X-Message-Number: 2520
Date: 07 Jan 94 04:43:29 EST
From: Mike Darwin <>
Subject: SCI.CRYONICS The problem of cryonics
The Problem of Cryonics
by Mike Darwin
Thomas Donaldson in his Cryomsg #2512 has further opened an
already large wound on my hide, and one which has been festering for
some years now. The wound I refer to is the problem of cryonics and
research. I wish to start out by echoing most of what Thomas has said.
As one (of the VERY few) who has done and IS actually doing research to
improve human cryopreservation , and as someone with a long history of
involvement in cryonics I feel uniquely qualified to comment on Thomas'
remarks.
Much like Thomas I have, over the years, come to realize that the
criticism some professional cryobiologists have leveled at cryonics has
some powerful truth to it, and that we had best pay attention. I will
in fact spend a fair amount of time here criticizing cryonics myself.
In fact, so strong has my feeling become that I now try to avoid using
the word cryonics as much as I can and I no longer use the words cryonic
suspension to describe the act of cryopreserving legally dead people.
Before I get down to the criticism I have of cryonics and to the
positive things that I think can and should be done to address them, I
would like to provide a little history about the two broad approaches to
cryonics that have existed almost since its inception.
The very first cryonics organizations (LES and CSNY) espoused
what I will call Approach A. Approach A emphasized the importance of
research to improve and ultimately perfect human cryopreservation and
emphasized cryonics (freezing people with today's crude techniques) as
a long-shot with at best unknown chances of success. Approach A is best
characterized by a statement made during its inception: "Being frozen is
the SECOND worse thing that can happen to you." Approach A focused on
hard work and real-time progress towards suspended animation with the
goal being implementation and integration of human cryopreservation with
medicine and with the society as a whole.
Approach B came fast on the heels of Approach A. Approach B
emphasized the capabilities of the future to carry out repair, the
current evidence that cryopreservation techniques were achieving good
preservation (usually through irrelevant and often misleading tangential
cryobiological research), and focused on public relations, impressive
*appearing* physical plants, and membership/customer recruitment as the
primary answer to cryonics' problems. This is not to say that Approach
B did not want to see cryobiological research done. By all means they
wanted to SEE it done (which is quite distinct from wanting to DO it).
Approach B is best characterized by the statement: "I don't worry about
the extra damage caused by lack of access to the Chamberlains' perfusion
technology; our friends of the future will be able to fix those
problems,the important thing to consider now is the well-being of CSC."
Approach B relies heavily on "Our Friends of the Future" to solve all
our problems. (That quote, incidentally, is from Robert F. Nelson,
former President of the Cryonics Society of California, which let all
its patients thaw out and decompose.)
When we started in cryonics 30 years ago (1994 is the 30th
anniversary of the publication of Ettinger's THE PROSPECT OF
IMMORTALITY) we started with both Approaches having one fundamental
thing in common: an unproved assumption. This assumption being that
(relatively) prolonged periods of global cerebral ischemia followed by
cryoprotective perfusion and freezing to dry ice or liquid nitrogen
temperature are compatible with the recoverability (i.e., survival) of
human beings so treated.
We felt and feel compelled to apply this treatment NOW because we
have no other better alternative and because the stakes are VERY high
(the otherwise certain loss of lives which are valuable to us, sometimes
including our own!). What we then did was to subject our hypothesis
that this approach might work to VIGOROUS internal and external
scrutiny. There have been nearly 30 years of such scrutiny and few if
any pieces of evidence put forth which argue compellingly AGAINST
human cryopreservation have surfaced during this interval. However,
this does NOT mean that it will work, only that good and SPECIFIC
reasons WHY it will NOT work have not yet been put forth.
* Frankly this is not much to go on (it is, after all, a trying
task to disprove a negative!). * Such reasons may be put forth
tomorrow, or the day after, in which case we have all been "wasting" our
time and if we are wise will go elsewhere in our attempt to remain
alive.
The difference between those practicing Approach A and those
practicing Approach B is that those of us in the Approach A camp did
not stop there. We then went on to take our theoretical speculations
about the best approach to implementing human cryopreservation and try
them out in the laboratory and get feedback. We've cryopreserved cats,
rabbits, and dogs using the same techniques applied to humans and
sought to determine whether or not we are preserving the structures
which neuroscientists tell us are likely to be important to identity.
Where possible we have used viable (i.e., real-time recoverable) models
wherein dogs are recovered alive to determine the efficacy of the front-
end (reversible) part of our procedure. And lastly, but by no means
least importantly, we have sought feedback from the patients themselves
in the form of laboratory evaluations, clinical observations and, where
practical, gross anatomical, ultrastructural and histological
evaluations.
