Specimen Standards for Evidence-Based Human Cryopreservation Organizations, Part 1

By Mike Darwin

 A Brief History of Attempts to Create and Implement Minimum Standards in Cryonics

INTRODUCTION

First Era 1964-1972

The first attempt to create formal minimum standards for cryonics organizations in the form of the Cryonics Societies of America (CSA) was initiated by in 1968 and was implemented largely through the efforts of the Cryonics Society of New York. The CSA was to be a national standards and enforcement organization, comprised of representatives elected by the individual, member cryonics societies.

Figure 1: Requirements for membership in the Cryonics Societies of America.

Creation of the CSA, and the terms of its incorporation were agreed to by the Officers/Directors of the then extant cryonics organizations: Cryonics Society of New York (CSNY), Cryonics Society of Michigan (CSM) and Cryonics Society of California (CSC). CSA was incorporated late in 1969.

The CSA called for basic accountability in matters such as public communications, information inquiries, membership rolls, financial and member/patient record keeping (submission of quarterly financial records), documentation of cryopreservations (including at least one “confidential” photo), uniformity of letterhead and logos, submission of regular progress reports and investigation of all persons or corporations offering cryonics services or promoting cryonics. Basic requirements were maintenance  of a phone and book listing under the heading “cryonics”, updated list of Officers & Directors, valid addresses for organization and Officers,  and subscription to “Cryonics Reports” for all local group members and a complete log of all written and telephonic information inquiries.

Ironically, one of the driving forces behind CSA was Robert Nelson who, in particular, wanted a standardized procedure generated to administer cryopreservation, particularly with respect to perfusion. A committee consisting of Ettinger, Nelson and Saul Kent was created in April of 1968 to do this, however, according to Kent and Henderson, there was no progress on this, the committee never met, and Nelson did not answer correspondence nor generate the promised liaison with Dante Brunol, M.D., and the CSC mortician Jeff Hicks. Despite misgivings, CSNY committed to be the central body and administration for CSA, and the artist Vaugn Bode generated a logo. Letterhead for national organization was created and standards for regional letterheads were created and implemented.

Figure 2: Vaughn Bode’s CSA logo of a side-view of a Phoenix in flight.

Another critical function of the CSA, and the one which may have motivated its initiation, was the creation of a Scientific Advisory Council (SAC) to the CSA. This Board was to have provided scientific and technical advice related to patient care, evaluated research proposals and recommended funding, and lastly and most importantly, serve to improve the public and professional credibility of cryonics. By 1968, resistance in the scientific community at large was hardening and the cryobiological community was well on its way to becoming highly polarized against cryonics. By this time the mother of cryobiology, Audrey Smith, had already made her public statement calling Ettinger “that horrible man” and Robert W. Prehoda was writing his virulently anti-cryonics book chapters in Suspended Animation: “The Night of January 12, 1967 and “The Lunatic Fringe.” There is some indication that Saul Kent, and perhaps others, may have either seen a precis of these chapters, or otherwise been appraised of their tone, if not their content (CSNY Correspondence Log, 1968).

Figure 2: The 28 April, 1969 letter from Saul Kent laying out the basic parameters required for a national cryonics standards organization to operate.

The SAC was formed on 05 August, 1968 and the relevant documents as well as its composition were published in Cryonics Reports in September, 1968:

Figure 3: The charter of the Scientific Advisory Council (SAC) to the Cryonics Societies of America (CSA). The SAC was to provide the scientific oversight and vetting that would be needed to determine which cryopreservation procedures were applied clinically, and to help direct research to improve them.

There is little known surviving historical documentation of the activities of SAC. According to both Saul Kent and Curtis Henderson, the SAC was not very active and not very responsive to requests for help, although, as they both noted, the areas in which help were most urgently needed either required speculation and expertise (expert speculation from a cryonics perspective, as it were) that the SAC scientists did not have (e.g., formulating perfusion, cooling and storage protocols) or required resources neither the CSA nor its member organizations had available (financing for research). It is clear from correspondence and conversations with some of the principals (Henderson, Kent, Barner and Gouras) that the major obstacle to the SAC’s long term viability was the inability of the CSA to provide anticipated funds for research to be generated by the CSA. There is no evidence that the CSA, acting as unit, provided any input or material support, scientific or technical. The list of the SAC members was used extensively to lend credibility to cryonics for promotional purposes and the list was reprinted as a full page of Cryonics Reports magazine until the SAC gradually disintegrated due to members resigning.

The CSA did remain modestly active for perhaps a year after its inception. There is documentation of essentially complete compliance with the CSA’s requirements in the archival files of CSNY, and much of this material survives and is being digitized. There is evidence that CSM provided substantial compliance, including providing membership rolls, records of information requests, and at least semi-annual bookkeeping summaries. CSC did not provide membership lists, patient records, or financial data. They did provide photographic evidence of the cryopreservation of Marie Phelps Sweet, under substantial pressure and amid allegations (untrue as it turned out) that Ms. Sweet‘s cryopreservation may have been a hoax used to raise money for CSC or Robert Nelson, and those photographs have survived and been digitized.

Figure 4: Robert F. Nelson, President of the Cryonics Society of California

While the CSA was neither very active nor effective, it did continue to exist, at least in name, until serious concerns about the operations of CSC, Cryonic Interment and the integrity of Robert F. Nelson were raised, and finally aired publicly by Saul Kent in an editorial in Cryonics Reports entitled “Trouble in Southern California?” which questioned the integrity of CSC’s patient storage operations (Cryonics Reports: 4(12) 1969; p 2) as noted in this quote from that article:

“At last years’ national cryonics conference in Ann Arbor, Mich. [actually held in April 1969, 8 months before--MP], and Marshall Neel’s presentation concerned a new cryonic storage facility which, according to Mr. Neel, was close to completion. Slides showing the process of construction were offered, and it was stated that within a short time there would be a grand opening before the media, at which several bodies then in individual cryonic storage would be placed into a large multiple-body unit. Cryonic Interment Inc. was the name of the company that was said to own the facility; Mr. Neel was announced as President.

 Since the conference there have been continual statements emanating from the leadership of the Los Angeles based company about the imminence of the opening of the facility.

 As of December, 1969, the facility has not been opened and there is no evidence to indicate that it will.

 We don’t know what has been going on in Southern California because the entire operation has been veiled in secrecy. It is just this air of secrecy that troubles us.”

 The CSA probably became legally defunct within a year or so thereafter since there are unpaid bills for corporation taxes and no evidence of disbursements for these from, either the CSNY or CSC financial archives which are complete for this period. Unless the fees were paid by CSM or by an individual(s) the CSA would have legally ceased to exist sometime in 1970.

 Second Era 1972-1976

Figure 5: Fred and Linda Chamberlain began a second round of unsuccessful efforts in the early 1970s to create a minimum standards  and compliance self- regulatory framework for cryonics. This effort, as had the previous one in the form of the CSA, proved unsuccessful.

The next attempt to establish industry-wide binding standards was initiated by Fred and Linda Chamberlain of the Alcor Foundation in 1972. The effort had, if I recall correctly, the acronym DOMSAC which stood for ” Document of Minimum Standards and Compliance” (DOMSAC). The core requirement of the DOMSAC were to:

“Set minimum standards for all technical aspects of perfusion and cool-down, including data collection formats, parameters to be logged, frequency of data acquisition, minimum equipment and chemical to kept on hand at all times, and so on.” The objectives of the DOMSAC were to:

  • Established a basic standard for organization, reporting and public disclosure of patient case data.
  • Required continuous public accountability (address, identification, a.k.a. and d.b.a. history on all Officers and Directors).
  • Established minimum requirements for emergency notification and communication systems.
  • Limited the scope and nature of claims that could be made to the public or prospective members/clients about cryonics.
  • Impose substantial administrative requirements, as well as mechanics for handling non-compliance and provisions for punitive measures if necessary.

Figure 6: Former President of the Cryonics Society of California, Robert F. Nelson (aka Frank Bucelli) being warmly received by Robert C. W. Ettinger, one of the two originators of the cryonics movement in 20

This document provoked extended haggling and arguments from Trans Time (TT) and the Bay Area Cryonics Society (BACS). (BACS and TT were essentially run by the same management at that time), and to a lesser extent from the Cryonics Society of Michigan (CSM).  The was concern expressed on the part of TT/BACS that the DOMSAC constituted an unacceptable step towards the surrender of autonomy, even if it was in the form of mutual oversight.” To what extent these sentiments were justified it is impossible to know. It certainly has been the case that getting cryonicists, even within their own organizations, to submit to oversight and regulation has so far proven impossible. For instance, Robert F. Nelson was in no way punished for his misdeeds at Chatsworth within the cryonics community, and he is welcomed at both CI and other cryonics functions, where he is treated cordially and has indicated he might reenter the cryonics business in the future.

What was clearly not understood then, or now, is that this “issue” inside cryonics is not a drawing room matter, or even a dirty political backroom matter. It stopped being either of those things when the first patient decomposed at Chatsworth or, more accurately, when Bedford was mishandled by Cryonics Society of California personnel on 12 January, 1967, with the knowledge and complicity of other key people in the cryonics movement.

 

Specimen Standards for Human

Cryopreservation Organizations Draft 2.4

Core Objectives and Related Considerations

The objective of these specimen standards is to return cryonics to the paradigm that was developed initially by the Cryonics Society of New York (i.e., fairness, openness, use of the scientific method, Evidence Based Cryonics (EBC) and diligent communication of comprehensive and accurate information to cryonics organization members or clients), and greatly elaborated by Alcor under the influence of Jerry Leaf and Mike Darwin in the 1980s. This paradigm can be articulated by the following points:

Organizational (Corporate) Structure & Governance

The organizational structure considered here will be that of the non-profit corporation United States corporation,  either charitable (501(c)3) or non-charitable.

The cryonics organization shall be a legally incorporated entity which complies with all applicable federal laws and regulations, as well as applicable laws and regulations of the states and the local jurisdictions in which it is based or operates. If the organization conducts programs outside the United States, it must also abide by applicable international laws, regulations and conventions that are legally binding on the United States.

The organization shall have a formally adopted, written code of ethics with which all of its directors or trustees, staff and volunteers are familiar and to which they adhere and they will adopt and implement policies and procedures to ensure that all conflicts of interest, or the appearance thereof, within the organization and the board are appropriately managed through disclosure, recusal, or other means. This Code of Ethics shall cover accountability, finances, openness, client/member rights, patient rights, confidentiality of medical and cryopreservation records, conduct of staff, and basic procedures for filing and adjudicating grievances within the organization by clients/patients and professional employees.

The cryonics organization shall establish and implement policies and procedures that enable individuals to come forward with information on illegal practices or violations of organizational policies. This “whistle blower” policy should specify that the organization will not retaliate against, and will protect the confidentiality of, individuals who make good-faith reports.

The organization shall have in place policies and procedures to protect and preserve the organization’s important documents and business records.

The organization’s board must ensure that the organization has adequate plans to protect its assets—its property, financial and human resources, programmatic content and material, and its integrity and reputation—against damage or loss. The board should review regularly the organization’s need for general liability and directors’ and officers’ liability insurance, as well as take other actions necessary to mitigate risks.

The organization must have a detailed, written plan of action to protects its patients in cryopreservation against legal or legislative attack, economic instability, insurgent attack by anti-cryonics individuals or entities, as well as plans to cope with and prevail over known existential risks to which its patients may be subject (i.e., hurricanes, tornadoes, earthquakes, blizzards, etc.).

Figure 1: Cryonics organizations must maintain transparency with respect to administrative, financial, scientific, technical and patient care procedures.

The organization must  make information about its operations, including its governance, finances, programs and activities, widely available to the public. Charitable (501(c)3) organizations shall make information available on the methods they use to evaluate the outcomes of their work and must share the results of those evaluations with members.

The cryonics organization must have a governing body that is responsible for reviewing and approving the organization’s mission and strategic direction, annual budget and key financial transactions, compensation practices and policies, and fiscal and governance policies.

Figure 2: The board of directors of the cryonics organization are elected by the cryopreservation members or clients of the organization who have been cryopreservation members or clients of the cryonics organization for at least 3 consecutive years. Directors’ terms may not exceed 4 years.

The board of directors shall be elected by the cryopreservation members or clients of the organization who have been cryopreservation members or clients of the cryonics organization for at least 3 consecutive years. Cryopreservation members with 10 or more years of consecutive cryopreservation arrangements may, at the organization’s discretion, be granted 2 votes in electing directors.

Candidates for the board shall be examined for psychosocial and fiscal suitability by a thorough, objective and written set of standards and examinations.

Directors term limits, order of service (staggered or otherwise) are that the discretion of the cryonics organization. However the length of any director’s term in office cannot exceed 4 years.

The organization must meet regularly enough to conduct its business and fulfill its duties. Directors’ meetings shall be held monthly and combined directors and membership meeting shall be held no less than annually.

The board of organization should establish its own size and structure and review these periodically. The board should have enough members to allow for full deliberation and diversity of thinking on governance and other organizational matters. Except for very small organizations, this generally means that the board should have at least five members.

The board of the  organization must include members with the diverse background (including, but not limited to, ethnic, racial and gender perspectives), experience, and organizational and financial skills necessary to advance the organization’s mission. All directors and officers must be have been cryopreservation members or clients of the organization for a minimum of 3 consecutive years before becoming eligible to serve as a director or officer. In the case of newly forming cryonics organizations, officers and directors must have been members or clients of another cryonics organization for a minimum of 3 consecutive years.

At least two-thirds of the board members, should be independent. Independent members should not: (1) be compensated by the organization as employees or independent contractors; (2) have their compensation determined by individuals who are compensated by the organization; (3) receive, directly or indirectly, material financial benefits from the organization except as a member of the charitable class served by the organization; or (4) be related to anyone described above (as a spouse, sibling, parent or child), or reside with any person so described.

The board shall hire, oversee, and biannually evaluate the performance of the chief executive officer of the organization, and should conduct such an evaluation prior to any change in that officer’s compensation, unless there is a multi-year contract in force or the change consists solely of routine adjustments for inflation or cost of living.

The board of any cryonics organization that has paid staff should ensure that the positions of chief staff officer, board chair, and board treasurer are held by separate individuals. Organizations without paid staff should ensure that the positions of board chair and treasurer are held by separate individuals.

The board shall establish an effective, systematic process for educating and communicating with board members to ensure that they are aware of their legal and ethical responsibilities, are knowledgeable about the programs and activities of the organization, and can carry out their oversight functions effectively.

Board members should evaluate their performance as a group and as individuals no less frequently than every 2 years, and should have clear, written  procedures for removing board members who are unable to fulfill their responsibilities.

Beyond the requirement of 3 consecutive years as a cryopreservation member or client, the board shall establish clear policies and procedures setting the length of terms and the number of consecutive terms a board member may serve.

The board should review organizational and governing instruments no less frequently than every 3 years.

The board shall establish and review regularly the organization’s mission and goals and should evaluate, no less frequently than every five years, the organization’s programs, goals and activities to be sure they advance its mission and make prudent use of its resources.

Board members are generally expected to serve without compensation, other than reimbursement for expenses incurred to fulfill their board duties. A charitable organization that provides compensation to its board members should use appropriate comparability data to determine the amount to be paid, document the decision and provide full disclosure to anyone, upon request, of the amount and rationale for the compensation.

The cryonics organization must keep complete, current, and accurate financial records. Its board should receive and review timely reports of the organization’s financial activities and should have a qualified, independent financial expert audit or review these statements annually in a manner appropriate to the organization’s size and scale of operations. For cryonics organizations with more than $500,000 U.S. in assets the independent financial expert must be certified public accountant (CPA).

