) and people in the NPO didn’t – couldn’t, in fact. Valuable work, work that would earn shares, got done by the FPCs, and everything else got shuffled off onto the NPOs. You can actually  see this happening at the time, if you take a look at the issues of “Life Extension”/”Long Life Magazine” on the CryoEuro Wiki, because people didn’t talk about BACS, they talked about Trans Time… And where the reward, or the potential for reward exists is also typically where all the time, attention and money will flow.

Eventually, as visibility increased, the state began to menace, and the directorates were fully separated. That’s when all hell broke loose! The people running the NPOs had to be disinterested directors, and they did not stand to make money (or shares), or gain in any way from giving advantage to the FPCs. Contracts, fee increases, and all the other “taken for granteds” between the FPCs and NPOs were now up for debate and consideration. And since they were now two truly separate organizations, jealousy, resentment, and plain old proprietary interest and territoriality took over.

I pretty much thought the FPCs would win, primarily because they did have that huge advantage of proprietary interest on their side. But what I hadn’t figured on was the patients! The NPOs had control of the patients; and it was with the patients that the real loyalties ultimately rested. TT and BACS pretty much destroyed each other. In the case of Alcor, Alcor prevailed, and in the case of CI, well, there was never an issue in the first place, since CI was always an integrated operation. And yet, why this happened remains a mystery to many, even to those who have put some effort into finding out what happened.

In a large, diverse and robust marketplace, commercial service providers servicing NPOs could possibly work. SA may be the first of these, but only time will tell.

However, while cryonics is small and not subject to normal market forces, the two organizations model has not been proven workable. It becomes particularly vicious when there is only one service provider and one NPO, but totally different directors (as the law here requires), because then it becomes like a long-married couple who hate each other, but because of children, fiances and other reasons, cannot divorce. Far from creating the checks and balances it was anticipated to, this set-up created a state of gridlock and animosity. Ultimately, it degenerated to people on both sides screaming that the other was trying to screw them. And since they couldn’t stop dealing with each other and go to the “competition,” it just ground on until there was little or nothing left. That is, in fact, in significant measure, how Alcor was reborn.

Finally, you will encounter this problem: the FPC will be absolutely essential to the NPO, because the FPC will hold all the assets for delivering the up-front (immediately legally riskiest) part of cryopreservation (CP). They will own the equipment, employ the people, own the vehicles…. So the NPO eventually finds itself not just held hostage to FPC , but at risk if the FPC screws up.

I’ll give you a highly personal example. I was a major shareholder in Cryovita, the service provider to Alcor, but Jerry Leaf held most of the shares. Alcor relied on Cryovita completely for rescue and perfusion and there were no alternative service providers available – none. Alcor didn’t own so much as a cannula, or a set of scrub clothes. Cryovita was a shares corporation and the shares were distributed in a complex and potentially problematic way. It seemed possible that if Jerry were to suddenly experience medico-legal death, that the continued smooth functioning of Cryovita could be at risk of being disrupted. That became one of several causes of a major split between Jerry and I, because I realized, as President of Alcor (which I was, at that time), that if Jerry dropped “dead,” Alcor’s ability to deliver CP could be at risk of disruption. Alcor didn’t have cash lying around to go buy all the required equipment in a hurry! It had taken Jerry and me many years to patiently accumulate it, and to do so at well below market rates.

But it was worse than that, because over the years, Cryovita had generated patents, made exclusive agreements, and otherwise done all kinds of normal business things that corporations do. The problem was, all that “stuff” was also needed and used by Alcor! So, I began acquiring those same capabilities for Alcor, which was, of course, a costly duplication of capital equipment and it caused a feeling of resentment in Jerry/Cryovita.

So, what actually happened when Jerry did have a heart attack and was CPed? Well, exactly what I thought might happen, but in a way I never could have imagined. Cryovita did split from Alcor (kindly selling Alcor some of the most critical assets Alcor needed to stay in business), but the people who took Cryovita away were Kathy Leaf (Jerry’s widow), Saul Kent, Paul Wakfer, Brenda Peters and myself – the very people who had been the most ardent advocates of Alcor for so hard and long.

What happened to Cryovita? Well, it morphed in various ways, but today it is known as 21st Century Medicine!

Naturally, this version of events will be strongly biased by my point of view, so I would suggest you ask others and check it out for yourself. Look at the back issues of “Life Extension” and “Long Life” magazine on the CryoEuro Wiki to get a feel for the “Trans Times” of the 1970s and ’80s. Jim Yount, John Day and especially Frank Rothacker of ACS, may also be able to provide you with valuable perspective.”

My guess is that almost all of the newcomers to cryonics over the past decade, or so, have not read any of Steve Harris’ essays. And they clearly know little of the actual history of cryonics, let alone have any distillation (regardless of the direction of its bias) of what is important in that history to remember and act upon.

If you Google “history of cryonics” this what comes up on the first page (and subsequent pages offer no greater resources). Ben Best’s article is actually the most popular (longitudinally). It’s a fine, bare-bones factual narrative. But it is bloodless and lesson-less; it provides no instruction for others striving to create cryonics without recreating our errors. [I want to be very clear here that this is not a criticism of Ben's article: it was not written to be a tutorial on the lessons to be learned from the history of cryonics.]

What makes history both “teachable” and “leanable” is the humanity of it. We are, as Campbell so eloquently said, “story creatures”; we learn through guided narrative informed by the power of the mythic. BACS, TT, CSNY, Cryo-Span, Alcor, Manrise, CI, these entities were created by individual people for very personal reasons, as well as for the visible and easily understood public ones. Most contemporary cryonicists seem to recoil from any consideration of the “messy” and “untidy” aspects of the personal motivations and dynamics that drove (and drive) organizations, in and out of cryonics. And yet, that’s where a lot of the most important reasons and answers are to be found that will lead on to successes, or doom us to repeated failures.

By Mike Darwin

Sometime in the next few months, it seems likely that Director Errol Morris’ take on Bob Nelson’s account of the cryopreservation of James H. Bedford, We Froze the First Man, retitled Freezing People is Easy, will go into production. The title is at once sarcastic, brilliant, inspired and accurate, because, as readers of Chronosphere already (should) know, freezing people is anything but easy. While there have been many movies made that touch on cryonics, use it as a plot element, or even rely on it  as a major enabler of the story, this will be the first film about cryonics. It is, of course, quiet possible for a film about  cryonics to be good – even great – and still be bad for it. This film offers substantial possibilities for both of those elements to be in play.

Perhaps the most important thing to beware of is that the script is not based solely upon Nelson’s heavily (positively) biased and often inaccurate memoir, but also upon the searingly acerbic episode of Ira Glass‘ popular Public Radio International (PRI) radio show, This American Life (full program at this link). What’s more, Glass is also a co-producer of Freezing People is Easy. It is possible to listen to the This American Life episode, entitled Mistakes Were Made, and forget the context in which it was aired on PRI – as part of a series of pieces on scumbags in public life who refuse to take responsibility for their bad acts.To know that this so, one has only to read this excerpt from the review of that broadcast by cryonicist, author and social psychologist Ronald G. Havelock, published in the May, 2009 issue of  Long Life, the news organ of the Cryonics Institute/Immortalist Society:

“First of all, I think we should absolve Nelson of blame for what happened. This poor
man was struggling with a task which was way over his head. He deceived himself, as
others have before and since, with the notion that many people would flock to cryonics
once they realized that it had a real possibility of working. he greatly underestimated
the length of time it would take for cryonics to become popular. We are still
waiting. More importantly, he also greatly underestimated the basic requirements for
making it work, the first of which is to have an adequately funded and competently
staffed facility with the ability to maintain itself over long periods. I think he gambled
that, something like that mythical ball field, if he started it and had real capsules
filled with liquid nitrogen, they would come. Those who actually came, including the
famous Dr. Bedford, came with hope and desperation in their hearts but they came
empty-handed. How could they imagine that this service would be free? Simply put,
they took advantage of this man, and he returned the favor by promising much more
than he could possibly deliver.” [1]

It is also possible to forget that, first and foremost, Errol Morris (The Thin Blue Line, The Guardian, The Fog of War: Eleven Lessons from the Life of Robert S. McNamara: center photo in montage above) is a documentarian with a clever, often indirect, but always ruthless approach to making film show the truth and expose hypocrisy.

Zach Hem authored the script and while his narrative talent might be questioned on the basis of his botched effort in Mr. Magorium’s Wonder Emporium, he also wrote the script for the 2006 film Stranger Than Fiction, which is a surprisingly intellectual meditation on life, death and the power of the mundane to make life worth living. Helm’s take on Nelson and Chatsworth should be especially interesting, because his perspective in Stranger Than Fiction and Mr. Magorium’s Wonder Emporium suggest he may favor the intrinsic value of the individual life; the issue which makes or breaks a viable approach to a “cryonics friendly” perspective in any work of art.

 Somehow I doubt it though, and the casting of Paul Rudd (Clueless, Anchorman, Halloween: The Curse of Michael Myers, The 40-Year-Old Virgin, Knocked Up, Forgetting Sarah Marshall, Dinner for Schmucks) to play Nelson does nothing to reassure me. It has also been reported that Owen Wilson and Christopher Walken are on-board – one wonders what their respective roles will be; Norman Bedford and Robert Prehoda?  Or perhaps Walken will play Bob Ettinger? If, as rumored, Saturday Night Live’s Kristen Wiig also joins the cast, will she play Nelson’s then wife, or the author of We Froze the First Man, Sandra Stanley, to whom Nelson was confiding the details of Dr. Bedford’s cryopreservation and with whom he was reportedly having an affair at that time?

The book is rich in characters familiar to those with any history in cryonics: Saul Kent, Curtis Henderson, Bob Ettinger, Robert Prehoda, Dick Jones (aka Dick Clair), Dante Brunol, MD, Stella Gramer…and many more. It should be a fascinating exercise to see which, if any, of these supporting characters makes it into the film by name, or in a clearly recognizable way.

But will Freezing People is Easy get made, and if so, what will be its fate? Cryonics has been around for 50 years and attracting international attention for almost all of them. Thus, it should come as no surprise that there were two previous efforts to make movies where cryonics was the subject of the film, most notably, a film of Norman Spinrad’s darkly comedic and politically (left) loaded science fiction novel, Bug Jack Barron. For over 30 years, there were regular reports from the Hollywood intelligentsia (an oxymoron, I know) that Bug Jack Barron was to be made by Universal Studios, directed by Costa-Gavras, with the script written by Harlan Ellison. The story of why Bug Jack Barron never made it onto film has the same bizarre, cursed and insane quality to it as does the history of cryonics itself.

The story of why Thomas Berger’s (Little Big Man) novel Vital Parts never made it into production is even more tragic,  and the links with cryonics go deeper. The first go-round at Vital Parts the movie, was in 1971, with a when director Hal Ashby (Being There ,  Harold and Maude,  The Landlord and Let’s Spend the Night Together ), with Walter Matthau was slotted to play the principal character in the novel, Carlo Rheinhart (a long running character of Berger’s whose middle aged make over in this novel was reportedly inspired by Bob Nelson), the loser in the midst of a mid-life crisis who is seduced into involvement in the bizarre world of cryonics by the seemingly transtemporal Bob Sweet – a man from Rheinhart’s distant past who seemingly knows too much to be merely human.

Berger had visited the Cryonics Society of new York (CSNY) repeatedly to gather background information for his book, so it is no accident that a Mr. Softy ice cream  truck features prominently in the novel; Gillian Cummings (aka Beverly Greenberg), who was later to die tragically in the CSNY facility, drove a Jolly Tim’s ice cream truck to help pay the liquid nitrogen bills for her father, Herman Cummings (aka Herman Greenberg). And it is also probably no accident that the creepily mysterious bob Sweet shares the same last name with on the most prominent cryonics patients of the time; the liberal (“negro rights”) activist Marie Phelps Sweet, later lost at Chatsworth, along with the other Cryonics Society of California (CSC’s) patients who were also in the custody of Bob Nelson. Matthau’s son, and the apple of his eye, Charlie Matthau, was later to become a signed up, bracelet wearing cryonicist who was condemned to watch his father die by inches while doing everything in his power to both keep him alive (he kept portable defibrillators in his father’s home, car and work places) and unsuccessfully persuade him to make cryonics arrangements.

