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 Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=29723