Cryonics organizations with assets of $1 million U.S., shall have an audit committee composed of independent board members with appropriate financial expertise. By reducing possible conflicts of interest between outside auditors and the organization’s paid staff, an audit committee can provide the board greater assurance that the audit has been conducted appropriately. If state law permits, the board may appoint non-voting, non-staff advisers, rather than board members, to the audit committee.

The board of the organization must institute policies and procedures to ensure that the organization (and, if applicable, its subsidiaries) manages and invests its funds responsibly, in accordance with all legal requirements. The full board should review and approve the organization’s annual budget and should monitor actual performance against the budget.

The cryonics organization should not provide loans (or the equivalent, such as loan guarantees, purchasing or transferring ownership of a residence or office, or relieving a debt or lease obligation) to directors, officers, or trustees.

The organization shall spend at least 30% of its annual budget on programs that pursue its mission. The budget should also provide sufficient resources for effective administration of the organization, and, if it solicits contributions, for appropriate fundraising activities.

Figure 3:  Reimbursement for expenses, as well as compensation for services for directors must be unambiguous and in written form.

The  cryonics organization shall establish clear, written policies for paying or reimbursing expenses incurred by anyone conducting business or traveling on behalf of the organization, including the types of expenses that can be paid for or reimbursed and the documentation required. Such policies should require that travel on behalf of the organization is to be undertaken in a cost-effective manner.

The organization shall neither pay for nor reimburse travel expenditures for spouses, dependents or others who are accompanying someone conducting business for the organization unless they, too, are conducting such business.

Solicitation materials and other communications addressed to donors and the public must clearly identify the organization and be accurate and truthful.

Without exception, contributions must be used for purposes consistent with the donor’s intent, whether as described in the relevant solicitation materials or as specifically directed by the donor.

The organization, if a 501(c)3, must provide donors with specific acknowledgments of charitable contributions, in accordance with IRS requirements, as well as information to facilitate the donors’ compliance with tax law requirements.

The organization must have clear, written policies, based on its purpose as a cryonics organization to determine whether accepting a gift would compromise its ethics, financial circumstances, program focus or the well-being of the patients in its care.

The cryonics organization should provide appropriate training and supervision of the people soliciting funds on its behalf to ensure that they understand their responsibilities and applicable federal, state and local laws, and do not employ techniques that are coercive, intimidating, or intended to harass potential donors.

The organization shall not compensate internal or external fundraisers based on a commission or a percentage of the amount raised.

The cryonics organization shall respect the privacy of individual donors and, except where disclosure is required by law, shall not sell or otherwise make available the names and contact information of its donors without providing them an opportunity at least once a year to opt out of the use of their names.

The board shall prepare a written job description for individual board members as well as prepare an annual schedule of meetings, determined a year in advance.

The board she see to it its members receive clear and thorough information materials, including an agenda, to all members two to three weeks before each meeting.

Figure 4: The comprehensive and complete minutes of every directors’ meeting must be recorded on paper, as well as electronically and must be c9ompiled into readily accessible books or volumes for inspection by cryopreservation members or clients at any reasonable time. Similarly, electronic copies of minutes shall also be available so that members distant from the organization’s headquarters may have access to the minutes.

The cryonics organization shall maintain complete and accurate minutes of all meetings which shall be gathered into volumes organized by month and year. These minutes shall be kept at the cryonics organization’s principal place of business and be available for inspection upon the request of any  cryopreservation member or client. Additionally, multiple electronic copies  shall be kept in discrete separate locations to prevent loss due to existential or other disasters and so that they can be made available to members or clients who are far distant from the organization’s principal place of business.

Each board member shall serve on at least one board committee or task force. (For new members, one committee assignment is sufficient.)

The board shall prepare written statements of committee and task force responsibilities, guidelines and goals. These organizational documents, which should be approved by the board chair, are to be reviewed annually, and revised if necessary. The CEO shall assign an appropriate staff member to work with each committee

The board shall create a written system of checks and balances to monitor committee members’ work and assure that tasks are completed on schedule.

Nondiscrimination

The medical model of cryonics as an emergency room (Accident & Emergency) where all comers able to meet the publicly specified requirements of the organization are competently and equally treated, regardless of age, religion, politics, criminal history, gender, sexual orientation, community influence, or celebrity. “Equally” is understood to mean here that all clients will receive the same minimum standards of care set out as being available upon meeting the specified minimum requirements of the organization. It does not imply that higher standards of care may not be paid for by clients able to afford them.  However, it does mean that if such higher standards are offered, or are available for an added fee or other considerations, that all clients shall be apprised of the availability of such non-standard services, as soon as such options are made available.

Figure 5: Cryonics organizations must not discriminate on the basis of age, religion, politics, criminal history, gender, sexual orientation, community influence, or celebrity.

Additionally, the cryonics organization shall adopt the following non-discrimination policy:

The cryonics organization believes that every person has a right to choose and arrange for his or her own cryopreservation and to enjoy its possible benefits of greatly extended lifespan. To this end, the cryonics organization does not discriminate against any person on the basis of race, religion, color, creed, age, marital status, national origin, ancestry, sex, sexual orientation or preference, medical condition, or handicap.

However, nothing in this statement prevents the cryonics organization from avoiding any situation that genuinely threatens the health or safety of cryonics organization employees, volunteers, patients in cryopreservation, or the public, or from requiring reasonable medical evaluations in some instances where a genuine threat to health or safety may be suspected to exist, or where the legal status of an individual with regard to mental competency may be in question.

Feedback, Quality Assurance & Quality Control

Quality control measures which provide feedback about the nature and effectiveness of all of the organization’s procedures will be publicly disclosed in an open and timely fashion. This is understood to include not only medical, cryobiological, patient care, or other technical and scientific procedures, but also financial, administrative and business procedures as well. Both classes of disclosure, technical and administrative, will be discussed with varying level of detail in this document. In administrative areas where there are long established and demonstrably workable resources, the discussion will be more superficial. In technical, ethical and other areas where there is little or no precedent, the discussion will be exhaustive and often accompanied by detailed examples of the required work product.

The clear message of this point is that a culture of openness and accountability is perhaps the most important ingredient to the long term success of any cryonics organization or, for that matter, any quality scientific, technical, or medical institution.

It is important to digress briefly here and discuss the problematic nature of such a high degree of accountability with respect to cryonics organizations, in particular. All human institutions, whether cryonics organizations or otherwise, find this level of accountability difficult to achieve. There are many reasons for this; however these two are by far the most significant: the basic human desire to avoid owning failure, error or misdeeds, and the ammunition public knowledge of failure, error, or misdeeds provides an enemy[1] — which segues into the next point.

Need for a Defensive Organization (a.k.a. Cryonics Defense League)

Cryonics as a whole has become fear-driven and in nearly constant crisis mode. Crises driven operation is necessarily mostly reactive rather than proactive. This is not how any successful organization advances scientifically or financially. Indeed, it is not how success is achieved in any area of organizational operations, even in successfully defending the organization in the long run. Because of this situation it is especially difficult for cryonics organizations to have a high level of accountability, even about seemingly harmless facts pertaining to their procedures and policies, because cryonics is not an established business institution, has an (arguably) increasing number of serious enemies, is widely misunderstood, has been subject to unjustified distortion and sensationalism, has been subjected to repeated rounds of invasive and destructive media siege, and is increasingly coming under governmental scrutiny. Under such circumstances it is completely understandable for a “bunker mentality” to develop.

Further, in order to protect its human cryopatients, a cryonics organization may have to develop not only a bunker mentality, but very aggressive and covert means to defend the well being of its patients. The author has spent the past several years reading extensively the history of emerging medical, social, political and religious movements. In no case was social acceptance or tolerance of any major paradigm changing movement achieved without the use of force and fraud. I even include Darwin’s theory of evolution in this analysis since, as Stephen Jay Gould noted just a few years ago in his book The Structure of Evolutionary Theory, Evolution is neither widely understood nor accepted – this, more than a hundred years after it was publicly espoused.

Cryonics organizations need a separate, defensive organization which can act semi-covertly or covertly as needed to deal with lethal threats, which all conventional approaches have failed to stop. Separating defensive capability from other operations would allow accountability to continue in every area of operations except the last and most desperate measures needed for defense of patients and members. This would allow some measure of psychological tranquility to exist in the organization as a whole, even in the midst of extreme threats, and thus for business as usual to continue and a high degree of experimentation and openness to be maintained even under difficult circumstances.  The most immediate analogy is one of the intelligence and military apparatus of a nation-state. Because these assets exist in a hostile world it is not necessary for citizens, businesses, churches, or charities to anguish over every threat to their existence. Yes, in times of severe crises, or all out attack, all of these entities may divert some or all of their efforts, attention, and support to the crisis, but on a daily basis, it is not necessary that they be consumed with the problems of their own defense. However, more relevant analogies would the Jewish Defense League (JDL) or the Worldwide Guardian Office employed by Scientology.

Until cryonics organizations can rely on a defense force which is competent and properly equipped to deal with even the worst crises, the organization as a whole will be drained of energy and other resources, and most importantly, will be paralyzed by anxiety, and become increasingly afraid to take any actions which expose more of its flank to attack. This is a response characteristic of most life forms more complex than viruses, and is one which must be dealt with. Every organization charged with protecting the survival of its members has such defensive mechanisms, from the amoebae to the U.S. Federal Government.  This is a critical need, which has heretofore been unappreciated in cryonics. The absence of such a defensive mechanism in cryonics is the principal cause of the increasing risk-averseness, and willingness to surrender authority over patients to the regulatory bodies of nation-states.

End of Part 1

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Cryonics: Failure Analysis, Lecture 1, Initialization Failure, Part 3

By Mike Darwin

FRAUDS & FAKIRS

SLIDE 57

While this small corps of serious and honest people was hard at work trying to re-launch cryonics on a solid footing, the legacy of the first era of careless and irresponsible cryonics activity was maturing into what can only be described as a failure of truly catastrophic proportions.

SLIDE 58

As early as 1965 Ettinger had appeared on national television and, in effect, endorsed cryonics operations which were either outright frauds, or were operated by an incompetent sociopath. No effort was made to verify any claims made, and all attempts to establish minimum standards for financial and technical conduct were rebuffed.

SLIDE 59

Wealthy and influential individuals with a deep personal interest in cryonics were put in touch with charlatans and con men that took their money and promptly disappeared. The men who appear on this slide were giants in their respective fields of music, television and cardiothoracic surgery. All were soon alienated by con artists such as Milgram and Gold

SLIDE 60

These internationally known and respected celebrities experienced similar mishandling, with similar results.

SLIDE 61

When the long awaited ‗freezing‘ of the first man took place on 12 January, 1967, the man in charge was Robert F. Nelson, aka Frank Bucelli, a Santa Monica TV repairman. Bucelli was much more than a TV repairman; he was a convicted felon with a long criminal record beginning in his youth; including violent offenses such as assault and battery as well as numerous charges, and several convictions for fraud and theft.

This background had been uncovered in 1966 by CSNY President Curtis Henderson, who had commissioned an investigative report on Nelson/Bucelli by the Pinkerton Agency, the most respected private detective service in the US at that time. This report was forwarded to Ettinger – but no action was taken. Nelson “froze the first man,” and in so doing he established the conditions under which cryonics would subsequently be practiced: lots of superficial media attention giving the appearance of openness and transparency, while at the same time operating in virtually complete secrecy from both the membership of his cryonics society (the Cryonics Society of California: CSC) as well as the press, the public and the regulatory authorities.

SLIDE 62

At the press conference CSC held following Dr. Bedford‘s freezing, the media were told that the first man had been frozen under “controlled conditions.” That a physician had been standing by with a mechanical CPR device (a Westinghouse Iron Heart) and that CPR had been initiated as soon ―as the patient‘s heart stopped,‖ followed by immediate packing in ice and cryoprotective perfusion and cooling to dry ice temperature (~ -77◦C).

The Method: Description of the “Method for Freezing Humans,” By Dante Brunol, M.D., In: Robert F. Nelson, We Froze The First Man, Dell, New York, 1968, pp. 136-156.

SLIDE 63

Subsequently, an elaborate protocol that was purported to have been used called ‗The Method,‘ was circulated to cryonics society officials across the US, and shortly thereafter published in a supposedly factual book about Dr. Bedford‘s cryopreservation produced by Nelson in collaboration with a professional writer, Sandra Stanley (We Froze the First Man).

SLIDE 64

The Press Release: “The first reported freezing of a human at death, under controlled conditions, occurred on Thursday, January 12, 1967.” Robert F. Nelson, We Froze The First Man, Dell, New York, 1968, p. 72.

There has been a great deal of effort of late to portray Nelson as a victim of circumstance, as a well intentioned man who ―got in over his head and handled it badly.‖ Nothing could be further from the truth. As the press release quoted on this slide makes clear, Nelson lied, and he lied from the start. Dr. Bedford‘s cryopreservation in no way even remotely matched the brief description in the press release announcing his “freezing.”

SLIDE 65

Nor was the reality of what had in fact happened in any way reflected in the myriad of subsequent media stories chronicling Dr. Bedford‘s cryopreservation. The media reported what they were told, principally that Dr. Bedford had received immediate post cardiac arrest cardiopulmonary support, cryoprotective perfusion with a DMSO-containing perfusate, and controlled cooling to dry ice temperature (~ -77◦C).

SLIDE 66

This slide graphically documents what the cryonics community and the world were told had been done for Dr. Bedford. The Amtec roller pump pictured here is the very model that is said to have been used in ‗the method‘ employed to cryoprotect and freeze Dr. Bedford. This newspaper article detailing his cryoprotective perfusion is the very article that caused me to become involved in cryonics in 1968.

SLIDE 67

It wasn‘t until the mid-1970s that I began to piece together a very different story of what had happened to Dr. Bedford on that January night in 1967. A picture began to emerge of negligence fused with gross incompetence. When Dr. Bedford was pronounced legally dead, Nelson was nowhere to be found. There was no answering service, no list of numbers where he might be reached, and no equipment or supplies assembled, tested and at the ready.

It was, in fact, hours before Nelson could be located. There was no oxygen to power the heart lung resuscitator. The Amtec pump was owned by CSNY, not CSC, and there was in fact no pump, no perfusion and not even a cooperating mortuary.

SLIDE 68

On 25 May, 1991, I at last had the opportunity to see for myself what Nelson and his cohorts had done to Dr. Bedford. On that sunny spring day we removed Dr. Bedford from his inefficient horizontal dewar to place him in an upright, “Bigfoot,” multi-patient storage vessel.

With careful preparation, this allowed us to examine Dr. Bedford externally, document his condition and take some (peripheral) tissue samples. We placed him in a large, foam insulated, open-topped tank of liquid nitrogen. This allowed us to examine him and evaluate his condition while keeping him continuously submerged in liquid nitrogen, thus precluding any danger of warming him.

SLIDE 69

This afforded us an opportunity to examine him for the first time in 24 years. Now, you too will have the same opportunity.

SLIDE 70

This is the reality of the “care” that Nelson gave Dr. Bedford. He was not perfused, but rather pin-cushioned with syringes of either neat, or highly concentrated DMSO. The large areas of scalded looking skin are probably a result of the hemolytic action of the DMSO solution which was being injected into the vicinity of the carotid arteries in the neck.

The frozen bloody exudate from his mouth and nose is a result of incompetently performed manual chest compressions administered in an attempt to ‗circulate‘ the DMSO to his brain and other vital organs.

SLIDE 71

This deceit and evasiveness alienated competent individuals and caused a cascade of problems that made the environment for cryonics more hostile. This in turn contributed to the lack of adequate capitalization and denial of access to high quality profession and technical services such as physicians, cryobiologists, businessmen and cryogenic equipment manufacturers.

