X-Message-Number: 33503 From: Date: Wed, 16 Mar 2011 18:24:38 EDT Subject: Reply to Chris Manning: CI & Change Content-Language: en Mike Darwin wrote: 'Attempting to make meaningful technical change at CI is a frustrating, micro-incremental, and mostly unrewarding process. Most suggestions are met with the ripostes that they are "unaffordable, impractical, or unnecessary."' I then quoted a suggestion I made to the CI group (concerning the way CI measures the LN2 levels in the cryostats) and the reply I received from Andy Zawacki. Mike then posted a long discussion about different methods of measuring fluid levels. Mike seemed to be claiming that there is a culture of resistance to change/improvement at CI. My comments were intended merely as an example of how CI responded to a suggestion from me. This example did not make it seem to me that such a culture exists at CI. Mike does however make some good points about measurement of LN2 levels. I will take the liberty of forwarding them to Andy (he won't be able to read them here), although I daresay he is already aware of them. BTW in my experience, a culture of resistance to change or improvement is found in many organizations. Chris Responded: I do read every CI case report, with the same layman's approach as described above for reading the posts made here. I would not describe them as 'nightmarish', I certainly would care if I thought they were, and I don't get the impression that they make a 'mess' of members' care. Mike replied: 'Notably, you don't ask for chapter and verse as to why I believe otherwise. Sigh. That's probably just as well.' It occurred to me after I posted the above, that I ought to have asked you to explain what you meant. You could of course have provided an explanation without waiting to be asked for it by me. MD: OK, well this is a really complicated and nuanced issue. First of all, nobody likes criticism, not even me. Having said that, I've had to deal with a lot of it over a period of at least 40 years, and so I've become accustomed to it. I've also learned that it is a great tool for FORCING me to examine my own premises and assumptions. That's good, but it's also bad, in that it has desensitized me as to how others feel in response to criticism. The second point to be made is that I don't think there is anyone in CI management that is malevolent or even deliberately careless or incompetent. That's actually a much easier situation to deal with (i.e., incompetence or malevolance). Furthermore, what I see as the really serious problems at CI are rooted in multiple factors (interacting with each other) some of which are not amenable to the normal mechanisms of reasoned discussion. A lot of technological decision making is very subjective. Apple decided to keep its code closed, and gave very compelling arguments for doing so. Microsoft decided to do the opposite. I REALLY liked Apple - in fact, Alcor had Apple Macintoshes as the successor to the Kaypro - but we simply could not find the programs we needed - so we had to switch to PCs. Similarly, Airbus decided to make gigantic more fuel efficient passenger planes and Boeing decided on smaller, faster more fuel efficient passenger planes. In the latter case, it still isn't clear who made the best decision - or if there is a viable market for both. These kinds of issues are "philosophical-engineering" decisions and they get sorted out in the real world by MARKET FEEDBACK. And there we have the BIG PROBLEM of cryonics. There is no market feedback. CI's culture and technical operations have been determined by a philosophy that is very different than that from which East Coast cryonics and Chamberlains-style cryonics proceeded from. Bob Ettinger is arguably the philosophical architect of CI's approach, and that approach may be summarized by the view, often expressed by Bob, that most of the "medical trappings and concerns over such technical details are superfluous, and that a Volkswagen and a Mercedes are equivalent in the most important way, namely they will both get you to where you are going." The problem with this approach is that if you aren't very much concerned with the details, and especially if you don't have corrective feedback, then it becomes perilously easy to begin practicing cryonics as a recipe - but one where you never get to taste the finished product. Until Ben Best arrived on the scene, there were no CI case reports, and what's more, there was no data collection or documentation of any kind. There wasn't even any meaningful MEASUREMENT going on. Why would there be? Anything we could learn, or write down, would be the scribblings of an infant to the super-technologists of the future. Unfortunately, that misses the real purpose of case reports, careful study and evaluation of what is happening to patients is in fact mostly to inform us, here and now, about how well, or poorly we are doing. But again, Bob' s response to this has been pretty much to reassure people that the important to thing is to get cryopreserved and stay cryopreserved; how this is done is not nearly so important. Again, this rooted in a philosophical position. Bob does not, for instance, believe that personal memories are critical to personal identity. He has written before that he believes that personal identity consists of a "self circuit" which he defines as an arrangement of neurons that instantiate the consciousness of the individual. He then argues (with considerable credibility) that such a collection of neurons and their basic circuitry of interconnection is likely to be inferable under a wide range of conditions of cryopreservation. The problem with this is that many cryonicists do not agree with that position. I don't think many cryonicists would be happy being resuscitated with the wiring responsible for generating "consciousness" being intact, but otherwise being tabula rosa - total amnesiacs about their life before cryopreservation. This position is actually pretty close to the position that almost everybody now cryopreserved can be revived (technologically) TODAY - because it is possible to clone primates. If memory is unimportant, or relatively so, then we can start recovering patients right now by cloning them in China, or the Russian Federation where it is legal. If the "self circuit" is