X-Message-Number: 3142 Date: 15 Sep 94 00:02:01 EDT From: Mike Darwin <> Subject: CRYONICS praises and comments For some reason (probably rooted in quantum uncertainty) two of my recent messages to Cryonet did not post. As you might expect, both of these messages were nice ones complimenting or thanking people. Hopefully this message will post as it contains at least one added compliment. First, my compliments to Nick Szabo on his post about determinism. This was a very well written post and it demonstrates IMHO a deep understanding of physical law. Not only was the post thoughtful, but it was *well written and clear*, a different matter altogether. Second, my thanks to Bob Ettinger (the first message not to post) for posting the CI storage unit numbers -- and my apologies for suggesting this information was not previously available if indeed it was. I did have the 4 liter per day number for the first unit, and I did have the figure of 1K per year for LN2 costs per patient. However my file didn't show cost for construction or CI's costs for LN2. Thanks for these numbers, they help me in my own mind to make tradeoffs. I stand by my remarks about high vacuum units. These things are pretty robust and they can easily and inexpensively be made as safe (convenient) in terms of vacuum failure as a perlite units by the simple expediency of covering them in perlite (which is very inexpensive) and/or burying them. Open-cell foam is a very interesting idea and I hope Bob can pull this one off because clearly in the long run units with better surface to volume ratios are the way to go and this approach sounds like an ideal one to achieve that end simply and easily. About 3-4 years ago I began to advocate underground storage. Recent developments have only increased my desire to see this approach followed. My reasons for this are: 1) Substantially increased protection against high speed projectiles (both accidental and deliberate). Pressurized systems are used by all cryonics organizations to take delivery of LN2 and, while these containers have safeguards, explosive failure is not impossible. Further, most cryonics organizations operate out of mixed-use facilities where highly pressurized gas cylinders are used in shop work and in perfusion and stabilization (oxygen, sheild gases for welding, nitrogen, etc). These cylinders occassionally spontaneously explode (witness the recent Luxfer aluminum cylinder debacle: we had several recalled ourselves!) and are a definite hazard if mishandled. Underground storage eliminates risk from accidental generation of high velocity projectiles. Further, in the long-run, terrorist or vandal activity cannot be ruled out. Gunfire into a cryonics facility through roll up doors or even through concrete walls is a real possibility. Such projectiles would easily penetrate both fiberglass and stainless steel dewars. There has already been one possible veiled threat at extortion by "kidnapping" a patient. Attempts to destroy a selected patient, or patients at random by use of explosives or explosive driven projectiles cannot be ruled out in the long run and may in fact become a suddenly greater risk if a high profile individual (be s/he popular or unpopular) becomes cryopreserved. 2) Particularly for major metropolitan areas there has probably never been a greater risk of nuclear detonation. Obvious high priority targets are Washington, D.C., and New York City with lesser priority targets being other high density Eastern Seaboard or Southern or Midwestern US cities (of course, San Francisco and Los Angeles cannot be ruled out -- but in terms of kill per kiloton the high density cities of the Boswash corridor can't be beat). Nuclear terrorism is a threat to patients because of the direct disruptive effects of the blast, and also because of the high levels of radiation which follow (particularly if a deliberately dirty warhead is used). Underground storage protects against these contingencies as well as a host of others. 3) An underground cavity serves as a natural reservoir for perlite if a high vacuum dewar is being used. My third comment is both praise and thanks and it goes to Brian Wowk for his posting about risks. Brian says it very well. There is no riskless cryonics. Indeed, some seemingly very low risk strategies can result in disaster just as certain and just as devastating. What do I mean by this seemingly paradoxical statement? Well, evolution teaches us that conservatism comes at a price. Risks *are* risky but they also usually carry disproportionate payoff or no one (but an idiot) would take them. In fact, doing nothing is a risk; the marketplace may change, the evolutionary niche disappear and bingo -- you're part of the fossil record. I have taken risks in trying to optimize cryonics patient care. Some of those risks were, at best, of problematic utility. The Dora Kent case is a case in point. Bringing Mrs. Kent into the Alcor facility was not a smooth move. In retrospect, this decision was a stupid one. The interesting thing (from my perspective) was that it did not seem an exceptional risk at the time (either to me or to most of those working with me; there were apparently exceptions to this, but I was unaware of them or chose to ignore them at the time (I wish I could say with any degree of certainty which)). I have certainly taken other risks of perceived small magnitude, and some of moderate magnitude and I have observed others take such risks. I have for instance gotten into very hostile confrontations with hospital authorities whom I believed (and in fact KNEW) to be acting both contrary to the patient's wishes and illegally. I once observed Alcor's former suspension team leader Jerry Leaf directly threaten and intimidate a (male) nurse who threatened to obstruct a patient's cryopreservation. While such tactics are last-ditch and extreme, they have worked. As I have gained experience over the years I have learned a great deal about how to get what I want (and more to the point what the PATIENT WANTS and NEEDS) without resorting to hostility or other risk-taking behavior. A good part of success in any field of endeavor is learning how to control your environment. And a good part of success in controlling your environment is learning how to *create* it. Home hospice, careful psychological management of key people, appropriate planning, and financial incentives can all help here. Also, as Brian points out, knowing WHEN to ignore the rules is critical. I have been forbidden to give medications on hospital property several times in my career. It would be absurd to violate such a rule if the