It also provoked intense hostility from the scientific community at large and last, but by no means least, it resulted in Chatsworth. Nelson‘s lies hadn’t stopped with Bedford and they would not end until cryonics was nearly destroyed by his misconduct at Chatsworth where 9 people were found to have been allowed to thaw out (or in some cases had never been

frozen at all) and decompose under shocking conditions. Chatsworth resulted in a nearly decade long hiatus in progress in cryonics and the number of people cryopreserved dwindled to less than 1 per year during the interval of 1975 to 1987!

ABSENCE OF PREPARATION AND PLANNING

SLIDE 72

While fraud and deceit drove the failure of cryonics on the West Coast of the US, other factors were in play on the East Coast. In contrast to CSC, CSNY was operated in an open, above board and honest manner. While CSC‘s patients were decomposing at Chatsworth, CSNY‘s patients were relatively well cared for. In a sense, cryonics existed as two parallel universes a continent apart. This had a polarizing effect, dividing the few cryonics adherents who existed at that time (both the committed and the less so) into opposing camps; each suspicious of and unable to cooperate with the other.

SLIDE 73

On the East Coast, CSNY was making mistakes that would also prove damaging and eventually lethal. While fraud was not an element in these errors, lack of planning and foresight certainly contributed mightily. CSNY and its brother organization Cryo-Span, Inc. had no business plan, no protocols or procedures for delivering the technical aspects of care, and no emergency communication or response system. As CSNY‘s

President, Curtis Henderson was later to say, “We were just making it up as we went along.” On 28 July, 1968 CSNY cryopreserved its first member, Steven J. Mandel.

In the slides that follow I want to give you some visual images that will hopefully provide you with a feeling for what cryonics was like at that time, both in terms of its technology and in terms of its public image.

SLIDE 74

Steven was a 24-year-old aeronautical engineering student from New York City who was already gravely ill when he made arrangements with CSNY and purchased his life insurance. In fact, he was uninsurable, and experienced legal death well

before the non-contestability period of the policy had elapsed. There was no money to pay for the immediate expenses of perfusing and freezing him, let alone to cover the cost of indefinite storage in liquid nitrogen. This situation became known to the management of CSNY within days of Steven‘s cryopreservation.

SLIDE 75

Despite the absence of funding, CSNY proceeded to place Steven into long term storage and rely upon promises from his mother, Pauline Mandel, to provide regular payments for his long term care.

SLIDE 76

This decision was made for many reasons including lack of experience, naiveté, and a strong desire to ‗keep up with the Nelsons‘ and garner media attention which it was believed would further the program and attract additional members and customers.

SLIDE 77

This decision depleted the organization of its capital equipment and cash and subjected it to the considerable expense in time and money of operating a storage facility for whole body patients. While in some ways this was beneficial in that it ‗forced‘ these facilities into existence and also forced the principals of CSNY to confront the logistic, technical and business realities of actually delivering human cryopreservation services, it did not provide them with either the capital or human resources to do these things effectively.

SLIDE 78

Unlike Nelson, who was able to show impressive drawings of his non-existent facility, CSNY had to be content with exposing its modest, indeed crude appearing operation to public scrutiny. The rough nature of the operation, housed as it was in the groundskeepers‘ room of a Long Island cemetery did not inspire confidence in the public or in CSNY’s own members.

SLIDE 79

Despite, and in large measure because of these difficult experiences, Curtis Henderson became focused on developing reliable cryogenic storage equipment, and one beneficial outcome of CSNY‘s efforts was the creation of the first reliable and cost-effective equipment for human cryogenic storage, the Minnesota Valley Engineering dual patient upright, Superinsulated™ high vacuum dewar.

The previous horizontal units manufactured by Cryo-Care Corporation of Phoenix, AZ were notoriously unreliable and very inefficient making long term care cost-prohibitive.

SLIDE 80

Because the patients accepted by CSNY were all third-party cases – situations where the relatives had either initiated cryopreservation or were expected to pay for it, decisions about how patient‘s were cared for became disconnected from rational, scientific or even simple and straightforward technical requirements. The relationship of the cryonics organization was not with the patient, but rather with his next-of-kin.

SLIDE 81

When the MVE dewars were first put into service in August of 1969, it was argued that for commonsense reasons of safety, patients should be racked in the dewar in a head down position. In the early 1970s I argued strenuously that in addition to providing extra protection in the event of vacuum failure, racking patients in a head-down position in the dewar would prevent the enormous thermal cycling that the head and brain were experiencing each time the unit was topped up with liquid nitrogen (i.e., quench cooling of the head from ~ -145oC to -196oC in a matter of minutes).

This proposal was met with fierce opposition by relatives, and (some) CSNY members, alike. Emotional and public relations considerations were paramount. I was told, “We can‘t have our patients in there upside down standing on their heads! People will really think we are crazy!” If you look carefully at the photo of the patient at the upper left of this slide, you can see a line demarking the liquid nitrogen level. Because liquid nitrogen is dispensed in 160 liter containers the liquid level after filling had to be allowed to fall to approximately mid-chest level, exposing the upper body to a continuous series of cycles of cooling and warming with a delta T of ~50oC.

SLIDE 82

The third party problem was greatly exacerbated when CSNY cryopreserved Ann DeBlasio in January of 1969. Mrs. DeBlasio was the wife of a blustering and contentious New York City police officer who often ended discussions by waving his firearm menacingly.

SLIDE 83

DeBlasio, seen looking in through the doorway as his wife‘s dewar is consecrated by the family priest, Rev. Severio Mattei, had no idea of what cryonics was really like.

Understandably, he expected a professional operation with a solid technical basis and, at least, a reasonable aesthetic front. What he was confronted with were a group of people who defied convention in almost every way and a primitive facility that could not even be locked and where groundskeepers tossed their cigarette butts onto the floor and left the waste from their lunches on his wife‘s temporary storage container.

SLIDE 84

So, while Ann DeBlasio became CSNY‘s second patient in long term storage, the situation was not stable and there was dissatisfaction and unhappiness on all sides.

SLIDE 85

This cramped, crude CSNY facility, coupled with a lack of professionalism and the absence of a business-like approach crippled, and arguably destroyed CSNY – and did much to injury cryonics as a whole.

SLIDE 86

While the men who ran CSNY were honest and made no attempt to hide their shortcomings, they nevertheless projected, through their publications and literature, an image of competence and skill that was wholly lacking. In fairness, they understood much of what needed to be done, but having committed themselves to the formidable and unrelenting task of actually delivering cryogenic care (in the absence of adequate resources) it became virtually impossible for them to pursue the proper course of action.

End of Initialization Failure, Part 3

 

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Cryonics: Failure Analysis: Lecture 1: Initialization Failure, Part 2

By Mike Darwin

FAILURE OF HUSBANDRY

SLIDE 34

The core ideas of cryonics, that death is a function of remaining biological structure (information), technological sophistication, and that deep cooling can arrest decay and preserve structure indefinitely to await resurrection by a more sophisticated future medical technology were first promulgated by Robert Chester Wilson Ettinger in a science fiction story, The Penultimate Trump, in 1948.

SLIDE 35

Ettinger did nothing beyond laying the idea out in his story until 1962, at which time he began to be concerned that no one else had come to the same conclusions he had. It occurred to him that if he did not act to at least inject the idea into the culture, he might not benefit from it himself. Ettinger, in turn, had been inspired to create cryonics based on a 1931 science fiction story, The Jameson Satellite by Neil R. Jones, in which one Professor Jameson has his body rocketed into orbit following his death where he remains, frozen, until many millennia later his brain is removed and repaired by aliens, the Zoromes, who place him in a robotic body and allow him to accompany them on their romps around the galaxy.

SLIDE 36

At about the same time, an intellectual and remittance man named Evan (Ev) Cooper had come to the same conclusions as had Ettinger and he privately published a manuscript that proposed a “freezer program.” Cooper, unlike Ettinger, had no scientific training and his proposals for using arctic or Antarctic storage lacked scientific rigor.

SLIDE 37

In 1964 Ettinger published The Prospect of Immortality after it passed scientific review by universally respected experts at the time, such as Isaac Asimov and the maverick cardiac surgeon and cryobiologist Richard Lillihei.

SLIDE 38

Aside from the idea of cryonics, Cooper and Ettinger had a number of other things in common. Both men were intellectuals (academic-types) who possessed large personal libraries, read voraciously and were described by their contemporaries as “visionaries” preoccupied with ideas. Both men sought leadership positions, and both men looked to others (governments, NGOs, corporations, entrepreneurs) to subsume and implement cryonics.

SLIDE 39

Their personalities were those of the classic introvert. I want to be at pains to point out that this is in no way a criticism of either man. In general, we do not get to pick our personalities or temperaments, and these men were what they were: there is no fault or blame involved in being either an extrovert or an introvert.

SLIDE 40

Both men saw cryonics as integrating into and augmenting the existing cultural paradigm; Cooper, from a left of centre perspective, believed cryonics should be implemented by the United Nations and administered from a top-down, central-planning perspective as a public welfare measure, while Ettinger, from a right of centre perspective, envisioned cryonics being implemented by large corporations and entrepreneurs offering a wide range of services in a largely laissez faire manner.

SLIDE 41

Nevertheless, these traits had consequences for cryonics that were, on balance, not conducive to its successful launch. Things might have been different if either man had had a Huxley to his Darwin – a vigorous, outspoken, charismatic, articulate and, above all, honest and well informed advocate of their ideas.

SLIDE 42

Precisely for the reasons outlined above, two highly influential men who understood cryonics, and believed in its technical feasibility, rejected it, one personally and privately, and the other vocally and publicly. The science fiction writer, savant and media darling Isaac Asimov, understood immediately that cryonics would up-end the existing order and ultimately lead to a fundamental transformation of mankind into something other than human. He found this extremely disturbing and “unnatural,” and wrote and spoke extensively against cryonics on social, environmental and moral grounds.

The widely respected science fiction author and futurist Fred Pohl also understood the likely workability of cryonics and in fact wrote a very positive cryonics themed novel, The Age of the Pussyfoot (first published in 1966). Pohl rejected cryonics exclusively on the basis of survivorship guilt and concern over his ability to adapt to a world transformed by technologies even he might not be able to imagine. Pohl actually turned down an offer for a no-cost cryopreservation from me and several others active in cryonics on September 1st, 1979, and he expressed his reasons for doing so pleasantly, articulately and in person.

FIRST ERA: 1964-1972

SLIDE 43

Despite these shortcomings and setbacks, cryonics was initially received fairly well in the US. There was enormous publicity and most of the initial newspaper, radio, magazine and

TV coverage was open minded, and not infrequently positive. There was a great deal of public interest, and media appearances by Ettinger, and others, typically resulted in hundreds of requests for information.

SLIDE 44

But the culture, both scientific and popular, was woefully unprepared for the idea. It is difficult, today, to communicate what the world was like in 1964. The discovery of the structure of DNA was only 11-years old, CPR was only 4-years old (Leonard Cobb would not hold the first citizen CPR training sessions in Seattle, WA until 1972 (8 years later), the Uniform Determination of Death Act was not passed until 1978 (14-years later) and the first heart transplant was 3-years in the future (1967). People uniformly saw life and death as binary states and the idea that the soul, or some other mystical life force left the body at, or shortly after the moment of death, was nearly universal in the general population.

SLIDE 45

Recovery from apparent (clinical) death which, is now widely understood and taken for granted, was a new phenomenon in 1964, and the Emergency Medical System (EMS) as we understand it today, did not exist. In most communities the mortician‘s hearse doubled as the ambulance and the person most likely to transport you to the hospital if you were gravely ill or injured was your local Funeral Director, or one of his embalmer employees.

SLIDE 46

It is debatable whether these formidable cultural obstacles could have been overcome. But what is not in dispute is that overcoming them was hopeless in the absence of careful planning and entrepreneurship of the cryonics idea. Both Ettinger and Cooper abdicated any responsibility for implementation of cryonics to others, and neither made any real efforts at a first approximation of the technological specifications or necessary business planning.

In Ettinger’s case, he uncritically and actively endorsed con men, frauds and the incompetent – actions that were to badly damage the credibility of cryonics with people of means and influence, as well as those in the scientific community and the professions.

SLIDE 47

Powerful, paradigm changing ideas require careful husbandry and meticulous planning. A good example of this that stands in sharp contrast to cryonics, is the idea of molecular nanotechnology, as first articulated and promulgated by Eric Drexler. Drexler understood not only the potential benefits of nanotechnology, but also its downsides: its nearly endless capacity for harm, ranging from mischief to catastrophe.

He also understood the need to back up general statements and assertions about the capabilities of nanotechnology with detailed scientific analysis and modeling. He did not write Engines of Creation and stop there; he followed through with Nanosystems, and he surrounded himself with talented, honest, competent and articulate people who could and did promote his ideas in a responsible way – to extraordinarily favorable reception. It is worth noting that Drexler, like Ettinger and Cooper, is also an introvert who shares most of the same personality traits with both men.

SLIDE 48

Drexler was both a scientist and an engineer, and he approached communication of his ideas to both the scientific community and the public, with care and precision. He clearly defined terms and, where necessary, created new language to express ideas that could not be effectively communicated otherwise. By contrast, those promoting cryonics gave no thought to making important semantic distinctions, such as the difference between the sloppy and imprecise contemporary medico-legal definitions of death, and the new reality that cryonics implied.

SLIDE 49

Similarly, identification and alliance of cryonics with the mortuary and cemetery trades (as opposed to the medical and scientific professions), and failure to develop any in-house standards of care; either technical or financial; lead to a total failure to professionalize cryonics.

SLIDE 50

This in turn led to the empowerment of amateurs and laypersons, usually with “outsider” personalities, often with accompanying deficits in social and emotional intelligence. These people attracted dysfunctional and sometimes frankly sociopathic personalities as members (and sometimes as activists). The problem of sociopaths in positions of power and authority in cryonics is a serious one which I will return to in detail later in these lectures.

SLIDE 51

In a rare moment of candor, Ettinger came close to acknowledging this interpretation of the failure of cryonics to launch, as possibly being material to how things turned out, and implicit in this statement is the acknowledgement that cryonics ‗failed,‘ that it did not succeed in either becoming a dominant force in the culture, or even in establishing itself as a respected (or feared) minority player. Consider, by contrast, the outcome for Scientology, a movement started by another of Ettinger‘s cohorts (fellow science fiction writer L. Ron Hubbard) 11 years earlier, in 1953.

Today Scientology is a multimillion dollar enterprise that makes or breaks legislation in the US, elects representatives to Congress, tell the IRS what to do, and has at least 50,000 hard core adherents in the US alone. While it is a tiny entity, and has by no means come to dominate the culture, it has managed to survive withering attacks and to carve out a place of safe harbor and exert enormous political influence relative to its size. That happened because of careful planning and clever strategizing. It was no accident and it was by no means inevitable.

SLIDE 52

And this brings us to the all important question, ―What was, at a minimum, required to launch cryonics successfully in 1964 – and perhaps more to the point, what are the implications for cryonics today; particularly as it is presented to new cultures that are effectively tabula rasa with respect to cryonics? The former Soviet Union and China are two prime examples of places where cryonics has not penetrated the culture: or is just beginning to.

Are there lessons to be learned and mistakes to be avoided from the first period of failure in the US? Are the nascent cryonics groups in these ‗new markets‘ behaving responsibly, are they repeating the mistakes made by those of us in the US from 1964 to 1972?

To answer that question it is necessary to spec out what should have happened in 1964. First, there needed to be a thorough explication of all the required technical elements of the program including necessary equipment (all phases of program), required personnel and their qualifications, an analysis of the market and obstacles to implementation of the proposed program. And, of course, essential to any complex enterprise, there needed to be a business plan including corporate structure (profit, NGO, etc.), cost estimation, timeline to implementation…and so on. None of his was done.

