X-Message-Number: 33371
From: 
Date: Mon, 28 Feb 2011 01:41:36 EST
Subject: Melody Maxim's Distorted Reality 6

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How Professionals Behave 
February 10 2009 at 6:51 PM Mike Darwin Mike Darwin   (Login  mgdarwin) 
Veteran Member 
Response to Now, see what you started,  FD??? 
________________________________________ 
Melody Maxim writes:  
"Gee, thanks.  
Maybe I'll find time to deal with this, next week...or maybe I just  won't 
bother. If anyone, (like FD), wants to take the time to wade through all  
this and ask me to remark on something specific, I might oblige."   
You have made serious and damaging accusations about the  competence, 

history and accomplishments of a number of people who have exemplary  records of
service to cryonics and the delivery of excellent care to  cryopatients. You 
have also denied that specialized knowledge and skills are  required in the 
delivery of perfusion to cryopatients; insisting instead that  any medical 
professional can enter the field and perform safely and responsibly.  You 
have refused to cite examples of the many documents I have supposedly  written 
on perfusion procedure (in or out of cryonics contexts) that contain  

erroneous information. You have not provided any evidence that any cryopatient
under the care of either Jerry Leaf or I suffered iatrogenic injury as a 
result  of the extracorporeal care we delivered.  
You have also refused to answer basic questions about the  

contraindications for applying perfusion procedures to cryopatients, as well as
fundamental 
questions about the technical parameters that should be used in  conducting 
in-field extracorporeal procedures. You have alleged that you were in  
receipt of photographic evidence showing air emboli in the arterial leg of a  
perfusion circuit I was responsible for, but have provided no documentation to 
 substantiate this allegation. You raise complex technical issues here on 
CF and  then, when challenged, assert that this is not the proper place to 
discuss or  debate or them.  
You repeatedly claim that, 'you are too busy' or that, 'you cannot  be 
bothered' to respond to clearly defined and objective questions about the  
charges you level, or the technical positions that you assert are the only  
proper way to deliver extracorporeal support or TBW to cryopatients, while at  
the same time you post many thousands of words on this forum dealing with  
comparatively trivial issues in cryonics. You attack the experience and  

professionalism of a fellow perfusionist (Jerry Leaf) with decades of clinical
and research experience as well as numerous peer-reviewed publications  

(including in perfusion journals) and yet you provide no information about your
work experience, professional accomplishments or scientific or technical  
publications. *Who are you?* What are your credentials and what is your work  
history in extracorporeal medicine? How many years of clinical or research  
experience have you had and at what institutions?  
This not how professionals in any discipline behave and it is  certainly 
not how fair minded people with even a passing respect for due process  
behave. Have you no shame?  
Lack of Expertise  Boldly Demonstrated 
February 10 2009 at 10:32 PMMike Darwin  (Login  mgdarwin) 
Veteran Member 
Response to Shame 
________________________________________ 
Melody Maxim writes:  
"Mike objected to me writing that I believe one of his recently  posted 
images clearly showed air in the raceway of the pump, in a perfusion  circuit. 
That was easy for me to find, so I'll post it, now. (I have recently  

apologized, to someone else, for posting something from another forum, on this
forum, but since Mike asked for his own image, I don't think anyone should  
object.)  
There is clearly a bolus of air/foam in the raceway of the pump.  (There's 
a clamp lying on top of the pump; look under it.) Mike seems to insist  on 
promoting the use of soft-shell reservoirs with occlusive pumps. Some people  
will say you can't pump air with a soft-shell reservoir, but that is not 
true.  If the reservoir is emptied, when combined with an occlusive pump, that 
pump  will draw a negative pressure that can result in air being pulled out 
of  solution and the creation of foamy air in the circuit. I believe that 
is  probably what happened in the image above.  
I've criticized, I've speculated, I've raised a lot of questions,  but I 
don't think I've actually libeled Mike, (George informed us all, some time  
ago, that slander is spoken and libel is written)."   
Mike Darwin: Ms. Maxim: Look closely at that photo and you will see  that 
what you are saying is 'air' has a yellow cast to it and does not have the  
characteristic elliptical end-cap of a bubble.  
The reasons for this are that it is NOT a bubble: it is plasma.  This photo 
was of a canine cerebral resuscitation dog CPB circuit and these  animals 
were supported with bypass only for a short period during initial  