Left to Right: Walter Matthau, Charlie Matthau and Hal Ashby.

The next go round at turning Vital Parts into a movie was in 1987, with the irascible, reclusive and heavily drug abusing Ashby trying to make a comeback from his exile to television with another important, quirky film. This time Danny deVito had been recruited to play Rheinhart, and, in an inspired bit of casting, Gene Hackman had agreed to play Bob Sweet. During a meeting between Ashby and the producer Jerome Hellman to discuss finalization of the production of Vital Parts, Hellman became aware of what appeared to be “traveling phlebitis” in Ashby and shortly thereafter actor Warren Beatty became aware of Ashby’s symptoms, ultimately resulting in Ashby’s seeing an oncologist who diagnosed him with pancreatic cancer, from which he subsequently died in December of 1988.

The two other films which feature cryonics as cryonics (e.g., medical time travel) are screenwriter Mark Andrus’ and director W.D. Richter‘s  1991 Late For Dinner; a treacley, train wreck of a film which reviewer Owen Gleiberman aptly described as a film “so meticulously scrubbed of what we generally think of as entertainment value that the result is mostly a quirky, dawdling snooze,” and the truly, irredeemably awful 1985 film Stitches, starring the late Eddie Albert, Parker Stevenson, Geoffrey Lewis, and Brian Tochi. Oh yes, and I almost forgot to include the garbled and largely incoherent Vanilla Sky (starring Tom Cruise and Penelope Cruz) by the otherwise brilliant director Cameron Crowe, of which Stephan Zacharek of Salon.com said: “Who would have thought that Cameron Crowe had a movie as bad as Vanilla Sky in him? It’s a punishing picture, a betrayal of everything that Crowe has proved he knows how to do right….But the disheartening truth is that we can see Crowe taking all the right steps, the most Crowe-like steps, as he mounts a spectacle that overshoots boldness and ambition and idiosyncrasy and heads right for arrogance and pretension — and those last two are traits I never would have thought we’d have to ascribe to Crowe.” While I am no superstitious mystic, the ill fated bad luck attached to cryonics – in an out of film – makes me want to shout out a warning to all and sundry involved with Freezing People Is Easy, to “Run as far and as fast from the project as you can for both your personal and professional lives.“

Any way you look at it, the film promises to be a deep wallow in black comedy. That’s normally a genre I really appreciate, and often enjoy. This time, I’m not so sure. Robert F. Nelson (aka Frank Bucelli) is a bad man – a man who did enormous damage to cryonics, but more importantly, to the lives of the many people he defrauded and destroyed; not the least of which are the 10 cryonics patients whose loss were a direct or indirect result of his actions.  It is probably too much to hope that Helm’s and Morris’ effort could be as dark and well executed a black comedy as Peter Berg’s Very Bad Things, which Roger Ebert aptly summed up as not “a bad movie, just a reprehensible one. It presents as comedy things that are not amusing. If you think this movie is funny, that tells me things about you I don’t want to know.” That’s the movie that should be made about Nelson. The question is, should it be a movie, let alone the first movie, made about cryonics?

Footnote

[1] This statement is so wrongheadedly stupid on so many levels, it is hard to know where to begin in critiquing it. A good place to start would be by noting that Dr. Bedford hardly came “empty handed” to Nelson, or to cryonics. Instead, he came bearing $250,000 1967 US dollars ($1,714,832.83 in 2012 dollars) all of which was subsequently spent on his cryopreservation. It should also be pointed out that the majority of the families of the patients lost at Chatsworth, and at the Cryonic Interment facility on the East Coast (as well as some of the patients themselves), paid exactly what Nelson asked of them at the time: $10,000 to $15,000 in ~1973 US dollars, or $53,099.29 in 2012 dollars; substantially more than what the Cryonics Institute now charges for whole body cryopreservation today. Finally, this statement neglects the finding of the civil court that found Nelson guilty of fraud and for “intentional infliction of emotional distress.”

Screening for the Risk of Deanimation

The term “screening” is used in medicine to describe routine examinations or diagnostic procedures of a defined group of individuals to identify diseases or risk factors for same at an early stage. Screening is usually categorized as a  “preventive medical examination” or a  “checkup,” and its aim is to increase the life expectancy of those examined  by reducing the incidence or severity of life threatening disease and enhancing the quality of life. The most accurate examination methods possible should be used to identify as many diseases as possible still in their non-symptomatic phase, so that early treatment or change in life style can be initiated.

It is critically important to understand that the purpose of a “deanimation screening scan” (DSS) is not primarily to interfere with the course of disease or to extend the duration of life during this life cycle. Rather, it is to predict or to warn of impending  deanimation with increased accuracy and precision. Any contemporary medical or health benefits are thus incidental. Indeed, it is precisely when DSSing is used to determine or influence current medical interventions that it becomes dangerous. Knowing when you are likely to deanimate with greater precision, for sole purpose of improving your cryopreservation, carries little if any risk of iatrogenesis beyond that which would be present if you found out you were dying at a later time, or didn’t find out and suddenly collapsed in cardiac arrest from a heart attack, or suffered a massive stroke. It is only when the course of treatment is altered by obtaining the data, or looking at it (see “The Black Box of the Baseline,” below) that DSSing becomes either a practical or an ethical conundrum.

The first problem we confront in a screening test for deanimation risk is that we are moving in completely uncharted waters. We have no benchmarks or baselines on which to structure our screening program, save for a modest number of pilot programs that have been undertaken to evaluate full body scanning as a primary tool for the detection of cancer and atherosclerosis in the general population, or in selected subpopulations. For now, these will have to serve as the basis for our protocols, as well as the important cautionary lessons learned from other screening programs.

For reasons of safety, (see Radiation & Risk, below) Magnetic Resonance Imaging (MRI) is preferred over Computerized Tomography (CT), because no ionizing radiation is employed in making the image. MRI has some important limitations at this time, most notably only a few centers have devices that image the coronary vessels with sufficient precision  to allow risk  assessment for coronary artery disease (CAD).  Similarly, screening for Alzheimer’s Disease (AD),(beta amyloid deposits) also requires CT-PET scanning and the associated exposure to ionizing radiation.  So, for the present, CT is the only way to screen for CAD and AD. For this reason, and for those who for economic reasons may need to use CT imaging, it is worthwhile to briefly discuss the much hyped “risks” of radiation from whole body CT scans and this is done in some detail below.

Figure 25: Typical finding in an elderly woman who under prophylactic full body MRI scanning during a clinical trial in Germany to determine if full body scanning would reduce morbidity and mortality from cardiovascular disease and cancer. (Gohde, et al.)

A specimen imaging protocol is presented as Appendix 1 and is taken from the study by Gohde, et al., “Prevention without radiation – a strategy for comprehensive early detection using magnetic resonance imaging,” which was itself a pilot study in the use of MRI as a screening tool for cancer and cardiovascular disease.

The Mechanics

Currently, there is only one way to get a  DSS and that is to do it yourself.  There are several reasons, which will be discussed directly, why that is not a good idea, or certainly not the ideal way  to pursue DSSing. There are a number of reasons for this, starting with the potential for harm. Primum non nocere is the first dictum in medicine: first do no harm. Information is the most powerful force in the universe and information concerning you own health and welfare is especially important. It is also information that you cannot be objective about. It just isn’t possible. It is for this reason that no good physician treats himself or his immediate family in life or death matters as the sole or usually even the primary caregiver. In fact, speaking from experience as a person knowledgeable in medicine, I have found that wise counsel and advice I can (and do) easily give to others  is strangely absent from my own ears when I am the patient.

This lack of objectivity is more than a nuisance, it can be truly dangerous; and here I will have recourse to an actual example. The first four people to undergo DSSing have done so over the past 11 months. These were all individuals who were over 60 and who had not had consistent (or recent) “physicals.” All were counseled about the dangers of VOMIT and about the negative psychological impact of potentially finding out “something was wrong.” All four individuals had significant anomalies on their scans – two of which were life threatening and these were (or are) being medically managed.

In the other two cases, the scans revealed anomalies that might merit further medical evaluation in testing, and in both cases, the decision was wisely made not to pursue those tests. Why? That’s a complicated question, and I’ll answer it by explaining the circumstances of one of these people:

Mr. Ling is an 82 year old man who is in excellent health. He is physically active, mentally sharp and still working part time in his profession of many years.  He underwent a DSS five months ago. The findings were, overall, very good. His coronary calcium score was roughly a third lower than expected for his age, he had no signs of neoplasms, or of peripheral or central atherosclerosis, and the only abnormal cardiovascular finding was evidence of mitral valve regurgitation, which was deemed not serious and not likely to progress rapidly. However, a number of nodules were found in his right lung, along with some enlarged lymph nodes. The radiologist who reviewed the scan suggested a possible biopsy, with or without “bronchoalveolar lavage” (BAL).

While Mr. Ling is in good health, he is an 82 year old man and BAL requires sedation with propofol or a similar drug, and carries with it the risk of significant complications.  As to a CT-guided needle biopsy of the lung masses or the lymph nodes, this is this discussion that took place between Mr. Ling and the radiologist who interpreted his scan: “OK, let’s consider what this could be? I’m not sick – never felt better, so it’s not TB or something infectious? And if it’s cancer, well, what kind of treatment options would I have at my age for lung cancer with lymph node involvement?”

Those were great questions, and as it turned out, the radiologist was only playing it safe – he doesn’t want to get sued if Mr. Ling finds out he has cancer and a lawyer says to  a jury, “The doctor who imaged him said, ‘You’re in you 80s, I see this kind of thing all the time. Don’t worry about it.”  The radiologist ended by noting, “Since you are planning on following up in a year with another scan, we’ll see if anything has changed then.” And Mr. Ling is fortunate to have sufficient financial means that if he wants to pop in for a scan two months later, he can do that, too.

The problem is, most people aren’t in Mr. Ling’s position, and many will be unable to reason their way past the information that they have “masses” or “lumps” in their lungs and “enlarged lymph nodes in their chests!” That kind of worry cannot only be expensive, it can be damaging to one’s health, and corrosive to one’s quality of life. The information from DSSing should be given in the proper context, in the proper way, by the proper people, with the proper knowledge.  Absent that, it can do real harm. And if the scan does reveal a grave or untreatable medical condition, then there is all the more reason for the person to have the necessary resources at hand to help him cope and plan.

Ideally, this program would be part of a comprehensive Member Survival Program (MSP) administered by the cryonics organization (CO) and there would be a staff person whose job it would be to maintain communications with members, encourage compliance with MSP protocols (including the preferred imaging protocol) and collect and manage the resulting data stream.

Under such a scheme, upon intake (approval of cryopreservation arrangements) all members would have (at their option) completed a comprehensive health history and demographic information questionnaire, most of which would be completed as part of their membership application. The data from this questionnaire, as well as any electronic medical records the member may choose to provide, would be entered into the CO’s comprehensive member data base. The availability of this data would then allow for downstream refinement of the “one size fits all” scan protocol being proposed here, by allowing for individual risk assessment for CVD and cancer. This would flag members at elevated risk of early onset of these diseases to consider commencing scanning surveillance at an earlier age.

The Schrödinger Scan: the Black Box of The Baseline

Unless otherwise indicated, the first (baseline) scan would be done at age 45 for men and age 50 for women. In order to completely avoid any deleterious negative psychological effects, as well any potentially harmful effects from VOMIT (as discussed above), the baseline scan remains blinded and unexamined for 1 year after it is made. This done by providing written instructions to the radiologist reviewing the scan to seal the report unless there are unequivocal findings of life threatening pathology.

At the end of the year long blind period, the scan is examined and any anomalies noted. If the member chooses, a repeat scan can be done to resolve any questions or concerns raised by the baseline imaging. For example, if what appears to be a suspicious mass or nodule was found, a rescan a year later will very likely disclose if it is a neoplasm e.g., it will have grown or spread). It may seem counter intuitive to not look at data which you have paid for, experienced inconvenience to get, and which “might” save your life, but that is the necessary price that must be paid for this intervention to be used safely.