SLIDE 53

To make clear what I‘m talking about here, I’ve created a block diagram of the vital elements of any cryonics operation, whether being created in 1964, or today. This is the bare minimum framework of functional elements required. Each of these, in turn, breaks down into supporting subsystems.

SLIDE 54

As an example, I’ve chosen the Emergency Response System (ERS) because it is the first link in the chain of member recovery in the event of life threatening illness or cardiac arrest. If the Cryonics Society (CS) can neither be reached nor respond when members or clients need them, then they have little to offer in the way of effective services, and certainly, they have nothing to offer in terms of confidence.

I’ve also listed every item, from cotton balls to capital equipment, required to undertake stabilization and transport based on what the technology available in 1964. These assets, both physical and organizational, may seem impossible to have achieved then, and may seem equally impossible to achieve now, in places where cryonics is starting over, or starting out for the first time.

SLIDE 55

However, history shows this is not the case, and I am in the unique position of having been both a witness and a participant in events that prove that it was possible to put all of these critical elements in place using a handful of people and far less resources (dollars expended) than were brought to bear on the failed launch of cryonics during the first 8 years of its existence in the US.

This slide shows what was achieved by 4 activist individuals who were part of a group of less than 30 people. Single-handedly, the Chamberlains wrote a comprehensive procedure manual and established best practices documentation (Standard Operating Procedures; SOPs in the US and Canada) to support it. They detailed protocols for taking call (responding to an emergency when the Alcor pager went off), hired a medical answering service to field emergency calls, developed and deployed emergency response kits and trained volunteer staff to administer cryonics first aid: manual & mechanical CPR, external cooling, anticoagulation & buffer administration, and transportation of the patient.

They built and tested perfusion equipment, contracted with an ambulance company and mortuary for technical and transportation services and, finally, constructed a mobile perfusion facility where cryoprotective perfusion and freezing could be carried out.

In addition to all of this, they kept the books, put out a technical publication, Manrise Technical Review, and practiced and drilled relentlessly to hone their skills and familiarize themselves with the equipment they would be using. And before they did any of this, they created a business plan which was realistic and scaled to the (very small) market they estimated they would be servicing.

And, I should add, all of us were employed full time during this period at demanding jobs; Linda was an executive secretary, Fred was an IEEE at the Jet Propulsion Laboratories and I was a full time student putting in 30-40 hr/wk at McDonald‘s (literally making hamburgers). Total dollars expended (adjusted for inflation) = $350,000.

SLIDE 56

Data collection sheets, flow charts and thorough documentation on how to use equipment, prepare perfusate and carry out cryoprotective perfusion and freezing were all put in place and rigorously validated before the first Alcor patient presented for care in the summer of 1976. Our competence and attention to detail had the effect of quickly attracting the best

and brightest in cryonics to Alcor (and Trans Time) and our professionalism ultimately attracted and deeply involved medically competent individuals such as Allen McDaniels, M.D., Jerry Leaf, Virginia Jacobs, and others. To approach cryonics with anything less than this is not merely to invite disaster, it is to ensure it.

 End of Initialization Failure, Part 2


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Cryonics: Failure Analysis: Lecture 1: Preface and Initialization Failure, Part 1

 

By Mike Darwin

This series of lectures had its origin in a presentation entitled Cryonics: Why it has failed, and possible ways to fix it, which was delivered at an ExtroBritannia meeting on Saturday August 2, 2008 at Birkberk College in London, UK.

PREFACE

SLIDE 1

Before I begin the formal, structured part of this presentation, a few words are in order to put it into context. We live in an age where passion and strong emotion have been largely removed from daily discourse and are now considered acceptable only in the realm of fiction; in movies and video games. Characters there are free to speak in extremes and to speak passionately; not so those of us who inhabit the real world. I will be breaking that taboo today because what I am going to talk about is a life or death issue for you, for me, and for the 7 billion or so other human beings on this planet. My life matters to me a great deal, and I‘m not ashamed to admit it.

Most of the people on this planet get through life on a daily basis by being carefully shielded from certain images and ideas which they find uniquely disturbing and destabilizing. Of course, if they were, in fact, immortal supermen, these images and ideas would have a very different effect. But, they aren’t immortal supermen; and neither are we.

So, some of the images you will see in this presentation, should you choose to stay, may be unsettling or even frightening. I do not apologize for this; I believe they are essential to communicate understanding and are, in fact, the only way to communicate that understanding effectively. So, if you are likely to be disturbed by images of death and decomposition, I suggest you make your exit now. You’ve been warned.

Finally, I want each of you to understand that I believe cryonics is the most powerful and humane idea in the world today, and I treat it as such. I don‘t ask you to do the same (yet), but I do ask you to understand and to respect that this is my perspective, and I have the floor. I do not suffer fools gladly and a good part of what I have to say today is the direct result of people tolerating fools and foolishness in cryonics.

SLIDE 2

It is impossible to understand what I have to say without understanding something of who I am and how I got to be that way. It has been said that a happy childhood is the worst possible preparation for life, and I can certainly attest to that. I grew up in a stable and secure environment; I lived in the house my grandfather had built and in which my mother had been born. While my parents were working class, they afforded me everything necessary for good intellectual and emotional development. As an only child in a loving extended family, necessities were assured and an enriched environment was a given.

SLIDE 3

Unfortunately, the one thing my parents and extended family could not protect me from was the reality of the inevitability of disease and death. My parents were in their mid-30s when I was born, and a consequence of this was that my grandparents and aunts and uncles began to suffer age associated morbidity and mortality when I was still young and most of them had died by the time I was a pre-teen.

The red symbols above indicate people who are now dead, many long dead. I‘m the babe in arms sucking his thumb. While my mother (holding me) and my father (who took the picture) are both still alive, my mother has descended into the dark hell of Alzheimer‘s disease. Several of the people still alive from the day in 1956 when that photo was taken are in failing health and will soon be dead. [Note: both of my parents died in November of 2011.]

The impact of these lost lives on me as a child was immense and terrifying and I soon came to the conclusion that, as Mike Perry has so eloquently put it, ―The individual ought to endure – for a life rightly lived is never rightly ended.

SLIDE 4

A particularly traumatic event, and one that was to shape my life, occurred when I was ~ 8 years old. I discovered my maternal cousin, Rae Rohrman, with whom I was very close, dead in her home a few doors down the street from where we lived. Rae was a non-compliant diabetic who died suddenly during the summer and was not discovered until I entered her home approximately a week after her death. She was in an advanced state of decomposition and there were none of the considerable resources or “contexting” of the mortuary industry or the church to soften the hard reality of what death really is.

It is an ugly, destructive process and in confronting it I began to realize that the mystical explanations I was being given as to why it was both necessary and good were merely a coping mechanism adults used to stop themselves from going insane, a version of Santa Claus and the Tooth Fairy for grownups which someone, someone quite human, had made up to keep the world as barely sane and orderly as it was. It was crystal clear to me that no one in their right mind would want what I saw had happened to Rae, to happen to them.

SLIDE 5

“That event and the deaths of others close to me, launched on me a quest to find a way to halt decomposition, and, shortly thereafter, to prevent death. I began experimenting with ways to interrupt and restart life processes in plants, insects and small vertebrates (red eared slider turtles) by cooling and freezing. In 1966 I was introduced to cryoprotectants and to tissue culture, and by 1968 I had amassed a substantial amount of experimental expertise and results. It was clear to me that cryopreservation offered the most likely path to achieving suspended animation.

With suspended animation would come two great boons: the ability to travel to distant star systems and explore the universe, and the ability to enter a state of indefinitely long waiting if death threatened. While I did not foresee reversal of aging or the application of this technology after so-called death had occurred, I found it enormously reassuring that death and decomposition could be forestalled, essentially indefinitely, and that even if experiencing life was not possible forever, in theory, avoiding death was.

During the course of a science fair project in 1967 entitled, ‗Suspended Animation in Plants and Animals‘ I was handed a newspaper clipping that introduced me to the idea of cryonics by telling the story of one Professor James Hiram Bedford who had been frozen after “death” to await a cure for his cancer, as well as rejuvenation from old age, to a state of healthy vigor.

SLIDE 6

I promptly contacted the various cryonics organizations extant at that time, and quickly joined the Cryonics Society of New York (CSNY) as a suspension member, taking jobs mowing lawns and doing yard work to pay for my life insurance. In 1972, while visiting CSNY on my secondary school holiday, I was asked, along with a young graduate student, Corey Noble, to perfuse and freeze a CSNY member, Clara Dostal, who had been pronounced legally dead a few hours earlier.

I was 17 at the time and had already amassed a considerable amount of hands-on experience in cryonics. This event, as you shall see a bit later, also had a profound emotional and intellectual effect upon me.

THE PROBLEM OF PARADIGM CHANGING IDEAS

SLIDE 7

The beginning of cryonics is probably best dated to the publication of Robert Ettinger‘s The Prospect of Immortality in 1964. This date is important because it provides context for much that was to adversely affect cryonics, so you should keep it in mind as we proceed.

SLIDE 8

I did not live in a vacuum, and my interests in science and coming developments in technology was keen. I was an avid reader of classic 1950s-60s science fiction as well as popular and “hard” science publications and books. In 1968 my country was the richest and most technologically sophisticated in the world, and it was about to land a man on the moon, and return him safely to earth.

In fact, it was about to land a number of men on the moon and recover them all safely. At that time, the United States (US) Federal Government was funding the National Aeronautics and Space Administration to an unprecedented degree. Not since the Manhattan Project had so much money and effort been expended upon a scientific undertaking.

A world view emerged from this effort, and it was a world view promulgated, endorsed by, and made completely credible to the populace by the US government. That world view was one that posited as inevitable the construction of a large, orbiting space station, the establishment of a permanent lunar base, and the beginning of the expansion of humanity into the solar system – and more speculatively, beyond.

This worldview is best summarized and most accessible today in the first half of the film 2001: A Space Odyssey which premiered in 1968, the year I was becoming deeply involved in cryonics. While the film was undeniably science fiction in its premise of encountering extraterrestrial life, it‘s technological predictions of what life would be like at the turn of century were universally considered completely reasonable by far sighted and respected scientists and futurists – even conservative ones such Dandridge Cole and Isaac Asimov.

That world, 33 years in the future, became my model, and the model for millions of other thinking people, young and old alike, for how the future would be. It was a world where space colonization was underway, life spans had been modestly extended, human hibernation was a reality and solid state organ cryopreservation was in use for storing transplanted organs. It was a reassuring view of the future, and in particular of my future, if I didn’t die before getting there.

SLIDE 9

By 1976 I was becoming uncomfortably aware that the future I expected was not materializing at a rate consistent with the worldview in 2001. Organ cryopreservation programs had been abandoned in all but one facility in world, the US manned space program was doomed, and interest in serious, interventive gerontology, let alone meaningful research, was nil.

The money and intellectual resources required to achieve these goals had been redirected to an endless series of wars, first in Vietnam and later in the Middle East and East, as well as a succession of botched and unsuccessful programs to end poverty in the US (the Great Society), cure cancer, and deal with longstanding mishandling of the environment. The spending spree of the latter days of the Cold War bankrupted the Soviet Union and, in truth, bankrupted the West, as well. The focus of the planet‘s population was on protecting itself against bogeymen of its own making and it spent and spent maniacally to create weapons systems of vast lethality and ever increasing complexity.

So, sometime in late in 1976 I wrote out a timeline of milestones that I thought would be necessary if I were to survive. This was a simple list of critical achievements with the dates by which they must be accomplished alongside them. It took a conservative and probably all too unfortunately realistic prediction, of the likely arc of my productive life.

While it has proved a more accurate road map than my naive first imaginings of my future, it too has fallen short and has proven flawed, perhaps fatally flawed. Since I was not then, nor am I now, either poorly informed about cryonics or lacking in real world experience in its practice, I suggest you might want to pay careful attention to what went wrong with this very conservative timeline, because it very likely has important implications for your future as well.

SLIDE 10

This quote, suggested by Robert Ettinger for the opening of Robert Nelson‘s book We Froze the First Man, was meant to imply that the success of cryonics was inevitable meant to imply that the success of cryonics was inevitable – that it was an idea whose time had come. Victor Hugo was an idealist, and a man who had the good fortune to live in an age where the time had indeed come for most of the ideas he cared passionately about and championed.

Overlooked by Ettinger was that powerful, paradigm disrupting and socially inflammable ideas require careful preparation of the culture before they can flourish. No thinking person would imagine it possible to arrive in a Stone Age culture, such as the Pirotribe, in the Amazon basin, and begin discoursing successfully on Quantum Electrodynamics or Natural Selection. The dismal experience of Western Christian missionaries (and of their “flocks” ) with African and Polynesian cultures similarly points to the futility of attempting to convert an unprepared culture to ethical or ideological standards that are alien to their environment and destructive to their culture and their entire way of life.

SLIDE 11

While applied engineering and electronics were undergoing explosive advances in 1964, the biological sciences lagged far behind. In the medical, biomedical and cultural context of 1964, the year Ettinger‘s The Prospect of Immortality was published, the discovery of the structure of DNA was only 11-years old, CPR was only 4-years old, the Uniform Determination of Death Act would be not be passed until 1978 (14-years later), the first heart transplant was 3-years in the future (1967), and most of the United States had no emergency medical system (EMS): ambulances were hearses driven by Funeral Directors.

Some Definitions “Culture“: The sum total of values, norms, assumptions, beliefs and ways of living built up by a group of people and transmitted from one generation to another.” Innovation: “The adoption of a new practice, process, or paradigm by a community —not just a new product or service. “Creativity“: To cause to come into being, as something unique that would not naturally evolve or would not exist via ordinary processes. Resulting from originality of thought.”

SLIDE 12

To understand the impact this primitive state of affairs in the life sciences was to have on the launch of cryonics, it is first necessary to examine the way scientific advancement proceeds in a culture, and in order to do that we must define some key concepts. Culture: The sum total of values, norms, assumptions, beliefs and ways of living built up by a group of people and transmitted from one generation to another. Innovation: The adoption of a new practice, process, or paradigm by a community — not just a new product or service. Creativity: To cause to come into being, as something unique that would not naturally evolve or would not exist via ordinary processes and resulting from originality of thought.

 

SLIDE 13

There are, fundamentally, two types of new ideas: Conventional: incremental innovations, with a high likelihood of success and a modest return on investment and Radical: (Paradigm Changing): favoring or effecting fundamental or revolutionary changes in current practices, conditions, or institutions with a low likelihood of success and a large return on investment.

SLIDE 14

In the early 1970s, again well after cryonics had attempted to launch, the philosopher and historian of science Imre Lakatos created a new model for how scientific change occurs. He posited that scientific advance proceeds on two fundamental and very different levels. Most of scientific and technological progress is incremental; it involves testing and validation or invalidation of the dominant scientific paradigm of the age.

For instance, in a world where the earth is presumed to be the center of the universe, all astronomical work will consist of the careful accumulation of information designed to support this view and to reconcile observed phenomenon with the core tenet that the sun, and other heavenly bodies, revolve around the earth.

At some point, discontinuities in the observed data may lead to an alternative paradigm; one completely add odds with, and antithetical to, the accepted explanation (theory) of how the universe works. This second type of progress is not incremental, but rather is revolutionary: it overturns the entire structure of the previous paradigm. It penetrates the protective belt of gentle scientific inquiry and smashes the hard core of the existing paradigm.

We tend to forget that scientific ideas do not exist in a moral, social or philosophical vacuum – or in a political one, for that matter. Scientific theories such as how the solar system is organized, how old the universe is, and how life arose and became diversified, inform human beliefs about their purpose and their place in the universe. And, they impact the complex web of powerful social institutions that create and enforce philosophical and behavioral norms.

