X-Message-Number: 29723
Date: Mon, 13 Aug 2007 14:48:18 -0400
From: 
Subject: Misconceptions Concerning the Handling of CI's 81st Patient

    I believe significant misinformation has been disseminated
about my role and the role of Suspended Animation in the
treatment of the 81st patient of the Cryonics Institute (CI).

     http://www.cryonics.org/reports/CI81.html

I want to correct some of this misinformation.

  I lost my appetite for chat groups well over a decade
ago when I realized how much time I could waste trying to
answer accusations. And that having answered some accusations
can lend support to the idea that not answering subsequent
accusations is a tacit admission of their truth. Some people
equate the search for truth with the search for dirt and will
only believe what appears to be evidence of deception, low motives
or incompetence. Things have become even more complicated for
me now that I find it so difficult to speak for myself rather
than for an organization -- having so many people trying to
censor me or put words in my mouth. With all these disclaimers,
I do know that sincere people read forums and that an
occasional attempt to correct misconceptions can be of great
value. I want to make an attempt at clarification while
disclaiming that the absence of further postings in reply
to subsequent accusations is an admission of guilt.

  The first issue I would like to address is the question
of whether the 81st patient received better care WITH
Suspended Animation (SA) than he would have received
WITHOUT SA. Note that this question is distinct from
the question of whether SA could be better than it is
or whether SA would have deployed more resources if the
patient had been fully funded. It is also distinct from
the question of how much medical training or what medical
credentials SA staff require to deliver basic cryonics
cool-down, CPS and related support.

  By the use of an ice bath, CardioPulmonary Support (CPS)
and an ATP the patient was cooled to below 10oC in about half
the time such cooling could have been achieved by a funeral
director using ice bags. Moreover, CPS during the cooling period
meant that tissues could remain viable in a way that would
not have been possible without CPS. Administration of
streptokinase, vasopressin and antioxidants in addition
to the usual heparin eliminated clots, increased
circulatory capacity and reduced oxidative damage. Blood
replacement with organ preservation solution in a timely
manner avoided reperfusion injury and reduced the cold
ischemic damage the patient would have suffered during
shipment in ice to CI's Michigan funeral home where
vitrification perfusion was performed.

  I have studied and written considerably on the subject of
ischemic damage to cryonics patients as, for example, in:

  http://www.benbest.com/cryonics/ischemia.html

  http://www.benbest.com/cryonics/IR_Damage.html

  For those who would trivialize the benefits of rapid
cooling achieved by the SA team I quote from the
cooling section of the latter article:

************** BEGIN QUOTE **********************************
Cooling of a cryonics patient with ice immediately following
pronouncement of death is the most frequently practiced
cryonics rescue procedure. It is commonly noted that metabolic
rate is halved for every 10oC drop in temperature. But the
reduction of lipid peroxidation by cooling is greater than
the reduction of metabolic rate. Experiments on gerbils
indicate that a drop in temperature from 37oC to 31oC nearly
triples the amount of time that neurons can tolerate ischemia
[CRITICAL CARE MEDICINE; Takeda,Y; 31(1):255-260 (2003)].
Temperatures below 15 C completely eliminated ischemic
oxidative stress in mice [FREE RADICAL BIOLOGY & MEDICINE;
Khandoga,A; 35(8):901-909 (2003)]. Rats subjected to 2 hours
of brain tissue ischemia showed a significant reduction in
neurological deficit as a result of only a 4oC reduction of
body temperature for 5 hours, which began one hour following
the start of reperfusion [STROKE; Kollmar,R; 33(7):1899-1904
(2002)].

The use of mild hypothermia after cardiac arrest is now
increasingly gaining acceptance in conventional medicine.
In a study of 137 control and 136 hypothermic patients it
was found that reduction of body temperature from 37oC (normal
human body temperature) to 32-34oC for a 24 hour period
following cardiac arrest increased 6 month survival from
41% (control) to 55% (hypothermic) and reduced 6 month brain
damage from 61% (control) to 45% (hypothermic) [NEW ENGLAND
JOURNAL OF MEDICINE; 346(8):549-556 (2002)].

Dog brains stored for up to 4 hours at about 2oC showed
restoration of cerebral electrical activity upon rewarming
[NATURE; White,RJ; 209:1320-1322 (1996)]. Experiments with
dogs that have been quickly cooled with blood washout solution
have shown that cooling from 30oC to 10oC can extend the
tolerable period of cardiac arrest without neurological
damage from 5 minutes to as much as 120 minutes [CRITICAL
CARE MEDICINE; Behringer,W; 31(5):1523-1531 (2003)].
*************** END QUOTE **********************************

  Criticisms of the medical qualifications of the SA team
are beside the point of what they achieved. Having paid
personnel with equipment and a willingness to maintain CPS
(manually, if necessary) during cooling is of enormous
value. Claims that the patient was the subject of
experimental procedures without foreseeable benefit are
similarly without merit. The patient received time-tested
cryonics protocols which had substantial measurable benefit
over what he would have received had SA not been present.

  Accusations have been made that the patient did not want
SA treatment, that I consciously opposed the patient's
wishes and that I subjected the patient's son to high-pressure
sales tactics. Included in these accusations is the presumption
that I had virtually no interest in the patient's well-being and
that I was almost entirely motivated by my desire to promote SA.
(Explanations given for my ultimate motives for wanting to
promote SA are more murky.)

  I was aware that the patient had attended the SA conference
in May with his son. I had also been told by CI facilities
manager Andy Zawacki that the patient had not been so impressed
with what he saw at SA. I do not believe that the latter is
the same as saying that the patient would not want SA service
at any price. It is false that I would have opposed the
patient's wishes if I believed he would not want their
services at any price.

  Knowing that the son had attended the SA conference with
his father I felt that he could appreciate the value of what
SA had to offer. I also believe that no one could better
estimate what the patient might want from SA than his son,
who had spent an entire weekend with his father seeing the
SA conference and touring the SA facilities.

  Seeing a possible opportunity which I believed could be
of benefit to both SA and the patient (a win-win situation)
-- and believing that the extra funds were available -- I
spoke to Saul Kent and the son about the possibility of SA
taking the case for $8,000. With the moment of deanimation
somewhat predictable upon removal of the ventilator there
would be no need for costly standby. I do not remember any
opposition from the son when I made the proposal to him.
How can anyone claim or know that I subjected the son to a
high-pressure sales pitch when only the son and I were on
the telephone? If the son had been pressured he would be
expected to express doubts and remorse afterwards. On the
contrary, he expressed great satisfaction with the services
SA provided for his father. Moreover, I do not believe the
patient's son would have allowed his father to receive SA
services if he had any indication that his father would have
been opposed. And I believe that the patient's son was in
a far better position to know what his father would have
wanted concerning SA services than anyone else.

    The agreement between CI and SA for this case
was an "ad hoc" agreement, so the usual contractual
terms did not apply.

  I understand that there are people who would love to see
SA destroyed. But I also believe that there are critics of
SA who would like to see SA improved. I am not in a position
to evaluate all of the criticisms. I hope that the criticisms
have a constructive result. But I do believe that to claim
that SA cannot offer great benefit at present -- and did not
give great benefit to CI's 81st patient -- is false. It is
true that CI and SA websites have have not been up-to-date.
Previous announcements are historical records which should
not be rewritten, but I have attempted to make an update
with a new announcement at:

  http://www.cryonics.org/SA/SA_CI_Announcement.html

and am open to suggestions for further corrections.

        -- Ben Best, President, Cryonics Institute

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