Frankly, I have found the results of most of these studies to be
discouraging and am working hard to try to improve the degree of
preservation we achieve. But the point is that those of us practicing
Approach A are (the best of us) *seeking feedback*. We are also
evaluating new ideas such as new mixtures of cryoprotectants, cooling
rates, concentrations of protectants (up to and including vitrification)
using a rabbit brain slice model with histology and ultrastructure as
the endpoint.
(Lest I give the impression from the above that we have been a
beehive of research activity over the past 30 years let me disabuse you
of that notion at once. Comparatively little of the work that needs to
be done has been done. And the overall level of interest in the
cryonics "community" to rectifying this situation seems next to nil.)
In my opinion this is about the BEST we can do right now, short
of actually reviving someone. However, it is still far from good
enough. And because there is no universally agreed upon gold standard
of results (since the best one, the patient waking up and letting us
evaluate how s/he is , is not yet do-able) there is room for much
useless and destructive speculative fooling around with the
cryopreservation protocol (and thus with the patient!). This has caused
many human cryopreservation patients to be subjected to protocols of
treatment which are KNOWN to be unnecessarily injurious by the criteria
we use in undertaking human cryopreservation in the first place
(minimizing histological , ultrastructrual, and biochemical disruption).
It has also lead to a willingness to make compromises to the care of
individual patients in order to serve the interests of the group (i.e.,
lets not rock the boat: we'll let this guy have 10, 20, 30 minutes, and
hour of ischemia so we don't risk the wrath of the hospital, the
Coroner, the Medical Examiner, etc, or this patient's suspension
threatens everything, so why don't we thaw her out and get the
government, relatives, etc. off our backs because we have the OTHER
patients and OURSELVES to think of).
It doesn't take a genius to realize that most of the PROBLEMS that
lead to compromise of the individuals' well being to that of the group's
well being stem from the fact that the practice of cryopreserving "dead"
people is completely OUTSIDE of the existing medical and social milieu.
AND WHAT IS MORE, IT WILL REMAIN OUTSIDE OF SUCH ACCEPTANCE UNTIL
REVERSIBLE, VIABILITY PRESERVING , CRYOPRESERVATION (i.e., SUSPENDED
ANIMATION) IS ACHIEVED.
So where does this leave us? It leaves us with some sobering
realizationsm, not the least of which is that until we get to the GOOD
SCIENCE of the "gold standard kind" (resuscitation) we are all of us
taking some hellacious risks. This is acceptable WHEN THERE IS NO OTHER
ALTERNATIVE AND THERE IS MUCH TO LOOSE, AND IN PARTICULAR, WHERE WE ARE
UNLIKELY TO DO MORE HARM (After all, the patient is already "dead" by
current criteria and has been quite completely abandoned by his/her
medicine).
And this brings me to my second major point: the issue of not
doing harm. When I first got involved in cryonics it all seemed so
simple. It was such a logical, compelling idea and it seemed so
COMPLETELY GOOD. Twenty-five years of involvement have sobered my 13-
year old's perspective considerably. Application of cryopreservation
to legally dead people NOW has MANY implications and effects and, as I
have observed first hand, much opportunity to cause harm if not to the
patient AFTER legal death, then certainly to the patient BEFORE and
during legal death; and just as certainly to those who survive the
patient in the form of his/her family and friends, the cryopreservation
organization's personnel, the society, and so on. I will list just a
few of the kinds of "harm" I have observed cryonics to have caused as
it is currently practiced :
* Patients have been kept alive or resuscitated from deep shock (and
accompanying merciful unconsciousness) to experience days, or in some
cases weeks, of painful (even agonizing) low quality life in order to
facilitate suspension.
* There is lack of closure for the relatives, loved ones, and friends
of the suspended: they must continue to worry and often take action and
spend money to insure the continued good care of their loved one(s) in
suspension:
Always there is a background of concern and anxiety: what about the
financial security of the cryopreservation organization?, what about
earthquakes?, economic upheaval?, vandalism?, etc. This ongoing
concern/anxiety (and at its worst, naked fear) constitutes a real cost
often not perceived by anyone in their early (pre cryopreservation)
stages of involvement. Even a noncryonicist relative has some burden to
bear since they can (and often do) experience anxiety about mishandling
of their loved one's remains (thawing/decomposition, public scandal, and
so on) as well as invasion of privacy and disruption of the normal
familial relationships during the dying process which is occasioned by
the presence of cryopreservation personnel, equipment, etc. at the
deathbed; whether in the home or acute or extended care facility.
(Given the past history of cryonics these concerns cannot be called
altogether inappropriate.)
* There is present lost value to life in terms of moneys out-the-door
for dues, insurance payments, and so on, which now amount to on average
over 1K per year per person for many cryonics organizations. While it
can be argued that this money buys real-time peace of mind, it can also
be argued that it buys a lot of real-time heartache and anxiety (see
below). A related financial issue is that cryonicists may leave family
members who are dependent upon them poorly provided for (in order to
facilitate their suspension) or they may tap into assets or cause
survivors to do so in ways financially harmful to the family. I have
personally witnessed this happen several times and it has been very
distressing to me.