The baseline scan must be regarded as the first part of something that will not “happen,” or be completed for another year – like a bulb that has been planted to bloom in the spring, or a bond that will not mature for another 12  months. The scan itself is only a part of the process: the necessary information to safely interpret it does not appear until the required interval of time has elapsed. After all, before this protocol was proposed, no one ever got scanned and they felt just fine about it (until they dropped over in cardiac arrest).  For those of a quantum bent, consider it an extended version of Schrödinger’s famous experiment, except instead of the cat in the box, it’s a CAT scan in the box.

Scan Intervals & Exceptions

If the baseline is “negative,” showing no evidence of evolving pathological processes that merit intervention or further monitoring, then it is being proposed that the next scan take place 5 years later. Similarly, with each subsequent negative “healthy” scan, the next scan would be 5 years hence until age 81, at which point scans would be done every 2 years until cryopreservation ensues.

Figure 26: Proposed algorithm for Deanimation Screening Scan intervals and actions.

These scan intervals are arbitrary and will no doubt need to be refined over time as experience is gained. Intuitively, it seems that there should be a relationship between scan intervals and increasing age, and it is possible to configure scan intervals based on things like increasing risk of SCA or terminal illness with age. However, until some real world experience is gained, a conservative approach which minimizes costs and maximizes the opportunity for benefit, seems best. There are lots of programmers, mathematicians and similarly qualified people in cryonics and if any are interested in working with me, I am interested in generating scan interval algorithms based on the rising risk of disease and death with age (if you are interested, contact me at m2darwin@aol.com)

Going it Alone?

If a decision is made to proceed with DSSing on an individual basis, there are a number of important things to keep in mind and to do:

* Do consider carefully the possible impact this decision will have on you and on your family. In fact, give some thought to discussing this with your spouse or significant other before moving ahead.

* Do select a good imaging center with competent and caring staff who can give you good counsel about the procedure and the results. Imaging centers that offer full body scans are often used to counseling patients: make sure the one you select is a good one. Talk with the staff about your concerns before you commit to being imaged.

* Do explain to the radiologist who will interpret your images that you are having a baseline scan done and you only want to know if there is unequivocal pathology present that requires immediate or urgent medical intervention. If you can’t get that assurance from him, ask for your results only in writing on the same disk on which your scan is written.

* Don’t look at your scan or the written report that accompanies it. If you have a reliable and willing CO, send a copy to them and ask them to send you the results a year from when they receive the media with the images and the report on it. Duplicate CDs are typically made and given upon request at no charge, or for a small fee at the time you are imaged, or when you come for your results. Bring your own media to save money!

* Do provide a copy of the disk with the scan on it to your medical surrogate and to anyone who is on you ICE (in case of emergency) contact list on your mobile phone. The reason for doing so is that, should you experience SCA during the blinded waiting period, the scan may still save you from autopsy if it documents the presence of CAD, or some other pathology that could have caused your sudden and unexpected deanimation.

* Don’t  rely on the DSS to keep you out of trouble, or to reassure that everything is OK, should you develop serious health concerns. Just because a scan shows no indication of pathology does not necessarily mean that there is none. If you have signs or symptoms that would have prompted medical attention absent scanning, act on them in the same way after scanning. Let your physician decide if the scan is significant in the context of any illness or concerns.

* Don’t forget that the scan intervals are 5 years and that is more than enough time for serious disease to develop. Indeed, the 5 year window is a long one, especially where cancer is concerned. A DSS is not a health promotion or a disease prevention program. It’s primary purpose is to let you know you are terminally ill, not to assist you in avoiding that eventuality.

* Do know that if you have atherosclerosis, “vasculopathy” and you want to monitor progression of the disease, your scan intervals will have to be much shorter than 5 years – probably 6 months to 1 year, depending upon the severity, your response to medical intervention, and so on.

Economies of Scale?

Medical imaging is a highly competitive, non-monolithic industry consisting of many operators, large and small, both independent and institutionally affiliated. Such market environments inevitably encourage the drive to survive, and thus typically offer the discriminating consumer the opportunity for real bargains. I made a number of calls to imaging centers around the US and discussed the possibility of group discounts and “scan plans” wherein members of an organization or group, even just a group of like minded individuals, could get deep discounts on scans. The majority of centers I spoke with were receptive to this idea, and several discussed specific numbers which were anywhere from 20% to 60% lower than their standard walk-in fee.

Thus, it should be possible for groups of cryonicists in a given geographical area to make arrangements with a local imaging center for scans. The same was also true when I inquired about group or institutional discounts for carotid and abdominal ultrasound screenings, with the difference being that in some cases, prices went from ~ $350 per screen to ~ $60 per screen, providing the group could be scheduled for the same time and place.

The Pre-Cryopreservation Baseline CT Scan

Figure 27: A hypothetical pre- and post-cryopreservation  CT cerebral angiogram. The post-perfusion image would be obtained by administering radiocontrast agent(s) into the perfusate immediately, or shortly before discontinuing cryoprotective perfusion, prior to deep cooling to storage temperature.

If it is at all possible, a final vital CT scan of the head (at least) should be done as close to the time of cryopreservation as possible. This scan should be done with contrast and with no concerns about clinical radiation dose limitations, since the member will be terminal. The objective of this scan is to document, in as much detail (highest resolution) possible, the morphology of the brain and its vasculature. The imaging technique used should be one that optimizes resolution of the cerebral angiogram. The reason for making these images is that they should allow for many important determinations about the quality of initial stabilization and cryoprotective perfusion and cryoprotectant distribution in the brain to be made, at leisure, during the period the patient is in storage.

If contrast agent(s) is injected into the perfusion circuit shortly, or immediately prior to the discontinuation of perfusion, it should be possible to obtain a post-vitrification angiogram, which in turn should allow for evaluation of cerebrovascular patency, as well as assist in determining the anatomical landmarks within the cryopreserved tissue. It should also be possible to add other kinds of tracers to the perfusate, which might allow for quantification of regional distribution of cryoprotectants, or of other molecular species of interest not only within the brain vasculature, but within the brain parenchyma, as well. Again, the presence of a baseline pre-cryopreservation scan will likely be of great importance in allowing accurate interpretation of post-cryopreservation images.

This scan must be a CT, as opposed to an MRI, since MRI scans are unobtainable in deep hypothermia, or in the solid state.

Radiation & Risk

When the mass media talk about the “risks” from radiation associated with CT scanning, the first question that should spring to mind is, “Risks to who?” Sensitivity to ionizing radiation varies based on the cell age and mitotic cycle, and what this means in practical terms is that the younger you are, the greater the risk radiation presents to you.  Children thus have a much higher relative risk when compared to adults due to their rapid cell division and cell differentiation rate.

Figure 28: The risk of developing cancer as a result of radiation exposure is strongly age dependent and decays dramatically as people age. By the time an individual is in his 60s, 70s or 80s, the risk of neoplastic disease from medical imaging becomes negligible. Adapted from ICRP Publication 60 (1990).
 

These data also demonstrate that you cannot simply use the average relative risk shown in Table 1 to estimate the increased incidence of cancer due to radiation exposure. In order to do this analysis correctly, you need take into consideration the age of all individuals in the irradiated group. For instance, a man of 80 has a life expectancy of about 8 years, versus 33 years for a man of 45. Thus the risk to individuals over the age of 70 is, for all practical purposes, essentially nil. Table 2 illustrates what the  American College of Radiology considers minimal to high radiation doses in “absolute” terms.

This is why there is an increase in the relative risk values for the “entire population”  if children are included in that evaluation. However, even a quick glance at Figure 28 (above), where the estimated lifetime risk that radiation will result in cancer (carcinogenesis) is presented relative to the person’s age, shows that children have a 10% – 15% lifetime risk from radiation exposure, while individuals over the age of 60 have minimal to no risk (due to the latency period for cancer and the person’s life expectancy).  The accepted latency period is, by the way ~ 10 years.

Table 1 shows the relative risk of developing cancer per sievert (Sv) unit of radiation exposure. Tables 3 and 4 provide some comparison benchmarks of radiation exposure both in relative terms (low, medium, high) and in terms of common, specific medical imaging procedures used in regional CT.

So, let’s put this information in the context of a cryonicist wishing to reduce his risk of unexpected deanimation. The protocol being proposed here assumes a baseline scan at age 45 for males (50 for females) which, if free of any indication of ongoing morbid processes, is to  be repeated in 5 years, at age 51. If than scan is negative, subsequent scans would be performed at intervals of 5 years (if negative) until age 81, at which time the scan interval would decrease to 2 years. If we assume a lifetime cancer risk of approximately 1 in 1000 and a total of 7 scans  until age 81, at which point any further risk from radiation exposure becomes irrelevant, we might expect to see an increase in the lifetime risk of cancer from approximate 33% to 34%.  Even if the number of scans were more than doubled to 20; one per two years during the interval between age 50 and age 80, the lifetime risk of cancer would increase at most to ~ 35%.[1] This of course, assumes that all DSSs are CT, as opposed to MRI.

These risk calculations are based on the linear no-threshold (LNT) model of radiation risk.  This model assumes that the carcinogenicity of radiation is proportional to dose, even down to the lowest levels.  No one really knows how carcinogenic low-dose radiation is, because the carcinogenicity of low doses is so small that it’s practically impossible to measure. The official position of the Health Physics Society is that quantitative estimates of risk for doses below 50 mSv per year (100 mSv lifetime) cannot be made.[2]

___________________________________________________

As useful aside, if you are interested in the progress being made in medical imaging, I would highly recommend the blog Magnetic Resonance Imaging: To See and Be Amazed: http://limpeter-mriblog.blogspot.com/ The site contains many beautiful images and is a treasure trove of information on both the mainstream progress, and the esoterica of MRI

_________________________________________________

End of Part 4

(ischemia) ~85% of the time!

By Mike Darwin

Removing a Central Objection to Cryonics

In case you missed it, what I just said in that slim paragraph at the end of the preceding part of this article has profound implication because it has the potential to remove what is unarguably one of  the largest and the most rational objections that there are to cryonics. That objection is that roughly two-thirds of those who have made cryonics arrangements will not be cryopreserved under good conditions, and that half of all those signed up will be cryopreserved under very adverse conditions, such as autopsy or long (greater than 12 hours) post cardiac arrest delay. The recent advances in non-invasive medical imaging I’m about to discuss here offer the opportunity to we cryonicists to make many, if not most such losses all but unnecessary.

Figure 17: False color CT 3-D reconstruction of a patient’s intracranial arterial vascular tree. The orange-red, cheery shaped anomaly behind the right eye is a large aneurysm. The brain and other intracranial soft tissues have been digitally subtracted to facilitate a complete and unobstructed view of the patient’s arterial vasculature.

The image that you see in Figure 17 is now a perfectly pedestrian medical image that can be obtained from a garden variety CT scanner available at most diagnostic imaging centers in mid-sized cities anywhere in the world. This particular image has the brain, the soft tissue and everything digitally subtracted from it but the patient’s arterial tree and skull. The cherry shaped protrusion on the right is an aneurysm which, if were to rupture, could cost the patient his life or leave him profoundly disabled.

Figure 18: Many brain aneurysms can be treated non-surgically by passing a very thin platinum wire within the aneurysm where the wire coils up to form a yarn-like ball inside the weakened, ballooned-out area of the vessel wall. A clot subsequently forms around the coil and the vessel eventually closes off the opening to what was once the aneurysm.

Fortunately, there is a procedure  called “coiling” (Figure 18) which allows most such aneurysms to be successfully treated. Sadly, very people with brain aneurysms know that they have one until it ruptures – by which time it is almost always too late treat it effectively.

Scan Your Troubles Away?

The question logically arises, “Why not look inside everyone’s head if we have the technology to do so? Wouldn’t that allow us to identify not only the people who have aneurysms they don’t know about, but also everyone who has a tumor, or a narrowed coronary or carotid artery, or a gallstone, or anything else wrong with them that they don’t know about? In fact, why not scan their whole bodies and see if anything is amiss? Wouldn’t that allow us to nip most slowly progressing degenerative diseases in the bud?”

