X-Message-Number: 3075 Date: 07 Sep 94 01:28:19 EDT From: Mike Darwin <> Subject: SCI.CRYONICS Ettinger I made a serious error on my previous post about Greg's work. When talking about toxicity at -30xC and pointing out that VS solutions are still toxic at this temperature. I MISTAKENLY put a (1) in front of the 30 making it -130xC! This is an error. It is NOT the case that vitrification solutions are toxic at -130xC. In fact, this is a sufficiently low temperature to inhibit toxicity and allow for "indefinite" viable, virtreous storage. Bob Ettinger writes: >>But Mike's assessment, I think, cannot QUITE be taken at face value. Until whole kidneys >>have actually BEEN processed in the proposed way and proven >>viable, we can't be sure. At CI we never take anything for granted. Basically, I agree with you in terms of being assured that the kidneys will function. However, insofar as being certain that the kidney's are ultrastructurally well preserved and free of ice even though they have not been been rewarmed en bloc (because of constraints on warming speed) I must disagree. As I understand it, Greg has evaluated whole, vitrified kidneys for the presence of ice and for ultrastructural integrity. Ice was absent, ultrastructure was intact. This is still as big step forward. I have a question for Bob: If we could remove any small portion of a vitrified kidney and rewarm it to demonstrate good function, would this satisfy you that the tissue (in this case the kidney) was preserved viably even though fast rewarming is not now possible? Granted, there is still the issue of the vasculature which might be microscopically cracked on rewarming or during vitrification. But here (and in my previous post) I was referring to tissue ultrastructure. Sorry if I wasn't clear on this. Bob also remarks again that the problem of kidney preservation has proven intractable for many years. Come on, Bob, you know better than almost anyone WHY it has proven intractable! The answer is that most of the research done was pure crap, not of a serious nature at all. And further more you know well that funding for this area has been horrible! Almost nonexistent! Even incuding the garbage research cryobiology is grossly underfunded and *you* have often said so yourself. To my knowlege there has been, for the last 15 years, only three places in world where organ cryopreservation was being "systematically" pursued: Armand Karow's group at the Medical College of Georgia (they stopped work nearly 7-8 years ago), David Pegg's group at the Medical Research Council (in the UK) and Greg Fahy's group at the Red Cross. Pegg's efforts were hardly of a focused nature and much of his work was NOT related to cryopreservation of the kidney or of any solid organ for that matter. The kindest thing I can do in commenting on Karow's efforts is not to comment. That leave's Greg. I talked with him two days ago and he confirmed my estimate of about $2 million having been spent over that lifetime of his work at Cross. Keep in mind that the average low-end start-up biomedical R&D company is capitalized in $5-15 million range. I think the prospects for research yeilding good results in cryonics are excellent. And I am not known for my optimism about anything. >>And Mike ought to know better than to keep trying to label me Pollyanna. I >>have never minimized the problems of maximizing our chances, and if I ignored >>the necessity of trying to maximize our chances I would be an idiot. The >>research effort at CI has never been restricted by the philosophical view >>Mike imputes to me--only by our finances and capabilities (which fortunately >>are improving). It was not my intention to label you as a "Pollyanna" nor do I think I do so in my post. However, it was and remains my intention to point out that there is a large philosophical and practical difference between the approach to cryonics patient care you consider acceptable and which you practice and that which I and others practice and consider acceptable. You have long been critical of the kinds of "high tech" approaches such as the use of bypass technology, 0.2 micron filtration of perfusate, use of medical grade (pyrogen free) water for perfusate preparation, gradual introduction of cryoprotectant and use of the kind of emergent (i.e., at the time of legal death) extracorporeal support technology which Alcor, BPI and others have employed as being of unproven benefit and therefore not (presumably) cost effective. These positions dovetail with your repeated public statements that patients prepared simply and inexpensively using a mortician and simple perfusion equipment and vascular access via the carotid or femoral with non-cannula assisted venous drainage and a 75% glycerol solution (which the patient is perfused with directly) are probably as well off as those treated by "higher tech" methods. Please understand that I am not "criticizing you" or denigrating your approach. You are free to do what you believe is best and as long as your clients understand what they are getting (and I believe they have ample opportunity to have such understanding; I have not seen any evidence of an intent or effort to defraud or misininform anyone by either you or CI). What I am doing here is pointing out that there