unique to each person, including to genetic duplicates, then this approach won't work - but nevertheless, we are still very close to being able to revive people, because as soon as we can image at the cellular level, we can map all the connections in the reticular activation system (RAS) and use technology, such as tissue printing, to reconstruct the self circuit of a given individual and substitute it for the RAS circuitry of a clone. I'm not buying that. Having said that, I have no objection to other people deciding that such is the truth of what constitutes their personhood. How could I object? I can't argue in any absolute or rigorous way that this point of view is wrong, because it is a matter of values and taste, which at least at this time, is not subject to testing or experimental validation. I can however, state with a good deal of authority and certainty, that many of the working assumptions we started out with in cryonics were wrong - incorrect - and therefore that the conservation of personal identity by criteria such as memory (declarative and procedural) will not survive some methods of cryopreservation based on our current understanding of physics and information theory. One of the analogies that Bob Ettinger used in The Prospect, was that because some cells survive freezing, even with very primitive techniques, this ought to imply that many others are only slightly injured. He used the analogy of soldiers on a battlefield after a battle. This analogy is incorrect. If a battalion is shelled on a battlefield with high explosives, some soldiers will survive, but many that don't will be blown to bits - literally. That's a binary situation, and it turns out that such is also the case with freezing injury in the presence of little or no cryoprotection. Most cells are simply osmotically and mechanically squashed by ice formation. They don't break up into stable, discrete pieces, but rather are re-morphed into new structures that carry no meaningful information about their former state. A few cells will escape this fate by the expedient of inhomogeneities in the ice-electrolyte mass that results from freezing, but this no bearing on the fate of the rest of the battalion of cells. A timely analogy is the earthquake and tsunami in Japan. It is perfectly possible to see a completely intact house resting atop a mass of bits and pieces of cars, toys, furniture, bodies, photographs, and just about everything else imaginable. A reporter can even peer in through the window and see a child's crib in the bedroom, some pictures still on the wall, books and papers, stereo equipment and CDs... This in fact was the backdrop for the NBC Nightly News here in the US last night. That house, virtually unscathed, was sitting there akimbo on that mass of mud and mayhem. As the reporter thoughtfully remarked, "It was impossible to tell where it came from." Well, maybe it is possible to tell where THAT house came from, but not for almost all the others, or the cars or the people, or all the wiring, and plumbing, and so on. That's a pretty good analogy to the kind of injury seen in freezing damage. I've done my best to summarize that on Chronosphere in an article entitled, "Does Personal Identity Survive Cryopreservation?" A shortcoming of that work, which is, surprisingly, closely related to the behavior of the people now attacking cryonics with a vengeance, is that you can argue over the evidence till the cows come home, or to till the stars burn out, by simply saying "what if...and launching into a scenario which is the equivalent of one of FD's or Unperson's conspiracy theories. In the real world, real people who are sane, or even marginally so, handle such issues by simply asking, "Where's the beef? Show me the proof! I don't give a damn about your speculations or your hypothetical's, show me 1 person, or better still 1,000 people whom you've waked-up from cryonic freezing and who are perfectly fine!" That is the same criterion used to solve almost all debates in the marketplace - prove it. Prove it by delivering a demonstrably working product. In fact, it goes much, much further than that in the real world, because the product doesn't just have to "work" it has to work very, very well. There are lots of computers, mobile phones, flat screen TVs and computer programs out there. Many are junk, and we've all been stung by making a bad decision. So there is word of mouth, consumer review resources, and all kinds of other feedback mechanisms that take us beyond binary issue of "works/doesn't work" to the nuances of how WELL it works. All of that's missing from cryonics. It is also missing in other areas of human action (so far) most notably in politics and philosophy. And again, in those areas you see the same kind of endless debates and often vitriolic arguments, most of which are a consequence of all involved having no way to sort out what is the right approach, and what is the wrong one. Progress in those fields has been horrible by comparison to fields of endeavor where there is feedback. Medicine used to be right up there with politics, but it has become increasingly evidence based, and this has greatly reduced the useless debating, refined practice, focused research and generally led to a great improvement in healthcare. It has a long way to go, but it is a start. Before the scientific method got applied to medicine, the discipline flailed around for centuries making little or no progress, and canceling out much of what progress was made. That' s cryonics today. Ted Kraver & Ed Hope at Cryo-Care, and later Bob Ettinger, had a lot of ideas about how to fabricate cryogenic vessels in which to store patients. Ted 's ideas were practically wrong, and Bob's ideas (using foam insulation, for example) were theoretically (fundamentally) wrong. While critical to the practice of cryonics, neither of these approaches resulted in any longstanding debate. People bought the CryoCare units, cussed and swore and vowed never to buy another, and went in search of a more reliable manufacturer. Bob tried to construct prototypes of his foam units, failed (cracks and failure of the insulation effect to scale linearly with increasing foam thickness) and tried something else. For a number of years Bob had no success in building a working