The answer to that question is a qualified “Yes and no.” The first and most important qualification to consider is the very substantial difference between them and us. They are going to die and, hopefully, we are not. Once you are content to die, it doesn’t really make a great difference exactly how it happens and it certainly doesn’t make any difference what happens to you afterwards. They will pay exactly nothing to avoid laying around dead for x-hours, or to avoid being autopsied. We, on the other hand, will pay something. That is a huge divide, because, as it turns out, the first and greatest barrier to such universal screening using CT and/or MRI is its adverse cost to benefit ratio.

Figure 19:  The rapid advance of computing and the high demand for ever more sophisticated medical images has driven the cost of 3-D CT and MRI scanning down to ~ $200 for a head scan $800 for a whole body scan.  http://www.superiorbodyscan.com/?gclid=CP_d5Neyiq8CFWwGRQodsHQX-w

While there are many CT and MRI machines, they are kept adequately busy, or perhaps just a little less busy than some of their owners would like, imaging sick and the worried well or hypochondriacal people. If the entire population, or even some modest fraction of it were to suddenly present for imaging, the system would crash. CT and MRI machines are very expensive and while the cost of scans has dropped dramatically, they are still not free. On the macro-level, governments, insurance companies and economists are constantly struggling to determine which therapeutic and diagnostic interventions offer the best return for the money invested in them.

The Problems of Bite Back and VOMIT

Surprisingly, information obtained from diagnostic tests can sometimes not only fail to yield any benefit, in which the case the money spent on the test is wasted, they can also cause harm. A recent example of this, much in the news, is the Prostate Specific Antigen (PSA) test used as a screening tool for prostate cancer (Figure 20). (http://www.pbs.org/newshour/rundown/2011/10/psa-testing-controversy-reignites-over-screening-debate.html) The problem with the PSA test as a screening tool is that to be effective in that capacity it requires a fairly long baseline, a good deal of contextual information (the patient’s race, family history, medications, and so on) and it requires good clinical judgment as well as a ‘patient’ patient.

Figure 20: It was anticipated that the PSA test, used as a screening tool for prostate cancer, would significantly reduce both the morbidity and mortality from the disease. It has so far failed to do so.

A single high PSA reading, or even several, may mean nothing. Most often it is the trend, rather than the absolute number; this is particularly true for black men.  In short, it’s a test that takes a lot of time and thought to interpret and use well and as such is probably not well suited to mass screening where a “yes” or “no” answer is sought before proceeding to costly, invasive and possibly injurious further evaluation.  Yet another problem is that even when prostate cancer is found and treated, it turns out that very few lives are saved because most of those cancers are slow growing and in men who will die of something else before the cancer kills them. Thus, the cost to benefit ratio of the PSA is being questioned, not the least of which because it causes many men to suffer and even die from treatments from which they did not benefit!

This is very much where medicine is today with respect to the “medical imaging singularity.” While it is possible to “look inside” just about everybody, the cost to benefit ratio for the health care system and for the “man on the street” would not justify it. In fact, it would be a medical catastrophe.

To understand why this is so it is necessary to understand three things. The first and most important of these is something called VOMIT, which is a very serious form of bite back associated with our new found ability to see inside patients with increasing exactitude. VOMIT stands for Victim of Medical Imaging Technology and refers to patients who suffer unnecessary interventions for abnormalities observed by imaging or other investigational technology, but which were not found during surgery or subsequent invasive diagnostic interventions. (Hayward, 2003) Here, I will go further and extend the definition of VOMIT to include any diagnostic finding which result in a diagnostic or therapeutic intervention which is not cost effective or causes harm to the patient. That is a very important caveat and tall order to fill, as we shall soon see.

The second is the relatively straightforward one of the ratio of the dollar benefit of resources expended to dollar benefit returned in years of productive life saved as a result of the intervention. Even in cases where early diagnosis saves lives, such as in breast cancer screening, the economic returns are equivocal. It is also often the case that “early” diagnosis with existing imaging technology is still not early enough to cure the disease. As a result, the patient suffers a longer, more miserable course of treatment and the healthcare system is subjected to greater expense with no return.

The third is the problem of information overload and it is somewhat related to VOMIT. The truism that a picture is worth a thousand words is probably a vast understatement. A single 3-D medical image contains a vast wealth of information – information which has heretofore been unavailable to both the clinician and his patient.  This might seem like a good thing, and in the long run it will be, but for now, and for a long while to come the details of the landscapes being revealed will, to a great extent, be terra incognito.

The Danger of TMI

When advances in microelectronics allowed for 24-hour ECG monitoring in the 1970s,  it became possible for clinicians for the first time to see the beat by beat electrical activity of their patients’ hearts for up to a day at a time, or longer. Prior to that, they were limited by the enormous quantities of paper tracings that would be required and the need to confine the patient to the clinic or laboratory. Now, with the advent of the compact and mobile “Holter monitor,” it was possible to capture the patient’s ECG data continuously under ambulatory, real-world conditions (Figure 21). Physicians were awash in a veritable sea-tide of data!

Figure 21: The Model 445 Mini-Holter Recorder which was released in 1976 allowed clinicians for the first time to “see” their patients’ ECGs under real-world conditions and for prolonged periods of time.

The problem was , they assumed, quite understandably, that they knew what it all meant. After all, doctors had been looking at patients’ ECGs for decades in their offices, in hospitals, at bedsides in homes and in physiology laboratories. They knew how to read  an ECG! So, when they discovered that some of their patients had periodic bouts or “runs” of very worrisome arrhythmias, they did the prudent and rational thing – they treated them for these arrhythmias with medications. Unfortunately, the result was the opposite of that expected; a significant increase in morbidity and mortality in these patients, because it turns out that in a subpopulation of healthy people, those arrhythmias were benign and not indicative of any health problem.  Thus, misinterpretation of the “same” information they were confident in dealing with in small chunks, presented in bulk and in a different context, was one of the unforeseen and arguably unforeseeable bite back consequences of Holter monitoring technology. (Harrison, 1978)

The Last Heart Attack?

If you assemble and then read over the Alcor case summaries of the last 40 years it is impossible not to be shocked by the seemingly high incidence of sudden and unexpected cardiac arrests. Because my data set is incomplete for Alcor, I can’t be definitive, but the number seems to be somewhat higher than for the same subpopulation of people from the general population (white, middle class, etc). Until, that is, you consider that most cryonicists are male. So, as you read accounts of cryonicists in their 40s and 50s arresting while scuba diving, while taking a nap or watching television, in part what you are seeing is selection bias at work. The point is, no one ever died of “sudden heart disease” a “sudden aneurysm” or, for that matter “a sudden cancer.” These are degenerative disease that takes years to decades to develop. While still difficult to detect in their nascent stages, their terminal lesions are usually very visible many months and sometimes for even for many years before they end lives.

Figure 22: Coronary artery calcium scoring using computed tomography and carotid intima media thickness and plaque using B-mode ultrasonography offer the prospect of detecting almost all coronary artery disease before it reaches the stage where it can cause a heart attack or sudden cardiac arrest.

There has been a great deal of media attention lately to an initiative called SHAPE; The Society for Heart Attack Prevention and Eradication,  which aims to all but eliminate heart attacks by combining CT of the heart to obtain a “myocardial calcium score” (a powerful risk predictor of heart attack)(Figure 22) and carotid intima media thickness and plaque using B-mode ultrasonography as part of a three step program to eliminate heart disease. The next two steps in SHAPE’s plan are a “polypill” combination of blood pressure and anti-atherosclerosis drugs and finally, perhaps, a vaccine. A similar “Last Heart Attack in America” initiative focused on coronary scanning along with dietary interventions to reverse atherosclerosis has been the focus of a feature length documentary on CNN in which former US President Bill Clinton is prominently  featured as a spokesman and advocate. The common ground of these two initiatives is that almost no one dies of a heart attack without there being  glaring evidence present in their hearts years before the infarct occurs. It is only necessary to look for it!

There can be no question that as imaging technology evolves, and as medical acumen catches up with what is available, that such imaging will become a routine part of any checkup  for patients whose age and risk profile merit it (and eventually, if they live long enough, that means most patients). As it stands right now, if you are a middle aged man or woman with a significant risk profile for heart disease, and you have a heart attack, it’s my personal opinion you have ample grounds to sue your physician for negligence.  Right now, that’s just my opinion, so it doesn’t count for anything, but the point is that sooner or later this, or a better coronary imaging modality is going to become the standard of care and heart attacks will become a rare event – a thing of the past – a relic from a time when doctors couldn’t see inside of you.

Ultrasound Investigations

There are cheaper, simpler and completely risk free ways (in terms of radiation) to  find out whether you have atherosclerosis or not.  The most predictive of these for money is the carotid ultrasound (CUS) test.

Figure 23: The carotid ultrasound scan is  a simple, non-invasive diagnostic investigation that employs sound waves to create an image of the two large blood vessels in the neck that supply most of the blood to the brain. If there is a buildup of plaque or a thickening of the limning of these two arteries the person is at increased risk of stroke and there is a high probability that there is also systemic atherosclerosis present. If there is evidence of severe narrowing of one or both of the vessels, then it becomes urgent that medication and possibly surgery be used to correct the condition in order to avoid the likelihood of a crippling or lethal stroke.

This simple, non-invasive test takes just a few minutes and uses ultrasound waves to image the carotid arteries and the blood flowing through them (Figure 23). If there is thickening of the arterial wall, or plaque present, then it is a virtual certainty that the person has systemic atherosclerosis and warrants a more extensive workup. This test is often also “packaged”  with a quick “look-see” at the abdominal aorta also using ultrasound, to rule out the possibility of an abdominal aortic aneurysm – something that is more common in smokers once they reach middle age, and beyond.

If you shop around diligently, the cost a CUS can be as little as your transportation costs to the health fare or community center where it is being offered, often as a “loss leader” by health care providers or medical imaging companies seeking more remunerative business opportunities (if they find something amiss during the CUS).  The cost of such an evaluation can range from as little as $60, to as much as $380.

A CUS is ideal for people on a budget and for those under age 45 with no history of heart disease, cancer or other pathology or risk factors that might put them at increased risk of sudden cardiac arrest.

Why Full Body Scans?

Figure 24: The full body CT or MRI scan is often offered as “add-on” to the complete or the “executive’s” physical. Many imaging centers offer these scans without the need of the patient’s person physician prescribing the scan using their in-house radiologists to write the order for the test. http://www.prevenium.com/contact.asp

 Put simply, there is no substitute for seeing, or to put a new twist on an old adage: a picture is worth a thousand medical tests. While the origins of all of the degenerative diseases that kill us are at the molecular level, mostly we die as a consequence of the macro-level changes they inflict on our bodies, even if the coup de gras is rooted in the action of things like adhesion molecules and inflammatory pathways; as is the case with most heart attacks. It is the large, easily “seen” bulges of aneurysms, masses of plaque or tumor that kill, and these almost always take years to develop. What this means practically is that, with a few exceptions, aside from suicide, homicide and accident, virtually no one has to die – or to deanimate without plenty of advance warming. The implications for cryonics are as obvious as they are profound.

End of Part 3

(ischemia) better than ~85% of the time!

By Mike Darwin

Ischemia: The Problem of “Long Down Time”

 Almost every cryonicist I’ve ever spoken with envisions his cryopreservation will occur under ideal circumstances. He will be diagnosed with  some vague and ill defined terminal illness, bravely decide to end futile treatment and then enter hospice with a team of skilled and caring cryonics personnel at his bedside. He will nap, read, watch TV, and then, near the end, nod off surrounded by loved ones as the cryonics personnel hover nearby. This may not be the most attractive picture in any absolute sense, but it is certainly as reassuring a one as it is possible to find in contemporary cryonics. And while many, or even most cryonicists may find this scenario credible, much of the rest world doesn’t.

 Figure 10:  Approximate U.S. distribution of predictable deaths by cause based on 2004 data. Note that ~57% of all deaths occur sufficiently suddenly, or under circumstances such as accidents, which preclude standby or other cryonics stabilization measures. Chart derived from data: [National Vital Statistics Report, Volume 53, Number 5 (October 2004)]. This data may be compared to the data in Figure 10 to see how closely the US national incidence of sudden and unpredictable death map that of Alcor’s experience (Figure 11).