is difference in approach and that I believe (rightly or wrongly) that philosophy underlies such a difference. I believe that protecting patients from known (and in my opinion) significant sources of injury such as plugging of capillaries with debris from unfiltered perfusate, direct injury to cell membranes from contaminants in water and perfusate components, protection of staff from etiologic agents through the use of sterile technique, protection of the patient from bacterial overgrowth during long periods of external cooling (when extracorporeal cooling is not available) through sterile technique and use of parenteral antibiotics, and so on, constitute good care. Indeed, constitute the lower limit of care I consider accceptable. I do not believe that patients with autolytic injury from long periods of unstabilized postmortem delay, compromised capillary beds, and so on will fare as well as soon as patients better treated. I am cautiously optimistic about the long term. But I am ever mindful of the history of cryonics and of the world at large. Storage time is DANGEROUS time for the patient. When the US went through WWII there were no wars raging on our own soil. Nevertheless, that effort resulted in a country in which there were no new appliances manufactured, no nylon stockings made, and in which fuel was rationed. In such an environment frozen patients would have fared badly in my opinion. Currently, a good hunk of the world is engulfed in chaos and poverty. While things are improving in many areas, it is by no means clear to me that we are on the verge of utopia or even on the verge of a "stable" world order. As best I can see the world is mess and the prospects for things getting worse are at least even with their getting better. What I am saying here is that I do not blithely accept the liklihood of patients remaining frozen for centuries. I think we'll be doing very good to keep most of those now frozen in cryogenic storage for 50 to 150 years. Autolytic damage, cracking, and the kind of injury we observe on freeze-substitution (and thus in the frozen state) and after thawing may require very long periods of storage time to develop the technology to reverse. To the extent we can meaningfully minimize this injury I think we should do so. On this I do not think we are in disagreement. As to what constitutes a meaningful dimunition of injury --* there* we have disagreement. And I believe that such disagreement is strongly influenced by philosophy. I have not, to my knowledge, said anything negative about CI's approach to cryobiological research. As far as I can see doing a survey of exactly what kind of injury your cryopreservation technique results in is a good and logical place to start -- and I commend you and thank you for it. And it is in fact what I did with Jerry Leaf in the early and mid-'80's and what I am doing now myself here at BPI. Finally, I meant no disrespect by my previous post. You are the Father of cryonics and, as I have often said, are owed a great debt of gratitude. However, I do disagree with your position in a number of areas and I stand by my remarks that your post did nothing to enhance the credibility of cryonics and further that some of us do not share your philosophical conviction about the "revivability of everybody." To me, cryonics should remain within the domain of what we can envision as possible within known physical law. Sincewe have no reason to believe that we are destroying the fundamental fabric of identity by cryopreserving people (and some reasons for believing we aren't) it makes sense to proceed to do so and *hope* for the best (since the alternative is certain loss). But, and here is an important difference in perspective, it is by no means clear to me that we are suceeding cryopreserving sufficient information to allow us to infer the healthy, functional state of the individual from cryoinjured state we render them into -- even when we apply cryopreservation under the best of circumstances. You clearly do not share this viewpoint and it clearly has influenced (in my opinion) your actions and approach to cryonics. I found it ironic that you require of Greg's vitrification technique that he first un-vitrify and successfully reimplant a kidney befoe you'll "believe it" or considered it "proved" cryopreservation. Surely you will grant those of us more conservative cryonicists the same reservations when it comes to the issue of the recoverability of people cryopreserved with today's damaging techniques: we'll *believe* it when we see it. In the meantime we can perhaps be forgiven for regarding human cryopreservation as an at best speculative and experimental approach to survival. Above all an *unproven* approach. Thus, we (those of us with such doubts) will feel better and better as the cryopreservation techniques get better and better. And we will feel beter still when the cryopreservation techniques are *fully reversible.*! Again, you are free to pursue a very different course *and I am in no position to prove you wrong at this time.* So, let's not impute evil motives where none exist. Only time will tell which of us (or our respective critics!) is right or wrong. Respectfully, Mike Darwin Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=3075