resuscitation. Before perfusion was finally discontinued, the animal  
decannulated and 
the wounds closed, the animal was left connected to the  extracorporeal 
circuit with the pump off and the lines clamped. An additional  reason for 
doing this was that due to some of the drugs in the resuscitation  protocol 
(including vasopressin) it was not possible to re-infuse the blood in  the 
extracorporeal circuit immediately after terminating bypass. The animals  were 
thus left connected to the circuit and blood was slowly re-infused until  the 
acutely unstable period following resuscitation was over. A consequence of  
this was sedimentation of the cellular components of the blood under the  
influence of gravity resulting in plasma in the pump raceway. Once the animals 
 were stable, any remaining blood in the circuit was transferred to an 
emptied  1-liter IV bag (usually the Normosol-R bag used in priming the 
circuit).   
What is seen (enlarged in the photo below) is PLASMA not air. That  is why 
the liquid has a straw-yellow color. The pump was not running when that  

picture was taken and if you look very carefully at the entire raceway you will
 see that there is some sedimentation on the other side (right of the 
photo) of  the raceway as well evidenced by a slight 'milky' appearance of the 
fluid in the  tubing.  
Another tip-off that this is an off-pump photo is the small bubbles  that 
have formed in the static blood at nucleation sites on the venous reservoir  
bag wall.  
The expert who has no expertise in this area is wrong.   
The Defense Rests 
February 11 2009 at 5:00 PMMike Darwin  (Login  mgdarwin) 
Veteran Member 
Response to Indeed 
________________________________________ 
No, Ms. Maxim, blood does not sediment at equal rates throughout a  CPB 
circuit and, in particular, when the tubing on the inlet side of the pump is  
nearly perpendicular to the floor you will see plasma separation occur there. 
 When the pump is subsequently very slowly operated to give small boluses 
of  blood back to the animal, that plasma will be drawn into the raceway.  
Additionally, blood foam appears pinkish-white and is NOT transparent or  
translucent.  
Certainly bubbles can and does form on the venous reservoir bag  wall 

during bypass, but NOT towards the bottom of the bag in the turbulent, high  
flow 
areas.  
Finally, since Ms. Maxim states she can tell that the pump was  indeed off 
(how, I wonder?) then assuming that what she says is foam IS actually  foam 
(which is not the case) then how can she know if it was of any  

significance? If, as I assert, this animal was off CPB and was getting  
re-infused blood 
at very slow rates of infusion and at discrete intervals, then  the 

presence of foam would be irrelevant. Indeed, near the end of such  infusions, 
the 
entire circuit up to the level of the arterial filter is full of  air - air 
used to displace blood.  
*While that was not the case in photo in question*, it points up  the 

danger of assuming things without adequate information. I'd also note that  Ms.
Maxim's hypothesizing that 'there could have been air leak around the venous  
cannula' is incorrect (and under the circumstances absurd and impossible)  
because the dogs in these experiments were undergoing fem-fem CPB with  
Biomedicus cannula and cannulae was so tight in the vessels that it typically  
took a fair bit of time and a great deal of careful effort to place them 
(they  were also ligated in place with silk snares). We had to use the largest 
cannulae  we could get into the femoral vein in order to accommodate the very 
high flows  required in this model. Secondly, in order to have a continuous 
column of 'foam'  in the pump raceway as she asserts, the reservoir bag 
would have to have been  pumped dry; and yet the bag and the tubing leading up 
to the pump are  blood-filled. Even more on point, such a continuous bolus 
of foam can only be  created when blood is subjected to substantial 