One likely reason for the scarcity of biomedical people involved in cryonics is that their actual, day-to-day experience is at sharp odds with the scenario I’ve just laid out above.  In countless hours of both focused and casual conversations with such individuals, what emerges is a sense of incredulity about the reversibility of the damage these professional and technical people witness as a part of their duties caring for the very old, and the critically ill dying; not to mention that large fraction of people who die suddenly and without warning, end up as DOAs in the emergency department or coroner’s cases. Regardless of whether their opinions prove the valid ones, we are clearly failing to communicate to them and to the community at large, an experience of cryonics which is not so biomedically adverse.

To do that, it is first necessary to move beyond  anyone’s scenarios or suppositions and evaluate the reality of what is actually happening to the patients we cryopreserve. That turns out to be a hard thing to determine with any degree of precision, because none of the cryonics organizations maintain any kind of statistical database on their members’ cryopreservations. How many cryopatients have dementia? How many were autopsied? What is the mean ischemic time from cardiac arrest to the start of cardiopulmonary support (CPS)? How many patients have ischemic times of 2-5 minutes, 5-10 minutes, 15-30 minutes, 12 hours, 14 hours, 5 days? What is the mean age at cryopreservation? [Absence of data on this last question I find particularly amusing in a group of people supposedly preoccupied with longevity and "life extension": how long are they living, on average?]  There is currently no way to tell.

There is not even any way to determine the age, gender, or any of dozens of other potentially critically important demographic details that are, or could be vital in assuring quality cryopreservations, reducing ischemic times, or reducing known iatrogenenic events. A concern of mine for onto three decades now is that we have no way to spot adverse epidemiological events that might be associated with our unique dietary supplement or other lifestyle practices. Perhaps most incredibly, there are no written criteria, however arbitrary, to assign any degree of quality, or lack thereof, to the cryopreservation a given patient has received (let alone that a given Cryonics Organization (CO) provides, on average). This had lead to what has become known as “the last one is always the best one” to date rating system, wherein each case that is not either an existential or an iatrogenic disaster, is pronounced by the staff who carried it out as, “the best case we’ve done so far!”

We cryonicists may be in some kind of willful, data free fog about what our situation is, however, it’s a safe bet to assume that most of the rest of the world, based on their own professional and personal experiences, are not so ignorant. The first step towards a solution is to understand the scope and severity of the problem by getting reliable numbers. While that is not easy to do, the Alcor Life Extension Foundation does maintain a crude, if incomplete accounting of all the patients they have placed into cryopreservation: http://www.alcor.org/cases.html. A cursory analysis of this yields the following breakdown. Even basic data such as cause and mode of death are missing from ~20 of the cases listed there – these have necessarily been excluded from the analysis below.

Figure 11: A major hurdle to evaluating quality in cryonics operations is the lack of any outcomes (e.g., reanimation followed by evaluation) or of any surrogate markers or scoring systems to serve as evaluation tools to determine not only the quality of cryopreservation care being given, but also the objective neurocognitive status of the patients when they enter cryopreservation. For the purposes of this analysis very crude criteria were used to assess the quality of the patient as a finished product at the end of cryopreservation. These were normothermic ischemic time between cardiac arrest and the start of CPS, catastrophic peri-arrest brain injury such as an intracranial bleed followed by prolonged cerebral no-flow before pronouncement of medico-legal death, very long warm ischemic times (> or = to 12 hours) and autopsy.

Using the criterion of “minimal ischemia” (≤15 minutes)[1], 48% of Alcor’s patients are cryopreserved under these conditions (Figure 10).  Thirty-nine percent of their patients suffer long ischemic periods of 6-12 hours or more (mostly as a result of SCA and UDA); and 13% suffer very long periods of ischemia (> or = to 24 hours) which are not currently preventable, or which conclude in autopsy prior to cryopreservation.  Put more cogently, you have less than a 50% chance of being cryopreserved (with Alcor) under conditions of minimal ischemia. While this number is discouraging, it is spectacular when compared to the Cryonics Institute, where it is somewhere in the low single digits.

Figure 12: The graph above is the same as in Figure 11, with the difference being that the losses have been expanded to include those that would be expected if the population wide incidence of end-stage, GDS-7 dementias were imposed on all the groups. The result is that percentage of patients who might reasonably be expected to have both minimal ischemia and no pre-cryopreservation GDS-7 dementias drops to just 26%.

But once again, these numbers are misleading if the criterion is cryopreservation under minimal ischemia conditions, because they do not take into account the number of patients who enter cryopreservation with dementia, or severe brain injury due to stroke, other neurovascular disease, or massive head trauma. If only dementia, at the current incidence for the general population is factored into the analysis, then the picture becomes considerably more bleak, as can be seen in Figure 10, with only 26% of  Alcor cryonics patients being preserved with relatively intact brains under reasonably good conditions.[2]

Impact of the BDDs on the Likely Survival of Personhood

Figure 13: The effect of advanced Alzheimer’s Disease on the macroscopic appearance of the brain is evident when coronally sectioned brains from an AD (R) patient and a healthy person in their mid-20s (L) are compared side by side.

Deaths from AD are typically deaths from end-stage AD, which usually implies severe global destruction of both cerebral hemispheres (Figures 13 & 14) on both a macro and microscopic level. Death due to AD is a prolonged process (~8 years from diagnosis to death), and the neurological deterioration that occurs as the disease progresses is often scored using the global deterioration scale (GDS) of primary degenerative dementias, which ranges from 1 (least) to 7 (worst) in severity. GDS scores in excess of 5 are associated with major loss of macro- and micro-scale brain structure and will be assumed here to represent serious compromises to, or the destruction of personhood.

Figure 14: The histological appearance of the brain in AD is shown in panels b and c above. In many areas of the brain there is virtually complete loss of the neuropil; the synaptic weave that interconnects neurons which can be seen in its normal state in c, the panel at the far left. The majority of the neurons and many of their supporting glial cells have died and been scavenged by macrophages and histiocyytes.  There are abundant deposits of proteinaceous plaque containing the  neurotoxin protein beta amyloid neurofibrillary tangles which are the remnants of neuronal long processes such as axons and dendrites. The extent and uniformity of the changes seen above varies from patient to patient during the course of the disease, but becomes increasingly uniform throughout both hemispheres of the cortex the longer the patient survives with a GDS score of 7 (end stage dementia).

A Deanimation Warning Device?

Figure 15: The medical imager as a deanimation prediction device?

 In his 1939 science fiction story Life-Line,” Robert Heinlein envisions a device that can predict, with considerable precision, when a person is going to die. While none of us cryonicists wants to die, most of us could certainly profit from knowing when we are going to deanimate. Better still would be also finding out how to postpone our cold dip in liquid nitrogen for a while, if it was possible to do so.

Many cryonicists will be familiar with this graph of Ray Kurzweil’s showing the impending arrival of the singularity (Figure 16).

Figure 16: Ray Kurzweil’s graph showing the exponential increase in neuro-image reconstruction which has occurred largely as a function of the exponential growth in computing capacity since 1970.

Well, if you are a cryonicist, I’m here to tell you that insofar as non/minimally-invasive medical imaging is concerned, the singularity is here.

From the earliest days of medicine physicians have desired one thing almost above all others and that is to possess the power to peer into their patients bodies and observe the goings on there. Since the discovery of x-rays by Wilhelm Conrad Röntgen in 1895 (Crane, 1964) there has been steady progress towards the satisfaction of that desire. The development of contrast media, endoscopy, computerized axial tomography (CAT or CT) scanning and magnetic resonance imaging (MRI) scanning have allowed increasingly exact and impressive images of the interior of the living body to be made.

However, a number of serious limitations have, and to a great extent still do prevent the full realization of the physician’s idealized desire to see inside his patients at will. Those barriers are field, dimensionality and point of view, as well as resolution, color, contrast and the dollar cost of the imaging.

In the case of CT and MRI those barriers have been breached to such a degree that it is now possible for cryonicists to be able to determine with a very high degree of accuracy and precision both of what and when they are going to experience medico-legal death. A corollary of this is that in many cases it will be possible for them to avoid what would have otherwise been an unavoidable very long period of ischemia and quite likely a medico-legal autopsy  as well.

End of Part 2

Reception area of the Alcor Life Extension Foundation in Riverside, CA in April of 1987. The photos above the refreshments cart were of some of the patients in Alcor’s care at that time.

Sometimes we get defeated by technology, sometimes by cluelessness and sometimes by a most unexpected intersection of the two.

In 1981 I conceived of the idea of hanging the picture of each patient cryopreserved at Alcor on the wall of the facility. I intended the practice to start, not in the place where it might seem obvious for it to; in the patient care bay (PCB) as a memorialization of the patient for his family and friends, but rather, in the reception area and offices, where the organization’s staff dwelt on a daily basis. It was my intention that as the patients accumulated in the PCB, the photos would begin accumulating in the offices, laboratories, corridors and workspace of the Alcor staff.  The intention was to provide a not so subtle reminder that there were people in those big stainless steel tanks, people who were desperate to get out of there.

Photos of Alcor patients apparently spilling off  (?) the walls in the conference room at the Alcor Foundation’s facility in Scottsdale, AZ in April of 2011. Photo courtesy of Stan Lipin

My intention was that, over time, there would an inverse and very adverse relationship between “success” in terms of patient population growth and “failure” in terms of growth in the number of pictures on the wall. In time, I envisioned (with some glee) the framed photos multiplying like locusts, becoming ever more oppressive and occupying ever more wall space.  I foresaw that they would likely encroach into the PCB. I also thought it likely they would be downsized. But mostly, I hoped they would serve their primary function, which was that each one was to serve as a reminder to those working at Alcor: “Hey, I’m still waiting, get me out of here! I want to get back to living, just like you are, too!”

This was not an idea which I kept secret. It was frequently discussed with other Directors, with staff, even with the officers and directors of other cryonics organizations. In fact, I now believe it is a practice which has become universal at cryonics organizations around the world. Or should I say, had become universal.

Alas, I hadn’t counted on technological advance. Technological advance is almost always a “two sided blade” and is this case, the blade cut in a way I hadn’t at all foreseen. The digital photo frame makes it possible to store essentially an “infinity” of images, and display them all in the physical space occupied by just one, over short sequences of time. In so doing, it removes the clutter, and thus the annoyance of hundreds or even thousands of actual framed, photographic images. One problem solved.

And another created. The purpose of institutions is to attempt to overcome the most damaging consequences of human mortality to civilizations: the destruction of knowledge, wisdom and the values they enable. In short, the loss of memory and accumulated experience that comes with the death of individuals.

Enter the halls of any civilization’s venerable institutions and you will see the images of the individuals they treasure on their walls and of those individuals’ ideas encoded in the books lining their shelves and engraved in the form of quotes and aphorisms on their walls. Stroll their great cities, or the corridors of their museums and you will see statues and likeness of the persons they treasure and admire cast in bronze and carved in stone; all these things are feeble attempts at conserving the ideas and values of the individuals who created the intellectual capital that sustains their civilizations. It is not just that they owe these men personally (they do) it is that these civilizations survive by remembering and living by the ideas that these men created.

Unfortunately, it turns out that ideas, standing alone and absent the context of memory, are weak things. It is one thing to know that fire burns, and another thing altogether to know that fire burns having been burnt by it. It is the power of knowledge in the context of experience that is wisdom, and it is wisdom that is destroyed by death. Knowledge contained in books, or nowadays in digital form, is but a shadow compared to that contained in the mind of a man who knows the real truth of a thing in the context of personal, hard won experience. Feeling, guided by reason over time, is the most powerful tool in the universe; and death is its ultimate enemy.

The human institution (first as oral tradition) followed by the written word, were man’s initial tools against death. Poor instruments that they were, they were used to fight valiantly in an attempt to conserve the memory of what was – a story of people, places and events over time. They were, to a remarkable degree, successful. The Royal Society is almost unbelievable in this regard, with every scrap of correspondence and every minor triumph and squabble being recorded and preserved. So are many neighborhood British garden societies – many going back hundreds of years. This will be true of every successful human institution from enduring religious institutions such as St. Catherine’s monastery in the Sinai, to the fraternal organizations such as the Masons in the US.