The Copernican theory gutted the authority of the Catholic Church and, to a significant extent, of the Christian religion, because it challenged the veracity of these institutions‘ teachings – teachings which, in order to hold moral authority, had to be absolute and infallible.

SLIDE 15

So, the success of novel ideas depends upon more than their being provable by observation or demonstration; they must also have compatibility with fundamental philosophical, moral, ethical, social, and political paradigms of the culture, and, of course, be technologically and economically feasible. They must also, critically, have credible, articulate and aggressive advocates.

SLIDE 16

As it turns out, there are, very broadly, two ways that paradigm changing ideas can be introduced into cultures. The first and easiest is by SEDUCTION: Incremental (limited) powerful desire for benefits absent any understanding of understanding of detriments (including destruction of the existing order). The second way is by INSURGENCY: Organized, forceful and determined effort to establish a new paradigm by subversion of the existing order.

SLIDE 17

Perhaps the best example of introduction of an idea by seduction is that of agriculture. Sometime between 100,000 and 80,000 years ago, humans began to make the transition from a hunter-gather life-style to agriculture. Today, we take agriculture for granted and we by and large uncritically accept it as an unblemished good.

However, the goodness or desirability of agriculture is hardly the picture of universal plenty that comes to mind when the word is uttered today, 100 or so millennia after agriculture was invented. In the context of hunter-gather society, agriculture was an unmitigated disaster that completely destroyed their culture, religion, way of life, and ultimately, much of their health and well being.

SLIDE 18

Hunter-gatherers controlled their population size, lived in small intimate groups, and were constantly on the move. Because they moved frequently they did not ingest or come into contact with their own wastes, or the wastes of the animals they fed from. They lived their entire lives in the open air under uncrowded conditions, and they ate a nutritionally diverse diet that was almost completely devoid of empty calories. As a result, they had little or no communicable infectious disease: no typhoid, cholera, or other water borne illnesses that result from fecal contamination of the drinking water supply.

In addition, group size was far too small to sustain communicable epidemic diseases such as smallpox, measles, mumps and tuberculosis (TB). TB, in particular, is an urban disease that requires close quarters and poor ventilation to be self sustaining and epidemic. It is also a zoonotic disease: one acquired from living commensally with animals – a necessary facet of agricultural life.

The quality and quantity of the hunter-gatherer life was thus both surprisingly high and long. Paleolithic man appears to have had a mean lifespan of between 45 and 53 years. Morbidity was brief and death came suddenly from misadventure or homicide. With the advent of agriculture during the Neolithic, life spans plummeted and remained well below hunter-gatherer levels until the first decade of 20th century in the US, and not until mid-century, globally.

SLIDE 19

The toll exacted by agriculture in terms of human suffering was immense. Agriculture allowed for a rapid expansion in the number of humans at the cost of hunger, starvation and an almost unimaginable disease burden. Cities became not only possible, but necessary, and up until the 19th century they were veritable killing machines which sucked in the surplus population generated by satellite farming communities and killed them off with infectious disease and dangerous working conditions. Cities did not become self sustaining in terms of population until late in the 18th century!

It seems clear that if our hunter-gatherer ancestors understood that agriculture would virtually exterminate their way of life, and create millions and even billions of starving and dispossessed people, they would have fled from it and burned the first would-be farmers alive. This didn’t happen because the immediate benefits of agriculture were so overwhelming: the ability to create a steady, seemingly reliable supply of food in superabundance was incredibly seductive.

Seeing the downsides was a virtual impossibility for people in those circumstances who lacked the scientific method, lacked the written word, and had little experience with new ideas or rapid change.

SLIDE 20

A similar state of affairs pertained in the late 18th and early 19th centuries when the Industrial Revolution began. The Industrial Revolution allowed for the prodigious production of high quality goods on a scale previously unimaginable. It created a cornucopia of wealth allowing the average man, and even the poor man, to enjoy goods and services that previously royalty, or the richest of the elite, could not have purchased at any price. The human cost of this was, again, very high: child labor, dangerous working conditions that crippled and maimed, and a reduction in air and water quality that killed thousands at a time often in the space of few days.

SLIDE 21

And again, as with agriculture, the Industrial Revolution was a fiat accompli before our species began to understand the adverse global environmental impact and come to the realization that the whole foundation of technological civilization was not sustainable. Hunter-gatherers lived in ecological balance with their environment; technological man cannot. To sustain ever advancing technology man must expand his environmental horizons into the solar system, and beyond.

SLIDE 22

Finally, telecommunications are an example of paradigm changing scientific advance operating via seduction.

SLIDE 23

Within my lifetime TV, mobile phones, and the Internet have transformed the culture and degraded or destroyed some of its more cherished institutions.

SLIDE 24

This tableau is how I grew up: the evening family meal taken in a stereotypical fashion with lots of opportunity to talk and socially interact with both my parents, and with members of my extended family. It was not understood by any of the participants to be a critical element in a cohesive and functional family life – it was just something everyone did and took for granted. But, in fact, it was (and is) a critical tool for facilitating communication, and allowing time and the proper conditions, to reflect on the day‘s events and consider what was necessary to be done tomorrow.

SLIDE 25

This slide lists but a few of the social and cultural sea changes caused by telecommunications with a high profile casualty being that family meal together, where people with comparatively uniform values and experiences communed with each other.

SLIDE 26

Not all novel paradigm changing ideas are seductive. Many are immediately and rightly perceived by the culture to be dangerous to the established order; ideas which can overturn political and social control mechanisms and completely disenfranchise, or even destroy bedrock institutions.

Because ideas about biology and medicine impinge upon the territory of religion in explaining man‘s purpose in the universe, and also on providing comfort and succor to the sick and dying, they are particularly scrutinized areas in terms of their compatibility with the hard core of the existing scientific paradigm – a paradigm in which the culture and its most powerful institutions are heavily invested.

Natural Selection, Germ Theory and Scientific Surgery created serious threats to the existing order that were immediately appreciated.

All of these ideas challenged the traditional view of Vitalism, and were steps towards “reducing” man, and indeed all living things, to the status of mechanisms: clockworks that could be rationally explained, understood and eventually manipulated at will. These novel ideas had the power, at least in theory, to confer on men the knowledge and ability formerly reserved only for god. If life was a natural phenomenon governed by the same physical laws that enabled the construction of timepieces, factories, bridges and manufacturing machines, what was to stop man from creating life itself and, in essence, usurping the role of god?

Insurgent attack on the hard core of critical paradigms is dangerous…

SLIDE 27

The culture quite rapidly comes to understand that such ideas are exceedingly dangerous and almost invariably takes extra-scientific steps – social, political and economic – to protect the existing paradigm and defend its hard core at almost any cost. The fate of Galileo for promulgating Heliocentrism is a classic case in point. And Galileo was lucky – extremely lucky. His fate was to be forced to recant his heretical ideas and spend the remaining years of his life under house arrest.

SLIDE 28

By contrast, consider the fate of Giordano Bruno, the Italian Dominican friar, philosopher, mathematician and astronomer, who is best known as a proponent of the infinity of the universe (his cosmological theories went beyond the Copernican model in identifying the Sun as just one of an infinite number of independently moving heavenly bodies: he is the first European man to have conceptualized the universe as a continuum where the stars we see at night are identical in nature to the Sun).

He was burned at the stake by the authorities in 1600, after the Roman Inquisition found him guilty of heresy. Challenging the hard core of critical scientific (and thus social, cultural and political) paradigms is dangerous and often deadly…

THE INHERENTLY DISRUPTIVE CHARACTER OF CRYONICS

SLIDE 29

…and at the very least it is inconvenient, incredibly unpleasant, and costly.

The real reason the Dora Kent drama played out was that cryonics, practiced well (optimally) caused extreme cognitive dissonance in the medical and legal authorities in the community in which we were operating. Over and over again they kept badgering me with the statement that, “Two minutes was NOT long enough to wait after cardiac arrest before starting cryonics procedures.” To which I responded repeatedly, “Well then how long is long enough? How dead does someone have to be before it is OK to start working on them? You define death as when cardiorespiratory arrest occurs; you say nothing about what can or should be done afterwards.” They found that enormously disconcerting and it made them angry, really angry.

SLIDE 30

So, if we look at cryonics objectively and in the context of this culture and this civilization at this time, then cryonics is just about the most disruptive and threatening idea that has ever come along. Unlike Natural Selection or Germ Theory, or even Heliocentrism, cryonics will inevitably overturn the Vitalistic view of life, challenge the conventional definition of death, erode the need for a mystical afterlife, invalidate the core tenets of contemporary medicine, and radically redistribute capital and disrupt inheritance, bequests, and mortuary customs!

 

SLIDE 31

What‘s more, it mandates a complete change in reproduction, perturbs generational succession, requires space colonization, requires (and supports) profoundly disruptive technologies such as cloning, regenerative medicine, nanotechnology, and AI, and most frighteningly of all, it Ends the Species and enables Transhumanism.

Cryonics is Profoundly Disruptive of the Hard Core of Contemporary Civilization Creates Survivorship Guilt; Indefinitely extends anxiety and uncertainty accompanying life-threatening illness; Prevents the psychological closure of  “true” death with disposition of remains; Creates indefinite anxiety about the well-being of cryopreserved loved ones.

SLIDE 32

Beyond these inevitable long term effects, cryonics has a number of poorly appreciated (by cryonicists) severely psychologically damaging adverse effects. As Curtis Henderson once observed,  “All biographies end in tragedy; everybody dies. Always.” A consequence of this is that no one need feel guilty about living – in the end we all end up dead – there are no survivors.

Cryonics changes that, because people now living have an opportunity to possibly ‗cheat‘ death, and that means that if they choose to do so and succeed, they will have to face the prospect that they did not act quickly enough, or aggressively enough, to save the lives of all their other loved ones who have died or will die and not be cryopreserved. This survivorship guilt can be crippling, and in some cases all consuming – but at the very least, it is always painful.

One of the few advantages of death is that it is final. It puts an end to the suffering and anxious uncertainty that must inevitably accompany life threatening illness. Anyone who has agonized over the fate of a loved one in the Intensive Treatment Unit (ITU) can at least begin to understand the psychological impact of stretching out that period of uncertainty over a lifetime, and beyond.

The devastating effects of this kind of limbo are often seen in cases where children are abducted and not found, or soldiers are lost in battle, but no remains are recovered. Cryopreservation prevents the psychological closure of ‗true‘ death with disposition of remains and creates indefinite anxiety about the well-being of cryopreserved loved ones. Cryopreserved people are not put away in a cemetery where no further harm can come to them. Rather, they require indefinite care, vigilance and protection. This is often a source of extreme anxiety in survivors.

SLIDE 33

These immediate detrimental effects of cryonics become intensified during the terminal phase of a cryonics patient‘s life. The presence of the Standby/Stabilization team and their equipment and supplies disrupts intimacy during the “dying” process, may bitterly divide family members (those opposed vs. those in favour), and block deeply held (conditioned from childhood) mechanisms for coping with death and bereavement: no wake, funeral, and other comforting rituals.

With the understanding of these general and largely unavoidable obstacles, we are now prepared to examine in greater detail the specifics of why cryonics failed to launch in 1964.

 End of Preface and Initialization Failure, Part 1

Posted in Cryonics Biography, Cryonics History, Cryonics Philosophy | 6 Comments

Much Less Than Half a Chance Part 5

How to avoid autopsy and long ‘down-time’

(ischemia) ~85% of the time!

 

Saving Lives Now?

Coronary Artery Disease and Vasculopathy

I’ve been at pains here to emphasize that the primary purpose of the DSS is to alert cryonicists to the presence of a lethal or potentially lethal morbid process, so that we can make rational preparations for cryopreservation and avoid prolonged ischemia and autopsy. The question naturally arises, “Can this technology be used to extend or improve the quality of life now, during this life cycle?” In the case of atherosclerotic disease this seems likely, and several activist organizations within the conventional medical community are urging the adoption of cardiac CT calcium scans as screening to tool to allow for subsequent invasive, drug and dietary interventions, as necessary, to avoid heart attack. This is approach is not yet proven to reduce death from CAD, or to reduce the incidence of severity of heart attacks. However, it seems an eminently reasonable approach and, considering that each year 785,000 Americans experience their first heart attack, 470,000 more have a second, third…heart attack and 325,000 more experience sudden cardiac death. (Rogers, 2012)

In the past 48 hours I’ve learned that three acquaintances have died from SCA. Two of the three were a father and his daughter who suffered fatal heart attacks within a week of each other. Their brother had undergone coronary bypass surgery a few years previously, and the incidence of CAD and SCA in their family history was high. This case presents special irony, because the brother had undergone a CUS (which showed intimal thickening) and then a cardiac CT, which showed heavily calcified coronary vessels. It is hard not to believe that these diagnostic tests did not at least spare him a heart attack. He is now on aggressive drug and dietary treatment for his vasculopathy (he also has atherosclerosis in his peripheral vessels and in one renal artery). Whether a meaningful extension of life span will ensue can only be determined by large scale application of such screening, with accompanying long term outcome studies. However, from a cryonics perspective, it seems clear that, were this man a cryonicist,  this technology would have granted him a clear opportunity to benefit in at least the following ways:

* Notify his CO, his physician and possibly his local coroner or medical examiner that he has a (superbly) documented history of severe CAD. Since he lives alone and the circumstances of his life are placid, if he does suffer SCA, this makes it much less likely he will be autopsied.

* Consider acquiring and using a wearable automatic defibrillator, at least until such time as (if) his CAD has shown demonstrated reversal by angiography as a consequence of drug/diet treatment.

* Relocate to near his cryonics service provider to minimize both cold and warm ischemic times following medico-legal death.

* Use an emergency alert system to signal either (or both) cryonics or medical personnel that he has experienced cardiac arrest. Possible options here are the Vitalsens system by Intelesens and the NUVANT Mobile Cardiac Telemetry System.

* Alert family and friends to “check & report” on him so that he is not ischemic for days, or longer, in the event of SCA.

*Acquire cryonics first aid supplies, such as ice, instant ice packs, a head ice positioner, and other items that might be appropriate to his circumstances.

The ability to engage in these preparations alone is a huge improvement from a cryonics standpoint.

The illustration that opens this article is of two of the finest men I’ve ever had the privilege to know: Jerry Leaf and Dennis Ross. Both were long time cryonicists. Jerry is, of course, well known for his enormous contributions to cryonics, both personally and professionally. Dennis was not so visible, but was an important and energizing presence in cryonics as well. Dennis was one of the founding members of the Cryonics Society of South Florida, and was a source of good advice and wise counsel for me, and I’m sure for others in cryonics as well. Both Jerry and Dennis deanimated as a consequence of vascular lesions that could arguably have been detected with the imaging techniques available today that have just been discussed here. In Jerry’s case, the technology was nascent in 1991 when he suffered his heart attack. In Dennis’ case, the technology was mature, readily available and easily affordable to anyone whose income is middle class, or better and who appreciates the need to access it.

This is ever the sad paradox of medical singularities, in that there is almost always a considerable lag time between their introduction, and their working acceptance. As we’ve seen in this article, there are many sound logistic and practical reasons for delays in the widespread application of novel medical technologies. The devil is in the details, as has certainly been the case with the PSA test. And bite back can be punishing, as can be the unforeseen adverse effects of the new modality; cancer in the case of x-rays, and cancer again in the case of hormone replacement therapy in menopausal women (a treatment that has caused many malignancies and deaths).

The uniquely attractive thing about quantum advances in areas of medicine like imaging, is that they offer such powerful advantages with such little potential for harm – if they are used intelligently. In this unusual case, we have a great deal of prior (bad) experience with screening technologies to guide us, and we also have the long history of experience with using these modalities in their less spectacular form. We know, for instance, about the adverse effects of ionizing radiation and we know about the relative safety of MRI. The “singularity” making aspects of medical imaging as discussed here are thus not the application of new imaging means, but rather are a result of the exponential growth in computing under the overdrive force of Moore’s Law.