administration or nursing personnel charged with enforcing such a restriction were present -- and such a violation could trigger a "code gray" (calling security). But it would be equally absurd not to give medications if the team is alone in the elevator with the patient or in the abulance on the way off the hospital campus. Further, assessment of risk must consider whether such a "violation" is likely to trigger an extreme response (such as calling security) or whether the restriction is pro forma. By pro forma, I mean having been put in place because the hospital attorney wanted to take no chances. Here, an assessment of whether the hospital really CARES or merely needs deniability is critical. In the case Brian cites, if the hospital really wanted to enforce such a proscription they should have posted such as standing orders, held an in-service or briefing for staff, and made sure that the administrator in the facility was alerted to be called (along with security) to insure such restrictions were honored. Clearly, under such circumstances you would be a fool to proceed. But that is usually NOT the case and usually the nursing staff has nothing but contempt for such restrictions -- particularly if they have grown to respect the transport staff and understand them to be contrary to the patient's wishes. Further, very few people in medicine will interfere with the application of CPR even if an administrator wants it. It just isn't done. Dave Pizer quotes me about my Transport class part of which he says he attended. It is certainly true that I counsel against rash behavior and that I counsel against confrontational behavior on the part of the transport staff under *most* circumstances (leave that for the cryonics organization's administrators and lawyers to do). However, it is totally misleading and wrong to say that I counsel against all risk-taking behavior or all confrontational behavior. There ARE situations where I believe such are appropriate and I have discussed, in great detail, the shades of risk vs.. benefit to be had in such situations. I have used Brian's cited case (and others, including Jerry's unequivocally threatening confrontation) as examples of *when to take risks*. And not all risks jeopardize all patients that a company has cryopreserved. The examples of autopsy and so on are extreme ones and will (given the panoply of risks) be rarely applicable. However, tort risks are applicable. They are far more likely to occur and they are far more dangerous to a bundled than to an unbundled organization. While it is certainly true that the deep pockets philosophy of the US could involve most or all of the parties in an unbundled scheme, unbundling nevertheless still provides substantial protection. BPI engages in animal research and a range of other businesses which are important to human cryopreservation. It is unlikely that a tort, or a suit without a tort, in these areas would spill back to CryoCare or ACS anymore than it is likely that (Alcor) will be sued because its printer had a worker injured while running off a copy of CRYONICS magazine. There are no sure things in the world. But limiting liability by separating activities is a tried and true method for reducing risks and damages. Not certain, but a reasonable and viable approach. Finally, Brian's comments about the law are ones everyone should take to heart. It is my certain opinion that Alcor is in violation of the law. What law? Well, I have no idea, but SOME law, surely. Ditto BPI, ditto every man woman and child alive in the United States today. While ignorance of the law is no excuse, being informed about them all is not a physical possibility, either. This strategy of passing lots and lots of laws and then selectively enforcing them is as old as time. I saw it first hand during the aftermath of the Dora Kent case and during the DHS litigation. I do not fault Alcor for taking a conservative strategy regarding the law (at least TRY real hard not break any and certainly don't break any you know about!). In fact, it has become my strategy too, although with each passing month it seems I find out about more regulations and laws I have to comply with. But, be advised that in the long run this strategy will do no good whatsoever (in the sense of truly avoiding trouble). It may help influence your case positively (as it did that we were in good public health compliance at Alcor) and it may limit the the damage during the first volley; but it will NOT stop the trouble if the root of the trouble is deep and independant of any discrete incident of wrong-doing. An organization which takes "prudent" risks may attract more customers and grow faster than one which doesn't -- even in the cryonics business. And that may translate into better survivability in the long run. On the other hand, taking the wrong risks can be just as deadly. That is the what the *art* of survival is all about (and why it is an art rather than a science). And there are no sure bets. You pays your money and you takes your chances. I suppose I am particularly sensitive to these sorts of tradeoffs (and to the inherent capriciousness of the law) since I am a gay man. How many of you have received a ticket for jaywalking as a result of crossing a deserted street at 2:00 A.M. against the "Don't Walk" sign? I've seen it happen and seen the poor fellow beaten senseless when he simply protested that he was being treated unfairly because he just came out of gay bar. Similarly, (and Steve Bridge may recall this one) I've had first hand experience. I used to walk the 2-miles from my job at the hospital in Indiana to my home every day and night. One night I was walking home past a gay bar in my neighborhood (which ironically I did not frequent) when I was stopped by an officer on the other side of the building who asked me if "I came out that place?" I responded "Why? Is there trouble inside?" To which he responded "That's no business of yours, faggot." To which I responded "Well, whether I was in there or not is really no business of yours unless I am a suspect in, or witness to, a criminal act." I ended up in the back of the squad car in handcuffs. I got out of the squad car by noting how annoyed my Dad would be at having to process his own son as a "cherry" (police slang for someone never booked before) since he was desk sargent that night in Identification. A quick call over the radio and I was *driven* home. It was a valuable lesson. Two of them, really. I'll leave it to the discerning reader to figure out what the lessons were. Mike Darwin Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=3142