Robert Ettinger (left).

With the advent of scientific medicine and Ettinger’s book in 1964, it has become scientifically credible for human beings to reach for personal biological immortality and thus, for the first time, for a credible and a definitive “end to death.” Because what death really is, is the destruction of human knowledge and wisdom, and that is always and necessarily rooted in the destruction of individual humans. Wisdom, in particular, is uniquely a property of individual persons, and so is creativity. Neither of these fantastical properties which create and drive civilization can be distilled into books, carved into stone, or molded into bronze or plastic.

To achieve immortality for individuals it will be necessary to utilize the structure of institutions. It should be abundantly evident that such institutions will necessarily have to be the most stable and durable of those which human beings have so far managed to engineer. As such, they will have to most emulate that property which human institutions were created for in the first place: the conservation of memory of persons, places and events in order to conserve values over time. This why institutions incessantly speak of things like “grand old traditions” and “institutional memory.”  Admittedly, it is a hard thing to do. And it is a perilous thing to do, because it relies upon successful prognostication of the future; that the ideas and values selected for conservation and propagation over the ages are the ones essential for success; and that the ones not essential, do not discredit those that are.

Inherent in cryonics is a terrible arrogance and optimism which attracts a kind of people who seem to possess an inborn contempt for, or incomprehension of the value of the past. This is evident in their own disregard for it. There is a shocking lack of historical conservation at both CI and Alcor. In fact, it is so shocking and all pervasive that I know that my words here will have virtually no impact on almost all who read them, because no one,[1] at either place has any idea of what I’m talking about. It is, literally, the equivalent of talking to people who have never seen books, about how shocking it is that they don’t have libraries.

Organizations that are clueless about their own (recent) historical past should, not surprisingly, also be clueless about the deeper reasons for things like pictures of patients hanging on the walls. A few years ago, I was talking with one of the (many) former Presidents of Alcor who had a question for me about  something in a member’s paperwork. This President wanted to know what “BACS” was? Now, I am old. In fact, I’m a little older than cryonics (by about 9 years). But that still only makes me 56, not 156.  I felt a little like I do when I see anyone in the US being stopped on the street and asked questions like, “Who is the Secretary of State?” or “Who was Abraham Lincoln?” and the response is an utterly clueless answer.

If you’re an average reader here, and you don’t have a clue, that’s OK, because there really is no cryonics community to get acculturated in. The answer is that the Bay Area Cryonics Society (BACS, they changed their named to the American Cryonics Society, ACS, in 1985) was the dominant cryonics organization in the world from ~1974-1984! That’s a third of all of cryonics history and it’s not that long ago.  To not know that and to be running the world’s largest cryonics organization seemed wrong to me. Not because it was wrong per se, but because it was inevitably a marker for what had to be a veritable iceberg of other missing information that was of far greater import. And even that isn’t necessarily a fatal flaw. Realizing a deficiency of knowledge or character or resources, even a spectacular one, and working hard to remedy it is the oldest heroes’ tale in the world.

By CryoX

{This is a work of fiction  {or is it?}

Mirror mirror hanging on the wall
You don’t have to tell me who’s the biggest fool of all
Mirror mirror I wish you could lie to me
And bring my baby back, bring my baby back to me – m2m

My frequent flier card isn’t a card at all, it’s Parthenocissus tricuspidata (some would argue it’ the Roman numeral IV, instead). Whatever. For me it’s the magic weed that evaporates the financial distance between the coasts three or four time a year. Most of my frat buddies have their business junkets, we academics have our conferences. Alcor and Mike Darwin. Both on the West Coast, as  was my upcoming conference. Doable.

I hadn’t seen Max More since my undergraduate days, which I realized were rapidly becoming, no pun intended, a chillingly long time ago. My girlfriend (at the time) and I had attended some cryo/extro/CR get-together’s, and I met Max and his wife Natasha several times.  Max was this earnest, muscular, ginger, intellectual type who tried just a little too hard, was just a little too rehearsed and was more than a little too rigid. His wife Natasha? In some slightly different AU, Kurzweil has his Ramona. To me there is something artificial, slightly off and s-t-r-e-t-c-h-e-d t-a-u-t about her.  The only time I met Max without her around, I noticed a big difference in him; he was visibly insecure.

Now, Max More is President of Alcor.

I should have called to be sure Max was going to be there instead of just booking for the tour. Stupid. My flight was delayed out of LAX, and with the crazy delay from the limo, I barely made it from Sky Harbor to the Alcor building in time to meet the rest of the group. Unbelievably, the traffic in Phoenix is worse than it is in L.A.

The Alcor building is drab and unimpressive which, because of the idiodyssey of my limo driver, I really don’t understand. There are two Acoma Drives in Scottsdale and the moron (or his company) driving me from the airport had no GPS. We spent half an hour cruising around the Scottsdale Air Park before I finally became desperate enough to shove my Droid in his face and demand he call someone for instructions (shame on me for not having my GPS enabled for travel). The Air Park has lots of architecturally attractive buildings – some quite stylish if you like that Frank Lloyd Desert Look. The Alcor building is Brutalist Bad; plain-ugly-anywhere.

As soon as we were admitted to the lobby/reception area, a bomb went off in my head: Natasha! I don’t know if she had anything to do with it, but that was my reaction.  That kind of space is, by definition, supposed to welcome and draw you in. Instead, there is this big, cold, crystalline blob in the form of an “Infinity Mirror” almost immediately inside the door on the wall to your right, as you walk in.

There are all kinds of problems with this. First, it causes a distraction. The visitors aren’t interacting or socializing with each other, or the Alcor staffer (who should be a scantily clad voluptuous blonde). Instead, they are looking at the “pretty” on the wall, and some of them are even ape-touching it. One Merkeley woman in the group poked me in the ribs and said in an excited whisper, “Oh look into it, look into it.” That was my undoing. Fun-house mirrors, looking down tall glass buildings, certain angles at the Las Vegas  strip: all provoke intense, uncontrollable vertigo and nausea. Instantly, I was an undergrad in a dorm room staring up at an empty case of Dos Equis from the floor.  In one direction was the door to the outside, which the lady who had let us in had locked with a key. In the other direction was a mass of sharp angled stainless steel and glass furniture which I could see myself impaled upon and dying in a pool of my own blood and vomit.  I was paralyzed in front of the magic mirror. All I could do was shut my eyes and think of cool sea breezes. It worked.

The Alcor reception area is done up in grays, icy whites and shiny metals. This is a cryonics company. Its two most obvious and predominant negative images to overcome are death and the cold.  I didn’t really need the rest of the tour because even before the nausea had fully subsided, I realized that the special expertise Max had been hired to ply on Alcor was a new, high technology “preservative” skill called techsodermy, which is the cryonics equivalent for “dead” high technology companies. It was invented in the 1980s in Silicon Valley, and while I just made the analogy to cryonics, it really owes it origins more to taxidermy, because it was invented in order to fill dead tech companies with fluff in the hopes of convincing someone to buy them. (When we were waiting for our rides, the Merkeley Lady said the lobby reminded her of Benihana, and that she expected an “Oriental gentleman” with sizzling liquid nitrogen and  steak and shrimp to come out and start “chopping our meal” with a Ginzu knife at any moment. At least, she hoped it was steak and shrimp.)

My Old Man is all about money. In fact, he is money. He makes money appear and disappear. He moves money. He cleans it, he packages it, he inventories it, he “handles” it. That means that his clients are, mostly, people who rarely, if ever touch the filthy stuff. Some of them don’t even want to touch the little pieces of plastic that serve as markers for it. It’s an irony that the people who have the most money are the most visibly invisible of the super rich. If there is anyone reading this who knows what a Smythsons Diary is, I’d be very surprised. Perhaps a few more would know how to assess a man’s station by looking at his shoes, or his writing utensil? Today, casual dress is so commonplace and so comfortable…and if you want to be somewhere reasonably economically and you have commonsense and a lot of money, you book first class and you dress sensibly and comfortably. But, if you are in the know – then you know who’s who, and you don’t need a ledger book to tell you.

If you want peace and privacy, then you don’t travel by commercial means at all. That’s for the peasants. You use Flight Centres and privates jets, and there is no security screening. And if you want a blow job or a massage, or both en route, that can be arranged for a few hundred dollars more; a small part of the cost of coach ticket the flying public pays, and that after taking off their shoes and belts and switching planes in Houston and Dallas.

The people at Alcor are clueless about how to get the customers that matter. Not just the rich and the super rich (the people my Old Man services day-in and day-out), but the “good-judgment” segment of every demographic of the population. You may be a working class stiff from Boston in a cloth coat, but you know what the genuine trappings of quality, durability and class are, regardless of the style. Warmth, wealth, style, elegance, quality; whether understated or overstated, they always come through. So does Costco warehouse gray.

My Old Man wanted me to get an M.B.A. But he wasn’t altogether disappointed that instead of the usual frequent flier card I got that Mark IV. He’s interested in cryonics and he thinks it has a technical and (less so) a financial chance of working. But Alcor? I may be that desperate, but unfortunately for me (and him), he’s not.

Illustrations by Mike Darwin

This is a work of fiction  {or is it?}

We Froze the First Fly.

Great title.

I could have written it.

I should have written it.

I’m an insect endocrinologist.

This futon in the lab lounge is so hard and lumpy I’d’ rather crash on the floor. But it’s nearly as sticky-gray as the table cum journal holder, cum lamp stand at the end of it. I am waiting on some gel tracks to finish. I wearily sit up, grab the ratted copy of PNASty on the coffee-juice soaked table next to the fridge. It comes away from the faux wood-grain surface with a stickysssssss.  The journal opens, on cue to,  ”Conversion of the chill susceptible fruit fly larva (Drosophila melanogaster) to a freeze-tolerant organism.”

Did I mention I’m also a cryonicist?

My middle name is Drosophila.

Humiliation.

Embarrassment.

Feelings of worthlessness.

Should I call GOD (Grand Old (Mike) Darwin) when I get home? That’s a conversation I can’t have here, or at Starbucks across the street.

GOD knows everything, well, almost everything.

Yeah, I should call him.

He hates it when I call him that, so I guess I should call him Darwin here, or maybe just “him”, when it’s grammatically correct.

I started phoning him after I got turned onto the history of the interaction between scientists and cryonics by something Chris Hayworth wrote.

Then I was pulled into his blog.

This place (where I work) is close to one of the Great Libraries. Periodicals. Films. There’s maybe two places  you can go to find out about the history of cryonics and science as it happened: Mike Darwin, and the Library of Congress.  When I started, I didn’t know to start with Mike Darwin. I’d have saved a lot of time. But I think it would’ve warped my perspective .

Digging through the stacks of magazines and newspapers from the 1960s and the 1970s, ordering up 35 mm film, kinescopes, and videotapes that were the size of hard drives from 1980′s, was like opening old tombs. That stuff smells. It feels ancient. Dead. Gone.

Darwin is alive. Electric. Now. He ruins the past by making it present.

The gels are done.

I’m done.

Gone.

Home.

The bugdust can wait till tomorrow.

I get Darwin on the Droid and start pouring out my woes about the missed opportunity with frozen flies. He is only mildly moved. “It’s good work,” he says, “not so much because it’s great science, but because it shows people straining to do something, to try, to be clever. I know this will sound impossibly, prickishly arrogant, but this is work that could have been done, and should have been done by a kid in high school, or middle school as a Science Fair project 10, or even 15 years ago. No, no, not the DSC (differential scanning calorimetry), and all the sophisticated science, but the basic work of trying to successfully introduce cryoprotectants into flies, or other larger organisms, and then freeze them successfully. Planaria would be a great model for that!”

“Really?” I replied with some skepticism.

The image of a Justin Bieber, working studiously at my bench,  just didn’t crystallize in my mind?

“Hell yes!”