mechanical agitation such as  having been mixed with air in the pump. Thus, such
foam 
should be present not on  the intake side of the raceway, but on the output 
side; headed towards the  arterial filter.  
Other obvious questions are, "Why would I select a photo that shows  an 
iatrogenic event? Why would I use such a photo in public presentations,  

including in front of physicians and perfusionists?" Similarly, these  
experiments 
involved many people and were witnessed by many more. For them to  have 
been 'faked' would have involved the existence of a 'conspiracy'; the oft  

favored explanation on CF for events not understood and for which it would take
substantial effort to gain understanding. Using this case as an example, if 
 anyone on CF wants to know if air was pumped during the CRS experiments 
(indeed,  it was, once, and by me, but not in this case)or if the experiments 
were real,  they could go to the considerable effort of tracking down the 
people who were  present at some of them. They would then have to ask 

questions and perhaps  decide who had an axe to grind and who was telling the 
truth. 
Frankly, in the  case of these experiments, I don't think anyone present 
would be other than  honest and forthright.  
However, and this THE most important point, they would have to  evaluate 
any and all evidence in a FAIR as well as a critical manner. This is so  
because if your starting position is that 'Mike Darwin and everyone at 21st  

Century Medicine and everyone who witnessed these experiments is a liar,' then
you will ALWAYS be able to come up with an alternate explanation. Indeed, if 
 videotapes of these experiments were posted on-line, the response would 
be, They  are computer generated fakes paid for out of Saul Kent's millions. 
The  fundamental basis of scientific inquiry (which extends out of the 

laboratory and  into forensics and the law) is that you don't start an inquiry 
or 
investigation  with your conclusion in-hand. In the law this reality is 
summed up by the  injunction: 'innocent until proven guilty.  
Mostly, I have agreed with Ms. Maxim on her criticisms of cryonics.  Where 
I have disagreed I have offered concrete reasons which have NOT been  

responded to by her. Thus, I have been genuinely puzzled from the start that the
operational premise used by Ms. Maxim is that I am a bad guy and am 

'guilty.'  Guilty of what? Guilty of disagreeing with her on two technical 
issues 
(pumps  & reservoirs) and one philosophical issue (medical professionals 

entering cryonics will require additional training and mentoring)? So what? 
Where 
is her  rebuttal to the many points I've made in support of my positions on 
these  issues? And, what if I am, indeed wrong on all three issues? Well, 
then Ms.  Maxim and I disagree and it would be my poor judgment that was 
demonstrated.  That doesn't mean that I'm a diabolical liar.  
Honest people of great knowledge and wisdom often disagree over all  sorts 
of matters, but they do not accuse (or worse, insinuate) that their  

opponent in the debate is a dishonest fraud or an incompetent fool. To the best
of 
my knowledge, no facts in evidence on this forum suggest that of me.   
The take home message here is that if the starting assumption is  that a 
person is a psychopathic liar or a con artist then there is ultimately no  
resolution possible. Every reasonable explanation given, as well as the  
supporting evidence, will be explained away, ignored, or, most often, not  

answered only to be replaced by an endless series of other questions/accusations
which take enormous amounts of time to answer whereupon those answers will be 
 ignored or denied and a fresh round of accusations will be leveled.   
So, I've done my duty here which was to serve up an honest answer  to the 
distortions and outright mis-statements being made by Ms. Maxim in regard  to 
both the care of cryopatients during the tenure of both Jerry Leaf and I.  
I've asked critically important questions of Ms. Maxim which she has ignored 
or  failed to answer. That's all that can reasonably be achieved here. And 
yes, it  is important to go on record declaring such persistent and 

pernicious  speculations, insinuations and allegations as false. Ive done that 
and 
that's  all I can do under the circumstances.  


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