perlite unit. Then, Andy Zawacki was hired, and Andy brought skills to the task that Bob didn't have. CI got working cryostats. But very importantly, the first CI Cryostat is now gone, and some of the other early units will (IMHO) be retired. Why? Because they got feedback and improved the design. Even the first cylindrical CI units had a "learning curve" and the later ones perform better than the earlier ones. The only reason CI knows this is that they MEASURE the performance, and when they see variations, they try to figure out why, and move away from unfavorable factors and towards favorable ones. This all make perfect sense. And Alcor has had the same experience with their high vacuum superinsulated dewars. They don't make them in-house, but like any other piece of equipment, quality varies depending upon the manufacturer. By contrast, in the biological end of the operation, opinion and prejudice, and mistaken assumptions rule supreme. Hope will always triumph over reality where there is no corrective feedback. There are thousands upon thousands of volumes written about the nature of heaven and hell and how to get to either place; but no meaningful roadmap which travelers use to make the journey and then return to write reports. And so it is with cryonics. I got to these lengths here to show that there is no malice on my part; and no malice on the part of people like Ben and Andy. I am well aware that they honestly believe they are doing the best job they can and that their decisions are based on logic, reasoning and evidence which they believe to be valid. Ten or 20 years ago in politics, people on opposite sides of the aisle in the US had the same understanding of each other. They may have despised the other guy's ideology, but they realized that he was just doing the best he could trying to make sense of the world from a different background and perspective. It's a lot like the attitude many people in the West have towards other peoples' religion. As long they believe in god, the details aren't worth killing each other over. That's great for religion (less so for politics) because religion is fantasy as far as the real world is concerned. People don't show up on the church steps pissed as hell because they ended up there (in hell that is), or whinging about the Sunday Brunch in heaven. It's all stuff and nonsense, and its only purpose is to make people feel better about death until the time comes when they too, are dead. So, THAT is (in part) why it is so difficult to deal with CI, and why change is so micro-incremental in those areas that involve biology. If you are neither using evidence based methods to determine your course of action, nor personnel who can prioritize and decide accurately about such evidence as does exist, then you will mostly do nothing, or very little, and spend a great deal of the rest of your time on hand wringing. In order to specifically analyze CI case reports, I will have to have recourse to a medium other than Cryonet. Probably the best way to do this is to create an MS Word document which can be downloaded. This will allow for the inclusion of photos, excerpts (with graphs and charts) from CI case reports, and also allow it to all be present in one document. I'll try to do that, but it may be some days. I'll send it to you personally, or post the URL to it wherever you like. I'll also include some criticisms of the SA and Alcor case reports. As to the issue of misleading the public about the medical competence of cryonics personnel by using terms like "perfusionist," "surgeon" and the like. In the 47 years that cryonics has been in existence, Maxim is the first of what have been countless critics to raise this issue. After much thought on the matter, I'm inclined to agree with her criticism that cryonicists should not use those words, although for completely opposing reasons. I think it is extremely dangerous and misleading for anyone, in or out of cryonics, to believe that a medically qualified surgeon or perfusionist can competently or safely treat a cryonics patients without MUCH additional training. This is,in fact, the equivalent of assuming that a psychiatrist can do neurosurgery competently or that a dermatologist (or even a plastic surgeon) can do cardiac surgery competently. All of these specialties are just that, specialties, and they require much additional training, not just in technique, but in theory and fundamental physiology. The textbooks written for surgical physiology are very different than those written for critical care medicine, or for general instruction (such as Guyton's, for instance). When I established the domain of the cryonics emergency transport technician I did NOT use the word paramedic. Instead I chose "Alcor Certified Transport Technician" (ACT) as the name. I did this because paramedics don't (or didn't) rapidly induce hypothermia, monitor multiple body temperatures, moderate ischemia-reperfusion injury, perform hours-long mechanical CPS, nor do they do these things on patients who are "no codes," and therefore, on average, vastly more injured than the typical cardiac arrest patient encountered in the field. The idea that medically trained people can just be dumped into cryonics without a great deal of additional knowledge and skills is pernicious. A good way to make this absolutely clear to is STOP calling our personnel by equivalent names. Since the mid-1990s I've been working on a proposed standardized nomenclature for cryonics. It doesn't matter so much whether the terms I propose are adopted. What does matter is that standardized terms of some kind ARE adopted, and soon. One simple reason for this is that having half a dozen different words to describe the act of human cryopreservation, such as: cryostasis, biostasis, morphostasis, cryonic interment cryonic suspension, cryopreservation, cryosuspension, is sloppy, confusing to the public, and makes it impossible to track the penetration of the idea using technologies like Google Ngram. Words matter, and the public is already sufficiently confused and misled by others, that we don't need to be contributing to the problem ourselves. - Mike Darwin Content-Type: text/html; charset="UTF-8" [ AUTOMATICALLY SKIPPING HTML ENCODING! ] Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=33503