“In the 1970s, students, children,  were freezing mammals – reproducing Smith’s work – and Greg Fahy and I had both done experiments with invertebrates (and me with vertebrates) before the Science Fair banned such work. In fact, you can introduce 6% DMSO into gold fish. I never tried to see how much additional ice that lets them tolerate. Now, because all such biological “hacking ” is banned, no kid is going to try things like introducing combinations of molecules like perhaps a  membrane protecting sugar such as trehalose,  a protective amino acid such as proline,  and a small amount of a colligative agent, such as glycerol, DMSO or ethylene glycol into a common pest, like the California garden snail. Can’t be done. They’d send the poor bastard off  for a psych referral and counseling.  “Tsk, tsk, you maladjusted, mean little bugger,” they’d say.  ”Why, the next thing you know, you’ll be pulling the wings off song birds and sniffing your mates’ jockstraps in the locker room.”

“I had to admit, he had a point. ”

“So you’re saying I shouldn’t feel so bad that I didn’t do this  experiment 10 years ago?”

“No, I’m saying that as far as your likelihood of  brilliant scientific contributions to cryobiology goes, you’re fucked.  In my opinion, that window probably closed when you were a graduate student, and it certainly closed after you were a post doc. Any mark you make scientifically now in cryobiology/cryonics will be along the lines of what Donaldson did, and Donaldson was a fucking genius.”

“And I’m guessing you think I’m not?” I replied.

“Who do people always put words in my mouth, and then get royally pissed off at me? I’m glad you’re recording these calls, and I hope you not only save them, but that you actually listen to them some day. Because when you do, you’re going find that, to your considerable surprise,  after 20 or 30 years of telling people that “Mike Darwin called you a fucking moron,” in fact, what I really said  was nothing at all. Literally, nothing at all. Please, try and remember that.

People have this remarkable tendency to substitute their own dire adjectives at junctures like this when they are forced to confront the hard reality that they are not geniuses, or millionaires, or movies stars, or any other of those nearly impossible ideals and that, at least during  this life cycle, they are not going to be.  That is one of the most important reasons why we are tangled up in cryonics in the first place! Because, if you stop and think about it even a little, not even George Clooney, or Bill Gates, or Barac Obama, or anybody gets it all. They only get a teeny tiny bit of it: and then they die. Whitney Houston. Fantastic, angelic voice. Beautiful woman. Rich, rich rich! Miserable life. Dead. Great stuff, huh? ” Cryonics isn’t just about any of those things, it’s about all of those things, minus death, and infinitely more,  and that’s what makes its transcendent.  That’s why the prefix trans keeps popping up spontaneously in cryonics (and everywhere else in human culture).”

“So what do you think I should do?” I ask.

“If you mean what specifically, the answer is, ‘I don’t know.’ And that’s because you are not a PFC and I’m not a general. You’re not a grunt with an IQ of 90, under the authority of a nation-state, that I can order about at my pleasure. If I try to do that, you’ll turn on me like a cornered rat. In fact, odds are, you’ll do that no matter how I choose to interact with you. It’s just that the odds are a lot better that it will happen later, rather than sooner.

So I can’t give you orders. I can’t even really give you specific suggestions, because as soon as I do, you’ll start returning with all kinds of ‘well but’s', because again, it will rapidly degenerate into my planning your life. That won’t work.”

“So what does work?”

“The nature of an insurgency is that, in its early stages, it is self organizing.  Still, it must reach a critical mass. How it does that is still a mystery to me. I think it is part chance, part timing, part the presence of the right individual – the nucleating individual.”

“Do you think you’re that nucleator?”

“It doesn’t matter what I think.  At any one time there are a thousand, ten thousand, maybe a million guys who think they are the nucleators. I was in the UK at the baths and all the action had stopped. All the men had gathered around the telly  to watch this ghastly, absolutely ghastly woman with Asperger’s from Scotland sing.[i] There was no sex to be had anywhere; these men had paid good money to get laid and they’re watching this ghastly woman on TV! She sang. Objectively, her voice was good. Not great, not fantastic. Definitely the kind of voice that can make a meager living for you at the low end of the industry if you have a good personality and a great manager; clearly neither of which she had. Good singing voices are common. Great singing voices, truly great singing voices, are not. Now this, on the telly, commanding the attention of gay men in a city where you can hear the most magnificent voices in the world at St. Martin’s in the Field for fucking free (if you can read)!

As it turned out, she became a sensation, went onto fame in the U.S., sold millions of albums! It was mad, absolutely mad! And I assure you, it had nothing to do with her raw talent. She was one of millions and millions of would-be nucleating agents trying for that peculiar niche, and she was in exactly the right place at exactly the right time. Did she think she was going to be a multimillionaire hit recording star? It doesn’t really matter, because she is. It’s very much like the lottery if you are poor , disenfranchised, have no other options and desperately want to get hold of millions. Well it’s really your only chance, and if you don’t play, you can’t win.

I’d also hasten to add that you’d best be careful what you wish for and be damn sure you have the tools and the talent to handle it if you get it, because most people who  win the lottery are destroyed by it. And the results of winning for most insurgents and insurgencies are disastrous for them.”

“But back to me? Where do I fit in?”

“You say you’ve become ‘obsessed’ with the war between the cryobiologists and us. What have you learned?”

“That you single-handedly squashed those Cacks . Reading that history, the history that you wrote of the battle royale between the cryobiologists and the cryonicists,  between them and us, I mean, that was the catalyst. When I began looking at the source material, it didn’t compute. ”

“Why not?”

“They caved too quickly. It was all over as if they’d been hit in the taint with a sledge hammer. That didn’t make sense. Cacks don’t wage a 20 year war, invest their reputations and take the time to go on TV and talk to journalists, and then just stop. Not. Doesn’t happen.”

“So?”

“So I wanted to know what did happen. I know that you threatened to sue them. They’re herd animals.  But some of them are mavericks. And some of them are stupid, too. ”

“Like Dr. Arthur Rowe, who, in fact, is still alive, and recently, like a frozen Woolly Mammoth in some bad B-movie, has come back to life, eons later, and is making TV appearances again, trashing cryonics.”

“Yeah, like  Arthur Rowe.”

“There are colleagues of mine here who won’t talk to any journalist, but if someone from Wired or Scientific American comes sniffing around, they can’t help themselves. Greed and ego, ego and greed.”

“Exactly.”

“So, I wanted to know what happened and that’s when I started digging. I guess that’s when I began to understand your message on Chronosphere and to understand what the word insurgency meant. I think it’s Chris Hayworth who mentions that you threatened to sue the Society for Cryobiology.

When your name comes up in cryonics, everybody thinks they know you, and everyone has a story to tell about you. In a small group of people who’ve been involved for a while, I’m usually the only one that hasn’t got anything to say. Listening to that kind of talk is funny. I sit and think about the letters written to those scientists’ bosses. And to the bosses of those scientists’ bosses. About the phone calls, probably hundreds of phone calls made to university chancellors, blood bank officials, trustee members, university board members, grant committee remembers. About all the letters, hundreds and hundreds of letters on different letter heads, on no letter heads; letters written and mailed to the same types of people complaining about the unscientific, unethical, overreaching and improper behavior of their scientist employees.  Courteous letters and not so courteous letters.

And I have to wonder what kinds of letters some of those scientists, or their families, the ones who didn’t stop their unscientific and irrational attacks on cryonics, might have received?”

“I’m sure I wouldn’t know.”

“You know, a few of the secretaries and support staff who worked for some of the most outspoken scientific critics of cryonics are still around. They offer an interesting peek into that time. You ground those people down. In fact, you sacred the crap out of them.”

“I had help.”

“I’m sure you did. But it was you. It was your idea. It was your leadership. It was your insurgency, as you would put it.”

“Yes.”

“Melody Maxim?”

“What about her?”

“She was not merely annoying, she was becoming dangerously destructive. Not because of the true things she was saying. Had she spoke the truth – no matter how malignantly or viciously, no matter with what calls for regulation and policing, I would have remained silent. But she began to lie, to defame good men who were cryopreserved and who could not defend themselves; to threaten the lives of innocent people, and to try to destroy cryonics on the basis of fraud and force. Interestingly, the response of the cryonics organizations (and their members) twenty years after the cryobiologists’ attacks on cryonics organizations that were now orders of magnitude bigger in size and with assets larger still, was to revert to type. It was exactly the same as it had been before 1980. They simply argued with these creeps in their own forums, were picked off one by one, took it, watched the opposition grow dangerously and did nothing. And in the bargain, they fought with each other!

I was stunned. Frankly, I was more stunned than I am today, having just been informed that both my parents have  been dead for four months and that I was deliberately not informed about it. It shook me to core.  I realized, as I read over that traffic, that cryonics was in no way going to work. It wasn’t an opinion, or a guess, or a hunch, it was a simple fact. It was like turning on the TV on 9/11 and seeing those people falling from one of the Twin Towers. There could be absolutely no question in your mind that whilst those people were alive, they were absolutely certain to be dead within a (short) and quantifiable period of time.

You have to realize that I was not following any of that traffic in real-time. I was busy doing all kinds of other things. In fact, during that immediate time interval, I was in London,  soaking up art, music, food, culture and having more sex than any one person should ever have. It was only because of the persistence of this fellow with the handle of Finance Director (FD), who kept intruding into my life to tell me how I was being slandered by this Melody Maxim person, that I even began to read that pap.

And then it took awhile , a long while, to deal with the shock of that “cryonics 9/11.” At least credit me with a lot more sense than George W. Bush. My measured response was to write the “Failure Analysis Lectures” which have been, I must say, a spectacular failure.

But I also began Chronosphere, and I began efforts to squelch the attacks on cryonics. I believe those were successful. Of course, Alcor was also suing Larry Johnson, and I think that that was enormously useful in that it sent the clear message that lies, even if mixed with the truth, will be very costly. They can and will cost you your home, your job, your reputation.

Unfortunately, it is in the nature of the U.S. tort system, and of insurgencies, that they  have an inherent dark side. It’s in the nature of any force, of any weapon or technology that there is the capability for harm equal to or greater than that which is present for good. Insurgencies are more like projectile weapons, than, say,  bladed weapons, such as knives or swords. As such, they are more suited for warfare and they are mostly of use for killing and mayhem. This is also the difference between the National Guard and the Army, and between the Police and the Army, and it is why you never use the Army in place of the Police. Never. The problem with the Johnson victory is that while most of the book is lies, there is still a meta-truth to it. The “victory”, which was also a shallow one, is thus further diluted, because it was not a completely just one.

There is so little second guessing the fight against the Nazi/Axis ~70 years later because:

the Nazis were  kooks,

they behaved with abominable aggressiveness,

their European allies were kooks,

they behaved with disgusting barbarity,

they left the concentration camps to be filmed and photographed,

they were utterly and completely defeated and humiliated,

it was all beautifully documented.

What you witnessed in the ultimate response to Maxim was the rekindling of a mini-insurgency. I gave no orders. Before I came on the scene, Alcor was already prosecuting Johnson, albeit neglecting their flanks with Maxim and Arnold. However, that was not enough then and it is not enough now.

It’s not just about “enemies.” It ‘s about not making progress, about not doing science. It’s about not being excited, planning, thinking, innovating and being obsessed with, and in love with cryonics. The failure to defend ourselves; that’s a symptom of all those other things being absent. Only  the sick, the weak, the distracted or the demented fail to defend themselves.”

By Mike Darwin

Left: Science Fiction writer Fred Pohl, with friend.

Predicting the future is a tough business. It is an especially tough business when it is proposed  that the prediction be highly specific and technically accurate. Say, akin to predicting the iPhone with Siri in 1965. It’s often been noted that none of the Golden Age of Science Fiction writers like Heinlein, Clarke, or Asimov predicted the PC, let alone the laptop. And most didn’t have a clue about the emerging developments in biology. So, the odds that one of those esteemed gentlemen would have conjured up a hand-held device that you could ask just about any question to (and get a useful answer), pay your bills through, order your meals with, get directions from, do your banking over, get reminders, entertainment or voice mail from and have a conversation with…well, the odds of that were just about nil. Just about, but not, as it turns out, quite nil.