Cancer & Others

Unlike atherosclerosis, neoplastic disease follows a course that is more nearly exponential than linear. The earliest phases of malignant transformation occur on the molecular and the microscopic level, with many tumors remaining very small for a consider period of the time course of the disease. Even where tumors are detected “early” via imaging techniques, the outcome is variable, depending upon the nature of the malignancy and the effectiveness of the treatments available.

With the notable exception of prostate cancer (Schroder, 2009), the majority of cancers are diagnosed when the disease is well advanced – usually late Stage II, or later. In the case of breast and colorectal cancer, earlier diagnosis has proved effective at improving long term survival. Early trials of lung cancer screening for smokers are also proving encouraging. While there is considerable debate about the utility of early screening in reducing deaths from other cancers, it seems reasonable in the current treatment milieu that the earlier the disease is diagnosed, the better the chances are for survival. (Hanley, 2010)

Figure 30 : Cumulative percentage of people diagnosed with prostate, ovarian, pancreatic and lung cancer at each stage of the disease. Source: Wired Magazine, 17:01;80-122, 2009.

To a great extent the value of early diagnosis may depend upon continuing advances in the treatment of cancer at the molecular level. The past decade has seen the emergence of “molecularly targeted” drugs, such as Gleevec, and more are in the pipe. If cancer treatment becomes more rationalized and targeted, it seems possible that earlier detection will be of greater value. Alternatively, definitive treatment for cancers that inhibit tumor cell proliferation or induce selective tumor cell death, may render the need for the “earliest possible diagnosis” a thing of the past.

In the case of cancers, it bears repeating that DSSing is not intended, nor is it likely to serve as more than a warning of impending deanimation. Any “saves” that occur as a consequence will thus be incidental, and the scans should not be relied upon to disclose treatable neoplastic disease.

 Neuronal  Attrition Disorder of Aging (NADA)

As was pointed out earlier, all interventions to extend life span by effectively treating or delaying non-brain degenerative diseases will ultimately result in “brain failure.”  The question not asked by the legions of clinicians, activists, NGOs and others working to find a cure for AD (and the other dementias) is just exactly what will happen when they do? As they often point out, AD is a discrete pathology, and not a “normal” part of aging.

But curing it begs the question of what happens next, because brain cell death (both neuronal and glial) is a process that begins at ~ 2 years of age – at least for the neurons that comprise the gray matter of the cerebral cortex, and which proceeds relentlessly throughout the individual’s lifetime (Giorgio, 2010) Brain cell loss and degeneration become morphologically apparent in the brain’s white matter by the time we are in our early 20’s, although there is evidence that more subtle changes have been afoot for much longer. (Hedden, 2004) Losses in gray matter volume proceed approximately linearly with age in normal aging, and the average gray matter volume decreases from ~390 mL at age 22, to ~300 ml at age 82. (Courchesne, 2000) Total loss in brain mass between age 20 and age 80 is, on average, ~450 g, or roughly 1/3rd of our youthful brain volume.

Figure 31: Gray matter loss with aging.

Top: Voxel Based Morphometry (VBM) analysis of gray matter changes in aging. (A) Colored voxels show regions demonstrating significant negative correlations between gray matter volume and age (p < 0.05, fully corrected for multiple comparisons across space). Clusters are overlaid on the MNI152 template brain. Images are shown in radiological convention. (B) Plot to illustrate relationship between age and mean gray matter volume across all significant voxels. The pink triangles represent female subjects. [From: Giorgio, A, Santelli, L, Tomassini, V, Bosnell, R, Smith, S, De Stefano, N, Johansen-Berg, H. Age-related changes in grey and white matter structure throughout adulthood. Neuroimage. 2010;51(3):943-51.Epub 2010 Mar 6.]

Bottom: Growth and aging changes in gray matter for 116 living healthy individuals. Gray matter volume reached maximum by 6 to 9 years of age and thereafter declined linearly. [From: Courchesne E, Chisum HJ, Townsend J, et al.: Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology. 2000;216:672.]

Medicine currently has no name for the grotesque pathological state that will emerge when this failure mode is allowed to manifest itself as a result of the elimination of AD and the continued extension of the life span via various incremental advances in treating other, non-brain degenerative diseases. So that we can have a common shorthand for discussing this soon to be problematic malady, I have labeled it the Neuronal Attrition Disorder of Aging, or NADA, for short.

The near linear loss of gray matter volume and the accompanying heavy losses in gray matter neurons poses a severe problem for the aging cryonicist because they imply that ever more sophisticated advances in 1/2TM, and even HTM, exclusive of true brain rejuvenation, will lead to our becoming neurological struldbrugs,[1] and that is a condition from which not even cryonics can resurrect us.

 

Figure 32: VBM-style analysis of WM changes with age. (A) Colored voxels show regions where WM volume shows a significant linear (blue) or non-linear (green) relationship with age (p < 0.05, fully corrected for multiple comparisons across space). Clusters are overlaid on the MNI152 template brain. Images are shown in radiological convention. (B, C) Plots to illustrate relationship between age and mean WM volume across all voxels showing a significant linear (B) or nonlinear (C) relationship with age. The pink triangles represent female subjects. Giorgio et al. The graph in the green bordered box below shows white matter volume as evaluated by conventional MRI using T1 weighted imaging. This data shows a steady increase in WM volume until age ~40, followed by a modest decline in advanced old age. However, using more sophisticated directional Voxel Based Morphometric imaging, as shown in the purple bordered box at the top of this page, WM changes are revealed to be complex, inhomogeneous between brain hemispheres, and begin in the early 20’s. As can be seen in the VBM white matter graph (purple box) there are, in fact, extensive loses in WM, however they are regional in nature as opposed to the global losses experienced by gray matter as a function of ‘normal’ aging. Growth and aging changes in white matter for 116 living healthy individuals. White matter volume rapidly increased until 12 to 15 years of age, and thereafter increased at a slower rate, plateauing at approximately the fourth decade of life. [From Courchesne E, Chisum HJ, Townsend J, et al.: Normal brain development and aging: quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology. 2000;216:672.]

Beginning in middle age there is a very noticeable steady degradation in the integrity of the white matter tracts, particularly those in the hippocampus (the brain’s memory trafficking center). In particular, the perforant pathway (PP) is seriously affected, and there is typically a loss of upwards of 25% of PP axons with aging.(Hyman, 1986; Scheff, 2006)

 Figure 33: Group-averaged diffusion tensor images of anisotropy of white matter in young and normal elderly. Parallel movement of water molecules through white matter results in anisotropic diffusion, with greater anisotropy (and so greater white matter density) indicated by brighter areas. Older adults tend to show decreased white matter integrity compared with younger adults, with the greatest age-related declines occurring in anterior cortex. (Head, D. et al. Differential vulnerability of anterior white matter in non-demented aging with minimal acceleration in dementia of the Alzheimer type: evidence from diffusion tensor imaging. Cereb. Cortex (in press). This paper offers a comprehensive DTI study of white matter changes in normal and demented aging and demonstrates the loss of fiber tracts, gliosis and scarring that occur in the so called ‘healthy’ aging brain.

Until a scant few years ago, it was impossible to image the structural changes in long nerve processes in the brain. Now, with the advent of a technique called diffusion tensor imaging (DTI) (Dennis, 2007) it is not only possible to image these changes but also to quantify of alterations in white matter microstructure during aging.  Thus, for the first time, literally within the past 2-3 years, we are getting a clearer picture of the neuropathology of ‘normal’ aging, and it isn’t a pretty one. (Augustinack, 2010; Yassa; 2010; Abe, 2002)

The development of DTI has been especially useful in documenting age-related changes in white matter, and there is now solid evidence that one of first areas of the brain to undergo age-related white matter decay is the medial temporal lobe (MTL),41 which is the area of the brain that is central to the formation of new memories, and in particular, to the acquisition of new factual information and to remembering events.(Wang, 2010; Sauvage, 2010, Bjornekbekk, 2010) Changes in the MTL are first observed (and remain most pronounced in) the perforant path (PP). The PP is so called because it perforates the subiculum[2] and carries input from the entorhinal cortex to the hippocampus, where memory consolidation and encoding are thought to be moderated.(Yassa, 2010; Burke, 2006)

The importance of NADA to cryonicists should be obvious, while perhaps the relationship between NADA and DISSing, is not as clear. Even if there is currently little or nothing we can do to halt NADA, we do need to know the speed and extent at which it is progressing. This will help us to plan more effectively about the conditions under which we would like to be cryopreserved, and it will also offer us an opportunity to determine if any interventions we try to slow, halt, or reverse NADA are working. We don’t get the luxury of a do-over in this situation. The way that DSSing will be of use in this respect is by providing both a baseline (if you are younger than ~ 35-40) scan of brain morphology and volume, as well scans progressively documenting brain structure and mass changes as we age.

In the coming decades it seems entirely possible, if not likely, that therapeutic and lifestyle approaches will be identified that slow NADA. There are currently a number of promising drugs in the laboratory (some already clinically available for other uses) which decrease or partially reverse the brain mass loss associated with aging. It is an irony of NADA that one of the first and most precious capabilities of which it robs many, is the ability to see that it is happening at all. The decrease in raw processing capability due to neuronal loss concurrently decreases our ability to perceive the deficits it is creating. While the positive offset of accumulated life experience provides a great deal of compensation for the functional losses, the result is that most aging people have very little conception of just how seriously their brains are being degraded over time. The very slow and subtle character of the changes also allows for “continuous adaptation” to a condition then interpreted as “normal.”  In short, DSSing will provide a powerful source of objective, quantifiable feedback about the impact of aging on our brains.

FUD: “I have seen my death!”

 Figure 34: First x-ray of human hand; Anna Bertha Röntgen, 1895.

On 22 December, 1895 Wilhelm Conrad Röntgen made the first x-ray of human being. The subject was his wife, Anna Bertha, or more accurately, her hand. Anna Bertha’s reaction upon viewing the developed film was to exclaim, “I have seen my death!” (Hase, 1997) Prior to that time, there was virtually no way a living human being could see the skeleton of another, except after decomposition of the soft tissues was complete, following death. At that time to see one’s skeletal hand must have been a shocking reminder of mortality.

DSSing has the same potential psychological effect and it seems only fair to go further and speculate that the major obstacle to the effective use of this technology may not be the medical, ethical, financial or organizational ones, but rather, the fear uncertainty and dread (FUD) it may provoke. I have no answer to this. I would simply note that a major factor in even communicating about cryonics to the rest of the world is the FUD it provokes. Death scares the hell out people, as well it should. We cryonicists are extraordinary out of measure in our ability to either overcome that fear, or in some cases, to hardly perceive it at all.

As is the case with cryonics itself, DSSing provides us with an opportunity to extend our lives – but again, only at the cost of confronting our own mortality. The difference being that in the case of DSSing, it will be objectified, repetitive and incrementally worse with each passing interval of time. That’s not much of an advertisement for a technology, but again, as is the case with cryonics, it comes down to how acceptable you consider the alternative?

End

 Footnotes

[1] In Jonathan Swift’s savagely satirical novel Gulliver’s Travels, the name struldbrug is given to those humans in the country of Luggnagg who are born normal, but are in fact immortal. Although the struldbrugs do not die, they do nonetheless continue aging. Swift describes the plight of the struldbrugs in terms almost any resident in an nursing home today (who is still compos mentis) would immediately understand: “when they have completed the term of eighty years, they are looked on as dead in law; their heirs immediately succeed to their estates; only a small pittance is reserved for their support; and the poor ones are maintained at the public charge. After that period, they are held incapable of any employment of trust or profit; they cannot purchase lands, or take leases; neither are they allowed to be witnesses in any cause, either civil or criminal, not even for the decision of meers and bounds.”

[2] The subiculum receives input from CA1 and entorhinal cortical layer III pyramidal neurons and is the main output of the hippocampus. The pyramidal neurons send projections to the nucleus accumbens, septal nuclei, prefrontal cortex, lateral hypothalamus, nucleus reuniens, mammillary nuclei, entorhinal cortex and amygdala and as such, is the principal routing network for information from the hippocampus. The subiculum is also critically involved in the formation of procedural memories.

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Much Less Than Half a Chance Part 4

 

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).
 

Table 1: Nominal Risk for Cancer Effects *
Exposed population Excess relative risk of cancer
(per Sv)
entire population 5.5% – 6.0%
adult only 4.1% – 4.8%
*relative risk values based on ICRP publications 103 (2007) and 60 (1990)

 

Table 2: Relative Radiation Level Scale
Relative Radiation Level

Effective dose range

None 0
Minimal Less than 0.1 mSv
Low 0.1 – 1.0 mSv
Medium 1.0 – 10 mSv
High 10 – 100 mSv
* Adapted from American College of Radiology Appropriateness Criteria, Radiation Dose Assessment Introduction 2008

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.

 

Table 3: Average Effective Dose in CT
Exam Relative Radiation Level Range of values (mSv)
Head 0.9 – 4
Chest (standard) 4 – 18
Chest (high resolution,
e.g., pulmonary embolism)
13 – 40
Abdomen 3.5 – 25
Pelvis 3.3 – 10
Coronary Angiogram 5 – 32
Virtual Colonoscopy 4 – 13
Calcium Scoring 1 – 12

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 DDSs are CT, as opposed to MRI.

Table 4: Some Exposure Risks for Comparison

Activity/Exposure mSv/year
Smoking 30 cigarettes a day 60–80
New York-Tokyo flights for airline crew 9 .0
Average radiation dose for Americans 6.0
Dose from cosmic radiation at sea level: 0.24

 

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]

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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

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End of Part 4



[1] This also does not take into consideration the possible brief use of radioprotective nutrients taken prior to the scan.

[2] My thanks to Dr. Brian Wowk, Ph.D. from whom I stole this paragraph.

 
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 Appendix 1

Appendix I: Specimen Protocol for Whole Body MRI Examination to Predict Early Deanimation

Table A-1: Protocol for a whole-body MRI examination for atherosclerosis and colonic polyps. The total examination time (“in-room time ”) is approx. 60 min. SE: spin-echo sequence; TSE: turbo spin echo sequence; CA: contrast agent; FLAIR: fluid-attenuated inversion recovery sequence; HASTE: half-Fourier single-shot turbo spin-echo sequence; true FISP: true fast imaging with steady-state precession

A protocol for a comprehensive examination, not only of the vascular system, is presented as follows (Table A-1). Due to the systemic nature of atherosclerosis, a specific screening protocol has to demonstrate high accuracy in the detection of vascular changes over several regions of the body. This includes the cerebrovascular system with its extracerebral and intracerebral arteries, as well as the parenchyma supplied by these vessels. It is really rather difficult to predict cerebrovascular disease; only 26–50% of patients with a peripheral vascular occlusive disease (PVOD) have a cerebral component [79, 80]; many patients with a vascular disease are however only diagnosed once they have become symptomatic [1].

The screening protocol for atherosclerosis also includes the vascular examination of the aorta, supraaortal branches, visceral vessels, and the periphery. The possibility of imaging all these vessels in a single, brief examination has significantly changed the diagnostic procedure in centers having his facility. Finally, the heart should be examined. Even though the examination may often “only” be able to look for wall motion disorders and previous cardiac infarcts for reasons of time pressure or the lack of suitable sequences, even this provides important information, since the rate of unknown cardiac infarcts/unidentified CHD is not inconsiderable [2].