*There is also anxiety and altered behavior (refusing to fly in
airplanes, engage in sporting activities, travel abroad etc.) as
individuals seek to maximize their chances of being suspended under good
circumstances or being suspended at all. This extends to things like
having to forego experimental medical treatments because involvement in
cryonics would be a disqualifier or the travel that would make
suspension problematic. There is often agonizing over these issues and
what the right choice to make is...
* There is the shame and decreased social esteem that *some* people feel
as a result of having made cryopreservation arrangements (and I
emphasize SOME here because this attitude does not in my experience
characterize how most cryonicists feel; but it is a commonplace feeling)
Some respond to this by keeping their arrangements a secret, a practice
which has to have a deeper psychological cost , completely apart from
the energy required to maintain the subterfuge.
* The ENORMOUS personal and financial costs experienced by
cryopreservation organizations' staff, and caring family and friends
during the terminal phases of the patient's illness with death looking
imminent, followed by recovery, followed by crisis, followed by rally --
all the while triggering standbys and costing everyone tremendous
emotional and physical energy, not to mention money!
*Finally, there is the cost that the society as a whole bears as a
result of court system actions and extra charges to Medicare/Medicaid as
a result of application of premortem therapies to facilitate optimum
cryopreservation: these range from extending the dying process to allow
the timely arrival of a transport team to prescription of
medications/laboratory evaluations to improve suspension or more
accurately determine when legal death will occur, to legal actions to
determine the rights/limitations of cryopreservation organizations and
the individuals they serve as well as those of the next-of-kin.
What I am saying here is that over my 25-year-long career in human
cryopreservation I have come to appreciate that "cryonics" is not a
"no-load" undertaking and that the cost in both human and financial
terms is far, far higher than I though it would be 25 years ago. This
has caused me to shift my priorities in important ways. For one, I
would feel a hell of a lot better about these costs if I could be SURE
that the treatment had a definite chance of working in the same sense
that I can be sure of a heart transplant or a shot of antibiotic
working: no certainties but a reasonable statistical base to go with!
It's more than a little hard to watch someone writhing in agony because
of actions you've taken to keep them alive when the outcome is as
pitifully uncertain as it now is.
What is more, I think that human cryopreservation would be
profoundly better off for such a change as well. About 25-30% of all
patients cryopreserved NOW (and for the foreseeable future) will be
treated under terrible conditions ( which will almost certainly render
them unrecoverable): they will be coroners cases, be autopsied, suffer
from ULTIMATELY IRREVERSIBLE degenerative brain disease before
suspension, use up their financial resources and not get suspended at
all, and on and on and on. Further, as I previously stated in this
essay, I have come to the almost unshakable conclusion that respect for
the rights of the cryopreserved will not occur until we can demonstrate
that they are viable or potentially viable using the same rigorous
techniques used in other areas of medicine and science. All the
lawsuits and lobbying in the meantime will largely amount to tilting at
windmills if the society as a whole, or the empowered segment of it,
does not recognize the viability of cryopreserved individuals. And
even those treated under the BEST of circumstances are still being
treated after considerable periods of ischemic insult and after much
unnecessary damage...
If only we had suspended animation for the brain or something
approaching it. Where I differ from many others in the so-called
"cryonics" community is that I believe that achieving this "if only" is
eminently do-able in real-time with the application of effort and money
sufficient to the task . And further, I believe that the amounts of
effort and money are not impossibly large or far removed from our
grasp. That is the goal I have chosen to work towards. In the meantime
I will continue to "freeze" people and to do it the best way I know how.
But I have considerably less enthusiasm for the undertaking than I once
had and considerably less personal interest as well. I think this shift
in perspective is an eminently sane and valid one. I have no objection
to freezing people under the conditions I have described above
(providing that the patient UNDERSTANDS what the known "side-effects"
are). *But I feel that to pursue that course without an EQUALLY (as a
minimum) firm commitment to solving the problem of "cryonics" by
developing reversible brain cryo (or other) preservation is a fool's
game and doomed to failure. And what is more, one that I want no part
of.*
And that IS my take home message here.
Finally, a word about the Approach B people. They haven't
gone away. In fact, in my opinion, they have come to dominate
cryonics. They have depersonalized Our Friends of the Future and
renamed them Nanotechnology: which is a lot more impressive sounding.
They trivialize the horrendous problems and shortcoming of today's
cryopreservation technology and speak SERIOUSLY of the possibility of
today's patients being revived in 30 to 50 years! Such foolishness does
a disservice to everyone interested in cryopreservation as a route to
survival and such overbearing optimism will in my opinion cause these
people to make decisions elsewhere in their program that will lead them
to to the same inevitable (and unenviable) end CSC experienced a decade
ago.
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