In his 1965 cryonics novel, The Age Of The Pussyfoot, that Golden Age Science fiction writer, co-contemporary and friend of Bob Ettinger, Fred Pohl posited the existence of a device called the Joymaker, which every civilized person would necessarily have to have. The Joymaker incorporated the following features and uses:

• Access to sophisticated computing for money management, scientific calculations, etc.
• Access to planetary libraries at any time and any place.
• The education of children each of whom have their own Joymakers.
• Health Maintenance: the Joymaker monitors vitals, administers life saving or mood altering medications, summons emergency medical help and summons cryopreservation services in the event of cardiac  arrest.
• The Joymaker offers voice mail which is the core of interpersonal interaction in the novel.
• Orders all food and beverages and arranges payment, both in the home and in public.
• Orders all other goods for delivery and since payment is automatic, the expense of items is not always apparent to the buyers. Thus, the protagonist rapidly depletes his “fortune.”
• Replaces the public address system allowing any group of people to hear a public announcement on their Joymakers thus eliminating the need for loudspeakers in public places or interruption of entertainment programming.
• Locating people. The central computer can track the position of any Joymaker, and by extension, its owner. This information can be made available at the owner’s discretion.
• Jobs not requiring physical presence. One character is a “Reacter,” someone who samples new products and reports her reactions using the Joymaker. The central computer analyzes her reactions in the light of her known psychological makeup and is able to statistically predict how well the product will sell.

Left: Robert C. W. Ettinger, the father of cryonics.

The Age Of The Pussyfoot was set in the year 2527. However, in his Afterword to the novel, Pohl noted that he thought many of the functions of the Joymaker would be realized not in five centuries, but more likely in five decades.  Forty seven years after Pussyfoot, the iPhone with Siri is here, and most of Pohl’s predictions are  indeed a reality.  And, at age 93, Fred Pohl has survived long enough to see his predictions become reality. His friend and fellow science fiction writer Bob Ettinger was cryopreserved late last year and Pohl has been intimately aware of cryonics for ~50 years. He was one of the first people Ettinger contacted about the idea and over the ensuing five decades Ettinger never ceased to nag Pohl to make cryonics arrangements. The two were good friends and stayed in touch in writing – the last letter Ettinger wrote to Pohl shortly before his cryopreservation, admonished him, yet again, to get signed up for cryonics.

I too had tried to persuade Pohl to make cryonics arrangements, even offering him a “free freeze” in 1978. When Ettinger entered cryopreservation on July 23, 2011, Pohl wrote a moving tribute him on his blog “The way of the Future” and this prompted me to take up where Bob necessarily left off in urging Fred to make cryonics arrangements:

Mike Darwin says: Hello, Fred, this is from Mike Darwin, the guy who made you the offer of a “free freeze” after dinner that night in Louisville, KY in our suite in the Galt House hotel. You were the Guest of Honor at the American Science Fiction Convention in 1978, and we took you to dinner and made you an offer that, as it turned out, you easily could refuse! If you want to read an account of that meeting from the perspective of the cryonics people present at that time, it’s up on line, here: http://www.alcor.org/cryonics/cryonics8301.txt and is entitled, “When You Can’t Even Give it Away – Cryonics and Fred Pohl.

When you write about Bob Ettinger, “He wrote me one more letter, good-naturedly urging me to change my mind. That was the end,” I would say in response, “Uh, uh, it is much more likely, on the basis of probability alone, that was the end not for Bob, but for you.

Bob and I talked and corresponded about you a number of times over the years. Unlike you, I was not close to Bob, and we were often at odds. Interestingly, one of the few things that ever resulted in a genuine emotional connection between us was the offer we made to cryopreserve you for free. While he was too reserved and diplomatic to say so, your given reason for turning cryonics down, well, to be frank, I think it pissed him off a little. It was apparent that he genuinely liked and admired you and that, maybe just as importantly, he shared a common past with you. You and he grew up in the Golden Age of Science Fiction and you both shared the common narrative and heritage of what is now being called “The Greatest Generation.” The last time I saw Bob, was over dinner a few years ago in Michigan. He was quite frail, but wickedly lucid. I asked him if you were still compos mente and if he was still in touch with you. He sighed, “Yes,” and a “Yes.” And then he momentarily lost his temper, which is something I almost never saw him do. I don’t remember his exact words, but they were pretty to close to this: “I guess he doesn’t think that much of me or of the rest us, because he’s so worried about being alone and displaced from the people he knows and loves now. Doesn’t he think I’ll be there? Doesn’t he think any of the hundred or so others from our generation will be there? And if he does, and he is so worried about loneliness and social isolation, then dammit why doesn’t he come along to keep us company?”

I thought that was an extraordinarily good question. But logical and emotional arguments aside, it was painfully clear to me that HE WANTED YOU ALONG FOR THE RIDE. I had a hard time holding back the tears, and I had to excuse myself to the men’s room.

When most men die, their probability for any future goes to zero; in effect, their event horizon collapses. That’s about to happen to you (and to me, and to everyone else). Say what you will, Bob Ettinger now confronts two possibilities – oblivion, or one hell of a really interesting future. A future far more fantastic than anything you or he ever dreamed of, or wrote about. If nothing else, just to have come that far and to be in that position, well, it’s a hell of an accomplishment. And I am very grateful to Bob Ettinger for achieving it, because it opens that possibility to me, as well.

So, Fred, here’s the deal. Your friend is waiting for you: he damn sure wanted you to embark on the adventure (good or bad) that he has now begun. In fact, he kept at you to go until, literally, almost his last breath for this life cycle. He can’t do it anymore, so I guess it is my turn, once again, to ask you to reconsider and to join your friend and colleague on his journey into the land you both dreamed of when you were young, and in your salad days. Please, reconsider your arguments. It is now for sure you won’t be without a friend and cohort, and I can pretty much guarantee you that your revival won’t take place unless you have a use.
Finally, I can tell you for a fact that the best use you have is continue living and growing and telling stories. At our core, we humans are ‘store creatures,’ and we will remain so as long we *are* human. It goes without saying that story creatures need storytellers; your job is thus secure.

August 2, 2011, 11:47 pm

To which Fred replied:

Declining Immortality Twice

Mike Darwin’s response to my piece on the loss of that very good man, Bob Ettinger, caught me completely unaware. I am grateful to you for repeating the offer of a free freeze, Mike, just as I am grateful to the people who sometimes tell me that they’re going to pray for me. Even though I can’t accept your offer, it’s a kind thought.

Let me quote from a poem that was written long ago by John Dryden, in an attempt to sum up the teachings on this subject of the even longer ago Roman philosopher Lucretius. The last six lines say it all, but I’ll give you the whole thing. It goes like this:

So, when our mortal forms shall be disjoin’d.
The lifeless lump uncoupled from the mind,
From sense of grief and pain we shall be free,
We shall not feel, because we shall not be.

Though earth in seas, and seas in heaven were lost
We should not move, we should only be toss’d.
Nay, e’en suppose when we have suffer’d fate
The soul should feel in her divided state,
What’s that to us? For we are only we
While souls and bodies in one frame agree.

Nay, though our atoms should revolve by chance,
And matter leap into the former dance,
Though time our life and motion should restore.
And make our bodies what they were before,
What gain to us would all this bustle bring?
The new-made man would be another thing.

But I do appreciate the offer.

This entry was posted on September 9, 2011 at 12:30 am at http://www.thewaythefutureblogs.com/2011/09/declining-immortality-twice/

Fred Pohl may be the first man in the history of the world to have declined a shot at immortality not once, but twice! I would argue that the really amazing thing about Pussyfoot is not just that Pohl got the technology of the Joymaker right, but that he also got the biotechnology of the future more or less right – granted in no small measure due to that “good man” and good friend of his, Bob Ettinger.  Fred Pohl knew a sound and reasonable idea when he saw one , biological or otherwise,  and 50 years later cryonics has endured and the biological basis for it has grown steadily better. Lucky patients cryopreserved with little or no ischemia, using the best available vitrification techniques today, will have intact connectomes and minimal neuronal molecular damage. Such fortunate patients will suffer virtually no freezing damage.

Above: The Connectome.

 Any yet, Pohl is having none of it.

Right: Viktor Frankel.

I used to find this a mystery. To be surprised by it. To marvel at it. However, that time has long past. The first insight that offered a partial answer to that mystery came from Viktor Frankel’s book, Man’s Search for Meaning.  Frankel noted that there were two basic types of people in the concentration camps – those who drew their sense of identity and purpose from their social/societal position; husband, father, lawyer, doctor, mother, grandmother… and those who drew it from some other source, independent of their social context, or how they were labeled. For some, the origin of that sense of identity was religious, for others, it existed independent of any institutional or religious thoughts or beliefs. Those few people saw themselves as unique and worthwhile individuals deserving of and entitled to life and survival at all costs, independent of any external factors or forces.

Much later I realized that another component in the will to survive that is often material in making the choice for cryonics is the yearning to be transcendent. It is not enough to be able to see the future with accuracy and precision, it is necessary to yearn to be it. To quote Nietzsche:

 ”I teach you the overman. Man is something that shall be overcome. What have you done to overcome him? … All beings so far have created something beyond themselves; and do you want to be the ebb of this great flood, and even go back to the beasts rather than overcome man? What is ape to man? A laughing stock or painful embarrassment. And man shall be that to overman: a laughingstock or painful embarrassment. You have made your way from worm to man, and much in you is still worm. Once you were apes, and even now, too, man is more ape than any ape…. The overman is the meaning of the earth. Let your will say: the overman shall be the meaning of the earth…. Man is a rope, tied between beast and overman—a rope over an abyss … what is great in man is that he is a bridge and not an end.”

H. G. Wells said it far more beautifully:

“We look back through countless millions of years and see the great will to live struggling out of the intertidal slime, struggling from shape to shape and from power to power, crawling and then walking confidently upon the land, struggling generation after generation to master the air, creeping down the darkness of the deep; we see it turn upon itself in rage and hunger and reshape itself anew, we watch it draw nearer and more akin to us, expanding, elaborating itself, pursuing its relentless inconceivable purpose, until at last it reaches us and its being beats through our brains and arteries…It is possible to believe that all the past is but the beginning of a beginning, and that all that is and has been is but the twilight of the dawn. It is possible to believe that all that the human mind has accomplished is but the dream before the awakening; out of our lineage, minds will spring that will reach back to us in our littleness to know us better than we know ourselves. A day will come, one day in the unending succession of days, when beings, beings who are now latent in our thoughts and hidden in our loins, shall stand upon this earth as one stands upon a footstool, and shall laugh and reach out their hands amidst the stars.”

But Wells spoke of not of achieving that greatness personally, but rather of the species achieving it  – of our descendants achieving it.

To want it, to need it, to ache for it personally – that is a rare thing. It is the motive force that has driven biological evolution – and it is the motive force that has driven every human innovation and every human conquest – for good or evil.

Recently, a friend of mine asked, in wonder, why I was preparing for the contingency that technological civilization might collapse. “There would be no cryonics if that happened.” he noted, correctly.

“Yes, I know.” I replied.

“And it would be really horrible. A terrible, terrible undoing of the world.” he added.

“Yes, yes it would.” I agreed.

“Then why on earth would you want to be around to see that?”

“I can’t imagine missing the last act! I mean, honestly, I’ve had the chance to read up on all that happened before, I’ve trotted all over the planet, read the thoughts of the best minds of every known culture and civilization, and you propose I should wimp out and miss the denouement? I’m plenty savvy enough to keep redundant assets for a quick and painless exit at should I find myself in unbearable agony and no hope of survival. However, absent that, I can’t even conceive of betraying the intense curiosity I’d have about any apocalypse, even if my own survival were impossible.”

Frankel comes close to summing up my feelings on this matter when he says:  ”Man is that being who invented the gas chambers of Auschwitz; however, he is also that being who entered those gas chambers upright, with the Lord’s Prayer or the Shema Yisrael on his lips.” There is an implied qualification not present in Frankel’s quote:  “Man at his best is that…” The cryonicist is thus that being who chooses life, inquiry, knowledge and understanding of the universe as his personal and moral imperatives. He chooses to feel and to be these things – not just to think about them, or talk about them. He chooses action over contemplation, life over death.

The origins of that choice? Well, that is still a mystery, but one which, in the fullness of time, may we may hope to unravel.