The whole-body MR angiography was performed with the aid of a system-compatible “roller-mounted table platform” (back then the newer systems with integrated whole body image acquisition were not yet available) [3]. This platform allows acquisition of 5–6 three-dimensional angiography data sets following a single administration of contrast agent using the “bolus chase” technique. Besides the possibility of now covering a field of view in excess of 180 cm without repositioning the volunteer, an advantage of this system is the use of surface coils, which, thanks to their higher signal-to-noise ratio, deliver significantly improved image quality compared to the body coil integrated into the scanner.

Heart imaging involves an axial T2-weighted “dark-blood” sequence to produce a morphological overview; this is however extended in the craniocaudal direction to include the entire lung. Images of this type are very sensitive for the detection of focal lung nodules [4].

Functional imaging with fast gradient-echo sequences (T2/T1 contrasts are most informative), as well as late enhancement sequences using inversion recovery sequences to optimize the contrast of infarctions versus healthy myocardium, are acquired in several short and long axis sections. Here, late enhancement imaging uses the intravenous contrast agent previously applied for MR angiography, and repeated administration of contrast agent is not required.

In the last part of the whole-body MRI, attention is then turned to malignomas, and MR colonography is performed. Colon carcinoma, as the second most frequent malignant cause of death after bronchial carcinoma, is the special focus of attention. A three dimensional T1-weighted gradient-echo sequence is acquired following spasmolysis and rectal enema [5].

Appendix References

1. McDaniel MD, Cronenwett JL. Basic data related to the natural history of intermittent claudication. Ann Vasc Surg 1989; 3: 273–7.

2.  Lundblad D, Eliasson M. Silent myocardial infarction in women with impaired glucose tolerance: The Northern Sweden MONICA study. Cardiovasc Diabetol 2003; 2(1): 9.

3. Goyen M, Quick HH, Debatin JF, et al. Whole body 3D MR angiography using a rolling table platform: initial clinical experience. Radiology 2002; 224: 270–7.

4. Vogt FM, Herborn CU, Hunold P, Lauenstein TC, Schroder T, Debatin JF, Barkhausen J. HASTE MRI versus chest radiography in the detection of pulmonary nodules: comparison with MDCT. AJR Am J Roentgenol 2004; 183(1): 71–8.

5. Ajaj W, Pelster G, Treichel U, Vogt FM, Debatin JF, Ruehm SG, Lauenstein TC. Dark lumen magnetic resonance colonography: comparison with conventional colonoscopy for the detection of colorectal pathology. Gut 2003; 52(12): 1738–43.

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Much Less Than Half a Chance Part 3

How to avoid autopsy and long ‘down-time’

(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

 

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Much Less Than Half a Chance? Part 2

How to avoid autopsy and long ‘down-time’

(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



[1] This criterion is being very generous because it assumes that all interventions that begin within ~15 min of cardiac arrest are effective at preventing further ischemic injury. This is not the case for most cryonics patients where external cardiopulmonary support is not effective at restoring adequate perfusion and gas exchange, core cooling may be delayed by several hours, and cold ischemic times may be in the range of 12 to 24 hours.

[2] Again, using the very generous criteria of assuming that all CPS is effective CPS and that no iatrogenic events compromised the quality of the cryopreservations.

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Much Less Than Half a Chance? Part 1

How to avoid autopsy and long ‘down-time’

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

By Mike Darwin

It’s easy to concentrate on the biggest and most obvious reason that cryonics hasn’t attracted wider acceptance, principally the fact that it doesn’t work “yet” and it will be a long time before we know if does. But there’s a clue to another capital reason for its slow adoption which is to be found in the failure of cryonics to attract much enthusiasm or activism within its own ranks. Why is this?

I believe a central reason for this failure is that cryonics, even as it is currently configured and accepted by those who embrace it, performs dismally. Everyone seriously involved with cryonics is painfully aware, either consciously or subconsciously, that cryonics is at least a two tier lottery. Sure, everyone knows that we’re taking a “chance” on being recovered in the future by being cryopreserved in the first place. But to even get to that round of the lottery, you have to get cryopreserved, and it would seem material whether or not you are cryopreserved well.

For some, perhaps cryonics is a ritual exercise. As long as there are remains, a freezer, someone to take the money and hang picture on the wall, then you have a chance; and all chances are created equal. Their position seems to be same as that of the millions of lottery ticket holders before the winning number is announced: we all have the same chance at the prize. If that’s your attitude, you can stop reading this right now, there’s nothing more here to interest you – not even in terms of idle entertainment value, because this discussion, from here on out is deadly serious, and brass tacks practical.

 Figure 1: The autopsy rate has declined by half in the United State between 1972 and 2007, although it has shown a slight increase since these data were collected. Source: http://www.cdc.gov/nchs/data/databriefs/db67.pdf

As Figure 1 shows, the autopsy rate, which can serve as the ultimate, population wide indicator of a very bad cryopreservation,  constituted 8.5% of all deaths in 2007. That percentage has risen slightly since then and is now at ~ 9%. The situation isn’t quite as grim as it might first appear if you break down the reasons for autopsy and note that 55.4% of autopsies were conducted as a result of deaths due to “external causes,” which means suicide, accident or homicide. If you think you are in a “lower risk” category for these, you may  be right, in which your case your risk may be fractionally smaller. And of course, not all of these autopsies were state mandated: some were requested by the next of kin, or even the decedents themselves. Still, 9% seems a reasonable, overall unavoidable loss number currently confronting cryonicists given the culture we inhabit.

Figure 2: Since the first man was cryopreserved in 1967, the demographics of autopsy have shifted increasingly from the aged to those in younger population cohorts. Source: http://www.cdc.gov/nchs/data/databriefs/db67.pdf

If the age distribution of autopsies in the US is examined, the picture gets even more uplifting if you are, or you expect to live in into old age (which is, incidentally, medically defined as 65 years of age, or older). In this age group, the incidence of autopsy has declined dramatically from 37% of all postmortems since 1972,  near the time cryonics began, to only 17% as of 2007.

However autopsy is only one of a number of factors that can and do interfere with  cryonicists achieving “good,” or even “acceptable,”  (forget  ideal), cryopreservations. The other three factors which loom large are sudden cardiac arrest (SCA), unexpected death (UD, which is different than SCA) and brain destroying diseases ( BDDs, or dementias). While Alzheimer’s Disease is the most common of the BDDs, there are others such as Pick’s, Lewy Body, Parkinson’s and the vascular dementias, which together account for 20-30% of all age-associated BDDs.

Brain Destroying Diseases (Dementias)

Autopsy is only one of a number of factors that can and do interfere with  cryonicists achieving “good,” or even “acceptable,”  (forget  ideal), cryopreservations. The other three factors which loom large are sudden cardiac arrest (SCA), unexpected death (UD, which is different than SCA) and brain destroying diseases (BDDs).

 Figure 3: Incidence of dementias as a percentage of all cause mortality in males, females and the United States population as a whole. Prepared from data in the National Vital Statistics Report Volume 59, Number 10 December 7, 2011Deaths: Final Data for 2008: 2008http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_10.pdf

 Currently, the BDDs in aggregate (including catastrophic stroke) account for ~3.2% of all deaths in the US (Figure 3). However, insofar as cryonicists are concerned, this number is likely to be misleadingly low, because most cryonicists enter cryopreservation at or after age 65, the point at which the incidence of BDDs begin to climb exponentially. (Evans DA, 1990) This number is expected to, and in fact is exploding as a consequence of both the demographic shift due to an aging population in the West and increasingly longer life spans (Figure 4).

 Figure 4: The large increase in Alzheimer’s Disease as a cause of death in the United States is largely a function of the increasing average age of the population and the survival of many additional individuals into advanced old age. Source: http://www.alz.org/downloads/Facts_Figures_2012.pdf

 

 Figure 5: A breakdown of dementias by type shows that Alzheimer’s Disease accounts for 47% of the total as the sole cause of the dementia and is a major contributing factor in another 28% making it by far the most common pathological mechanism in play as the cause of dementia in the elderly.  [S. Seshadri, S, Wolf, PA, Beiser, A,  Au, RU, McNulty, K, White,R, et al. Lifetime risk of dementia and Alzheimer's disease: The impact of mortality on risk estimates in the Framingham Study. Neurology, 49:1498-1504,1997.]

 Figure 6: Incidence of Alzheimer’s Disease by age cohort in the US population as of 1988.[ Evans D, et. al. Prevalence of Alzheimer' s Disease in a community population of older persons. JAMA, 262:18;2551-6, 1989.]

In the 74-84 age cohort, 19% of that population has AD (exclusive of other dementias) and in those individuals over the age of 85, the diagnosed incidence is 47%. These numbers are almost certainly low, because many of the elderly are who are institutionalized for falls, or other issues not ostensibly related to primary brain disease, go on to develop brain disease in an institutional setting and ultimately have listed as their causes of death, pneumonia, urosespsis, sepsis  secondary to decubitus ulcers, or other causes that escape epidemiological surveillance for AD. Currently, AD is responsible for 2.8% of deaths in white males men aged 65  or older and 4.7% of white males who are 85 years of age, or older. These numbers are expected to triple by the year 2050.

 Figure 7: The incidence of Alzheimer’s Disease rises roughly exponentially with age such that over 1,100 people out of 100,000 aged 86 or older have the disease.

When cryonics was launched in the mid-1960s the problem of BDDs as a threat to the workability of cryonics was not even considered.  In 1967, the year the first man was cryopreserved, the average life expectancy in the US was ~70 years and the problem of dementias was a fraction of what it currently is.  Additionally, comparatively little was known about the pathophysiology of the BDDs at that time, and there was little or no awareness within the cryonics community of their potential to degrade or altogether destroy personal identity, perhaps even years in advance of the pronouncement of medico-legal death. The problem of BDDs and of age-associated destruction of the brain is arguably the foremost biomedical obstacle confronting cryonics in the long term, and it is for this reason that I will return to this topic again later in this article in the context of discussing its early detection, with a brief discussion of treatment, and ultimately, definitive interventions to halt and reverse it.

Figure 8: The Siemens Biograph mCT PET is a positron emission tomography/computed tomography (PET•CT) scanner that enables precise measurement of metabolic processes and data quantification, including the assessment of neurological disease and malignant tissues (resolution and molecular characterization of neoplasms as small 3 mm in diameter). The device can provide quantitative measurements of brain beta amyloid protein burden.

For now, I will note that because AD is by far the most common of the BDDs and because it has a unique pathophysiological feature, a remarkable advance in early diagnosis via noninvasive  computerized tomography (CT) and positron emission tomography (PET) imaging has recently become clinical available. Beta amyloid is the protein found in the plaques characteristic of AD, and there has been intensive research over the past decade to identify radiolabeled tracer compounds that will safely cross the blood brain barrier (BBB) and bind to both beta amyloid and tau proteins. (Barrio 2008), (Black, 2004)  In February of this year, the US FDA approved the Siemens Biograph mCT, a positron emission tomography-computed tomography (PET-CT) scanner capable of not only detecting, but of quantifying  amyloid in the brain. The Biograph mCT has been very well received, and within the space of a few months the machines have appeared in most major cities in the US. The Biograph mCT in conjunction with the recently developed FDDNP, (2-(1-6-[(2-[F-18] fluoroethyl)(methyl)amino]-2-naphthylethylidene) malonitrile) tracer allows for calculation of total brain amyloid burden (Wang, 2004) and visualization of discrete amyloid containing lesions as small as ~ 3 mm in diameter (tracers for tau protein, the other primary pathological protein in AD are currently in the pipeline for FDA approval).

 Figure 9: Top: PET scan of beta amyloid deposits in the brain of a patient with early moderate Alzheimer’s disease appear in red in the image above. The beta amyloid deposits are concentrated, as expected, in the frontal and prefrontal cortices as well as in the hippocampus. Bottom: Beta amyloid distribution in the brain of a patient with early moderate AD (L) versus normal control (R). One important consequence of this imaging is the growing realization of the global range of AD’s impact on the brain. As recently as a decade ago it was believed that the destruction of brain tissues was confined largely to the hippocampus and the prefrontal cortex, especially early in the disease. It is now understood that the histological destruction of AD is widespread and that during the end-stage of the disease few if any areas can be expected to be spared.

Very early detection of AD may turn out to be critical to achieving effective treatment, or even slowing progression of the disease, since significant beta amyloid and tau deposition seem to promote ongoing inflammation and interfere with putative therapeutic drugs. A good example of this is the recent fate (Vellas, 2010) of the investigational drug  tarenflurbil ((R)-flurbiprofen ) which inhibits gamma-secretase, the enzyme that produces beta amyloid AB-42, the species of beta-amyloid that forms fibrillary plaques. (Black, 2008) Unfortunately, the drug does nothing to remove existing existing AB42 deposits, which presumably continue to exert their neuron killing and pro-inflammatory actions.

(R)-flurbiprofen is highly effective in animal models of very early AD and the drug showed significant promise in Phase I & II clinical trials. However, development of (R)-flurbiprofen was dropped when it became apparent in Phase III trials that the drug would likely only be effective in a clinical setting if it its administration was begun before clinical signs of AD developed; in other words, when beta amyloid levels were very low and would be detectable only by testing cerebrospinal fluid or, now with sensitive CT molecular imaging techniques involving the screening of subpopulations of healthy individuals at risk.

This kind of effort and application of technology and pharmacotherapy may not profitable for pharmaceutical companies, but that does not mean that it would be be worthwhile for us cryonicists. (R)-flurbiprofen  is a close chemical relative of the OTC NSAID ibuprofen and it is a metabolite of the prescription NSAID flubiprofen.  (R)-flurbiprofen  is an enantiomer of flurbiprofen (~ 5%  of (L) flubiprofen is metabolized into (R) flubiprofen by the liver after ingestion) which is completely inactive as  a COX inhibitor, and is thereby free of the anti-COX side effects associated with NSAIDS.  Despite it’s lack of both COX-I and COX-II activity, the drug does have strong anti-inflammatory activity by acting through inhibition of NF-κB and AP-1 activation pathways, and this may provide added benefit in controlling the inflammatory processes associated with AD. (Tegeder, 2001)  As an interesting aside,  (R)-Flurbiprofen has also been shown to suppress prostate tumor cells by inducing p75NTR protein expression. (Quann, 2007)

(R)-Flurbiprofen is an example of a drug with considerable therapeutic potential that will almost certainly not see clinical application due to the high cost associated with regulatory burden and the logistical hurdle of needing to start therapy years before symptoms of AD manifest themselves. (R)-Flurbiprofen might also conceivably be useful as combination therapy with  the already FDA approved skin cancer drug bexarotene (Targretin), an antineoplastic, which has been shown to reverse beta amyloid deposition in a rodent model of AD as well as to improve cognitive function. Targretin rapidly cleared beta amyloid from the brains of animals in a variety of models of AD (<2 months) and while it is not a cytotoxic chemotherapeutic agent, the drug has sufficient adverse effects that it would be problematic to administer over a period of years or decades. A combination of short term therapy with Targretin to remove beta amyloid, followed by long term administration of (R)-Flurbiprofen is a possible treatment strategy that would seem attractive to explore. The ability to dynamically monitor beta amyloid levels in the brains of patients undergoing such novel therapeutic regimens, especially outside the confines of the medical-industrial establishment, is yet another advantage of this evolving singularity in medical imaging.

End of Part 1

 

 

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When a Singularity Bites You in the Ass

 How to avoid autopsy and long ‘down-time’

(ischemia) ~85% of the time!

By Mike Darwin

 

Foreplay

It has taken me roughly 30 years to learn that having the technological capability to achieve some marvelous end is only a small part of the battle to actually achieving it.  This is profoundly true in the world of biology and medicine because, unlike as was the case with “free speech” and “private life,” there was no Martin Luther and no Thomas Paine to definitively divorce these areas of human endeavor from the grasp of the religious moralists, the secular ethicists, and the social busybodies of the earth. The life sciences have yet to have their Martin Luther’s 95 theses nailed to the doors of the places in which this culture’s moral tyrants currently reside. The separation of Church from private life which began with Luther, and of private life from state, which began with the Magna Carta and the US Declaration of Independence, could take us only so far.

Now, we are in an interesting place and time, because never before have potentially lifesaving technologies been being generated at such a phenomenal rate. And yet, they remain outside our grasp as surely and solidly as if there were an impenetrable Prespex wall between them and us. We can look, but we can’t touch.

Beyond our physical inability – or seeming physical inability – to access those lifesaving capabilities, we also pay a heavy price in a different way. Our vision and perspective becomes warped. We literally become unable to see how we might help ourselves, because we have been conditioned to be dis-empowered. We lose the ability to think outside the box and we begin endlessly replaying the failed or marginal strategies that the existing system does allow us to pursue.

However, a close look at our predicament will reveal that that Perspex wall works mostly for the masses – for them – and not for us. If we are careful and clever, we can reach through it and extract much of the technological benefit sitting there. We can do this, but they can’t. Once we understand that, it has the potential to change our perspective on everything in terms of our chances for survival, and for our chances of living productively and in comfort, while much of the rest of world may well pursue a very different path.

That’s what this article, and the ones that follow it, are about. This article is preparatory, it’s a kind of foreplay to prepare you for the powerful penetration of the ideas that are to follow.

Of  Singularities & Hams

Figure 1: Jamón ibérico de bellota is a gourmet ham made from black Iberian pigs fed only acorns during the months prior to their slaughter.

 The first few times it happened, I hardly noticed, and I can’t remember the specifics. But when it really began to annoy me I can  remember, quite clearly, perhaps because I was already in a foul mood and the surroundings were extraordinary. We had been taken out earlier in the day to see the pigs from which the jamón ibérico de bellota is made. The vile, dusty, slobbering and altogether horrid beasts are fed nothing but acorns so that their flesh is rendered especially succulent and flavorful after elaborate smoking and aging. They were moving about with indifferent belligerence, unaware that their kin were to  be on the supper menu late that afternoon. The visit to their quarters made me thankful I did not eat land vertebrates and reminded me uncomfortably of some of my compadres at the Hacienda; the several “Mr. Bigs” who had gathered to discuss the creation of a new cryonics enterprise.

As we sat down to dinner in the courtyard of the Hacienda that evening, I was seated at a table with several middle aged cryonicists and two older ones, (sadly, including myself). It wasn’t long before I was bombarded with the question I would soon find irritating, and eventually come to loathe: “Have you had genomics testing done?”

Figure 2: The courtyard of the Hacienda where my dinner companions assailed me over my lack of diligence in having my genotype analyzed to determine my disease risks.

“And why would I have that done, I asked?” My questioner, an enthusiastic thirty-something, leaned forward a bit and explained to me how rapidly the cost of sequencing DNA base pairs was dropping, and that it was now possible to tell all kinds of things about an individual’s risk for diseases by genotypic analysis.

“It costs only  $200 US; I just had mine done.”

Others began to chime in. Since it was an international crowd, the stories were fascinating and I was content to listen. Some had discovered they had Neanderthal lineage, others had discovered less exotic, but no less unexpected genetic heritage. Finally, the conversation returned to me, the apparent elder statesman and, presumably, the example setting cryonicist at the table: why hadn’t I had my genotype evaluated, and much more importantly, why didn’t I have any plans to do so?

“Look, ” I said, “I think genomics  technology is going to be incredibly valuable. I think its most immediate value is going to be in pharmacogenomics – in determining which drugs work for which individual people and which drugs don’t work, or are actually dangerous for given individuals. A bit later, this technology will likely have real prognostic value. But not now, and not for me. I’m in my early-50s. My relatives are already sick, dying or dead of illnesses that are genetically mediated. I know what my genetic risks are. In fact, from my family history alone, I’ve known what those risks are for roughly 20 years now. Both my parents are now in their 80s, and I have a very good idea of what they are going to die of. And if they don’t die of those things, well, it will be from an accident, an infection or something not likely to be readable in the tea leaves of my genome.

 Figure 3: The Hacienda on the arid Spanish countryside outside Madrid where we took our repast and discussed singularities, past, present and future.

Interestingly, my parents have had every single disease that has also killed their parents, their aunts and their uncles: cancer, hypertension, atherosclerosis, alcoholism, type II diabetes, and Alzheimer’s Disease (AD). I’m pretty sure that AD is going to claim my mother’s life, and I’d say it is probably down to atherosclerosis, and possibly cancer or emphysema, in the case of my father. With the help of modern medicine, my folks have so far dodged all of the other genetically mediated bullets that have been shot at them. So, I know my genetic risks  (and to those I’d add the risk of some peculiar autoimmune diseases in late life are present in my maternal bloodline).

But by far my biggest risks, which would not yet (to my knowledge) show up on any genotypic test are Bipolar-2 Disorder and homosexuality, both of which have a devastating impact on longevity, dramatically increasing the risk of a broad range of pathologies, including cardiovascular disease, cancer, dementia, substance abuse, other mental illness, and all cause mortality. My point is that in most cases where genes influence destiny, you’re best clue is the evolved or evolving fate of your kin – unless you are an anonymous orphan, that is.”

Still, they wouldn’t give up. The implication was that I must have genomic testing. And, truth to tell, I had, and have, no objection to it. It’s not like I am opposed on religious grounds, as if it were fortune telling. “In fact, I think it’s a nifty conversation piece and personally interesting in the bargain. It’s just that I’d have a lot higher priority uses for my $200 in terms of the dramatic medical advantages it could buy me as a cryonicist, if I had $200 to spend on such things! It would make a wonderful Newton Day gift, the kind of thing you’d like, but would never buy for yourself.”

Now that, that statement really set them off! I had thrown gasoline on a fire. Didn’t I know that the exponential decrease in the cost of DNA sequencing constituted a Singularity in biomedicine, one that was, even as were sitting there that very moment, revolutionizing medicine? “Sure.” I said, “But  there are singularities happening all the time. The thing is, most singularities in medicine unfold over a period of decades, and very few individual patients gain benefit from them on the basis of special, unique, or insider knowledge.”

But, I had lost them. They were having none of it, and I wouldn’t be the least bit surprised if I’ve lost you as well. I was irritated and frustrated and I had already lost my temper badly earlier that day. So, I decided to bite my tongue and proceed in relative silence with the rest of the meal. But what I really wanted to say to those gentleman was that, “you wouldn’t know what to do if a medical singularity were to come right up here and bite you in the ass, because it already has!”

One of the (many) reasons the meeting had crumbled was the intransigence of one of the Mr. Bigs, who wanted cryonics with the stipulation that there be essentially no ischemic time. He had his approach to solving the problem which was, well, this meeting was some years ago, and I wonder if Mr. Big is still alive?

It was a strange situation. Mr. Big was clearly not a well man and he knew this to be the case. What I suggested was straightforward, involved nothing either exotic nor illegal and was something that I knew would work, based on the sorry experience of seeing it not work with men exactly like him. I tried to explain to Mr. Big that it was now possible to “simply” look inside of him, from top to bottom, and get a fairly accurate assessment of what his risks were for deanimating in the near future. Given his medical history, which he shared with me,  I also suggested that he have a condition treated which would, probably sooner rather than later, cost him his life, or leave him profoundly disabled. He was having none of that, either!

Instead, a few hours later, here we were seated together at dinner and Mr. Big was extolling the virtues of genomic testing as a way of avoiding premature cryopreservation-  to me.  A true, nearly unalloyed medical singularity had arrived for cryonicists, and for the previous two days they had snuffled and shuffled around each other with same indifferent belligerence of the hogs in the pen nearby who were awaiting their conversion to jamón and their journey away from the Hacienda in someone’s belly. It is at moments like this, which come with increasing frequency, that I sneak a quick look out of the corners of my eyes to see if I can catch a glimpse of some dimple or ripple in the fabric of reality that will clue me into the fact that my life has really been just a joke in very poor taste  – on me.

I’ve struggled mightily with how to effectively communicate the idea that for cryonicists, a singularity of truly incredible magnitude has arrived and that it is one which, in theory, should be available for use by us now. I’m reasonably sure I’ll fail in that task and that no matter how I might have framed the argument, or presented the evidence, the outcome will remain the same. And therein probably lies yet another powerful lesson about why Singularities, wherein everything is transformed in the blink of an eye, never really happen.

How ‘Fast’ are Most Medical Singularities?

Medicine, ironically  much more so than entertainment or warfare, is bound up with the sensitive issues of ethics and morality, which have historically complicated and often slowed the propagation of paradigm changing, or so called “singularity events” within its confines.  Vaccination, contraception, anesthesia, organ transplantation, mechanical life support, resuscitation medicine, in vitro fertilization and embryo and gamete cryopreservation have all been slowed or blocked altogether as a result of religious or ethical concerns. (1,2,3) Indeed, surf the net or turn on TV today and you will see hordes of angry people decrying vaccination, contraception, and arguing furiously over life support. Support for vaccination, ~212 years after Jenner, is even eroding in the nation that spawned it!

The idea that wound infections – sepsis – were caused by a contact-transmissible agent was definitely proved by 1848, in the form of the exhaustive statistical work documenting the effectiveness of antisepsis conducted by Semmelweis. By 1860, the theoretical grounding for the basis of that transmissible agent, germ theory, was in place. Scattered throughout Europe there were a few men who understood the new paradigm and could no doubt foresee many of its practical implications in medicine. These men must have been as frustrated as cryonicists in the middle of this last( 20th) century – men like Pasteur and Koch. If ever there was a singularity in medicine, this was it. And yet, what happened?

Figure 4: President (then General) Robert E. Lee of the Confederate States of America receiving his critical Magic Lantern briefing on the revolutionary, but heretofore unappreciated work of the Hungarian physician Dr. Ignaz Phillip Semmelweis, concerning the importance of antisepsis for the control of infections in battlefield and surgical wounds. The information proved of a vital strategic advantage in helping the Confederacy to successfully prosecute the war against Union forces. Lee is seen here in the sitting room of his home in Arlington, Virginia in this classic painting by John Elder.

Perhaps it might be more instructive if we ask ourselves what should have happened according to the Singulatarian, or even according to the “popular” model of how  powerful, beneficial ideas with virtually no downsides spread through the culture. For instance, one of the most popular “what if” questions in the realm of alternate history is, what if this or that had been different that would have altered the outcome of the United States Civil War?(4) Military historians all have their favorite “what ifs” in this regard, but mine, well mine wouldn’t be military at all, but would come down to a long, drawn out Magic Lantern (PowerPoint) presentation given to a very receptive General Robert E. Lee, on the eve of the Secession. The subject of that presentation would be the revolutionary findings of two maverick Europeans; Dr. Ignaz Philipp Semmelweis, and  Dr. Louis Pasteur, as they apply to battlefield medicine and the recovery and survival of injured troops in the conflict to come.  The Confederacy lost the war for many reasons, but in the end it came down to a lack of manpower and the disproportionately draining and depressing effect that combat related sepsis had on the South. [At least, that's my story and I'm sticking to it ;-).]

Lee would listen, his military surgeons would be briefed on the Confederacy’s “secret weapon” and the tide of history would be turned. Wild and playful imaginings? Yes, but they constitute a considerably more reasonable scenario for the rapid adoption of asepsis in the US (or even half of it!) than just about any other you are likely to come up with, because the reality of what happened is almost incomprehensibly tragic.

Figure 5: In his magnificent painting entitled The Gross Clinic, Thomas Eakins graphically captures the state of surgery in the US during the decades following the US Civil War. These grotesquely unsanitary conditions had by this time to a large extent become a thing of the past in surgical theaters through much of Europe.

Figure 6: Even 14 years later, when Eakins revisits the them of the operating theater in his painting The Agnew Clinic, full adoption of asespsis and antisepsis had not occurred in the US.

Semmelweis’ work had already been published and disseminated around Europe by 1848, and by 1861, the year the American Civil War was opening, Lister was reprising Semmelweis’ discovery of antisepsis in Scotland, not with chlorine, but with carbolic acid. The sad reality was that the Americans (North and South) were so pigheaded regarding germ theory and the value of asepsis and antisepsis to medicine, that it would not be until well into the 19th century before that particular singularity fully took hold of the United States.(5)

Indeed, Lister made an “evangelical” tour of US medical schools in 1876 to little avail.(6)  Whilst the Listerian revolution was well underway in Europe by then, the situation in the US was to remain, as it was so vividly portrayed by Thomas Eakins in his magnificent oil, The Gross Clinic, which was painted the year before Lister’s missionary visit to the germ loving heathens across the pond. Fourteen years later, when Eakins painted The Agnew Clinic, we can see the beginnings of asepsis just starting to take root in the form of basic cleanliness being imposed in theatre. Clearly, antisepsis/asepsis are an example of a technological singularity in medicine, albeit one that took onto a century to fully unfold!

The Problem of Bite Back

But beyond these arguably irrational roadblocks slowing the progress of technological singularities in medicine, there are two others: the very real problems of their rational management on both the macro and the individual (patient) scale.

Figure 5: Edward Tenner’s excellent book, Why Things Bite Back explores many examples and a number of reasons why technological advances often fail to reach their expected potential, and in fact, not infrequently turn out to be self limiting, or even self defeating.

Some of the technological singularities just listed, vaccination, for instance, can have very serious practical, economic and societal consequences. Rapid and widespread introduction of vaccination into equatorial Africa by Christian missionaries, absent the concurrent introduction of agricultural and other infrastructure, resulted in a population explosion and mass famine which has not abated to this day. Oral contraception has resulted in huge demographic and social changes occurring within a single human generation; a heretofore unprecedented event in the history of our species.

While medical advances are usually perceived as an unalloyed good for the patients who will benefit from them, this is rarely, if ever the case. The discovery of x-rays opened the interior of the human body to non-invasive examination, but it also exposed the patients so viewed to initially unsuspected exposure to damaging radiation – a problem that persists in radiologic medicine through the present. Beyond the problem of unforeseen or unknown dangers, there is also the problem of technological bite back, or what Edward Tenner has called the “revenge of unintended consequences.”(7) This is a major adverse effect of technological singularities, and one which often robs them of much of their anticipated bounty – not just for societies, but for individuals as well.

As I’ve just pointed out,  new medical technologies are sharply constrained in their utility at their start due to our inexperience with their bite back potential, and with the possibility of unknown  direct adverse affects of the technology  itself. However, every great once in awhile there are peculiar exceptions, and it just so happens that cryonicists are ideally positioned to enjoy just such an exception, starting now.

References

1. Fasouliotis, Sozos J, Schenker, Joseph G, TI, Cryopreservation of embryos: Medical, ethical, and legal issues. Journal of Assisted Reproduction and Genetics. 13:10 56-76;1996.

2. Simmons , RG, Fulton , J, Fulton, RF. The Prospective Organ Transplant Donor: Problems and Prospects of Medical Innovation. OMEGA–Journal of Death and Dying. 3:4;319-339:1972

3. Carrell. JL, The Speckled Monster: A Historical Tale of Battling the Smallpox Epidemic, Dutton, 2003, ISBN-10: 0525947361.

4. McKinlay, Kantor, If The South Had Won The Civil War, Forge Books, 2001, ISBN-10: 0312869495.

5. Murphy, FP, “Ignaz Philipp Semmelweis (1818–1865): An Annotated Bibliography,” Bulletin of the History of Medicine 20(1946), 653-707: 654f.

6. Herr, HWJ, Ignorance is bliss: the Listerian revolution and  the education of American surgeons. Urology;177:457-60,2007.

7. Tenner, EW, Why Things Bite Back: The Revenge of Unintended Consequences, Vintage, 1997, ISBN-10: 0679747567.

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