X-Message-Number: 7154
Date: 17 Nov 96 21:53:41 EST
From: "Steven B. Harris" <>
Subject: Cryonics & the Lack of Quality Control
In cryomessage #7141 (14 Nov. 96) John de Rivaz <
demon.co.uk> (Newsgroups: sci.cryonics Subject: Re: Prices)
Message-ID: <> says
optimistically:
>>Morticians only take part in the initial stages and perform
largely an administrative function. The Cryonics Institute
procedures have been investigated by experiments in Russia and so
far the results have been good. Full reprts are available in The
Immortalist. For details email <> <<
Comment: if electron micrographs showing disrupted myelin, and
neurons with the membranes entirely stripped off them and
existing as naked nuclei, are "good" results to you, then I
suppose this kind of thing is for you. The rest of us are
actively trying to do a little better than perfusion by a
mortician, or with embalming pumps. Or, for that matter, with
glycerol, which is on its way out as a cryoprotectant at
BioPreservation, and I suspect at Alcor also.
Comments such as those of de Rivaz illustrate a fundamental
problem in cryonics, which Mike Darwin has long termed the "lack
of feedback" problem. What Mike has been talking about there is
formally a lack of any kind of quality control management in
cryonics, as it is too often practiced.
For those of you unfamiliar with quality control (QC) theory,
the idea is that real "quality control" is absent, and therefore
that no rational and objective progress is made (or at least
demonstrated), without resort to a simple and very basic quality
control device called the QC feedback loop. In such a loop, some
kind of objective outcome of a process is measured, and an
objective quality rating (outcome measure) is generated,
according to whether or not some objective outcome goal has been
met. After this, an attempt is made to improve the process, and
the new process is tested, generating the same outcome measure,
which is compared with the last outcome measure. If the outcome
is better, the last process change is kept, (or at least noted
for future standards), and round two of improvements begin.
Quality control theory says that quality is improving only if
outcomes measures for a process improve (at least on average)
over time.
Now the importance of all this ought to be obvious. In
complex processes with complex outcomes, humans are well known
for fooling themselves about whether or not something is
improving, and about whether they themselves are doing a good
job. In a business (or any other organization), this human
perception problem can result in disaster, as lack of real
feedback about performance results in parasitism and accumulation
of dead-wood in jobs with no objectively evaluatable quality
function. The difficult place to apply quality control theory
are NOT places like assembly lines (where it is easy to measure
the number of defective widgets produced, etc); rather, it is in
jobs like office personnel management or delivery of medical
care, where it becomes very easy for workers to think that
they're going along for years doing a better and better job, when
by any objective criteria (which can be quite difficult, but not
impossible, to construct) they really aren't.
It will be noted that the "scientific method" itself is
nothing more than a quality control loop in which the measure of
objective success is both the economy and wide applicability of
theories which unambiguously give rules for predicting the
future. The "scientific method" is our name for the quality
control loop which guides the generation of new physical
theoretical knowledge. Similar kinds of feedback loops also
control the generation of new and successful art in engineering
and manufacturing and other crafts and disciplines.
Even the fine arts are subject to quality control loops
involving objective measures of skill in a craft, and public and
critical judgement about the success of each artistic
undertaking. There is much about art, however, which is not
subject to objective quality control as usually understood, and
this is one of the things which differentiates the fine arts from
the physical sciences. The physical sciences clearly progress
over time, whereas it is not clear (particularly in the 20th
century!) that fine art does. Without quality control, there is
*no telling* whether or not progress has been made, and that is
exactly the point we are trying to make.
There is a name for human enterprises which don't (and can't)
pay any attention whatsoever to objective quality or quality
control theory: they are called "religions." The problem with
religions is that success in the essential goal of most of them
(drawing closer to the divine or the mystical experience of the
sacred) is not something objectively evaluatable in a public way,
and thus there exists no way in religion to derive the kind of
objective feedback measure which is necessary for a standard
quality control loop. Is this year's method of worship better
than last year's? Or better than somebody else's? Maybe so and
maybe not-- there is no objective way to settle arguments about
this. It is for this reason that quality disagreements in
science, engineering, and business production lead invariably to
objective improvements in knowledge in these areas, so long as
quality control is practiced, whereas arguments in religion (as
has long been pointed out by the rationalists) lead only to
violence. Or (at best, in enlightened societies) to internecine
schisms and new religions.
It is worth noting that when quality control is NOT practiced
in science, engineering, or business, a peculiar pathology
develops which looks remarkably like religion. Or (charitably)
like modern art. And now we come to cryonics.
Cryonics is an experiment to see if humans in cardiac arrest
can be treated so as to preserve them in a way that the technol-
ogy of the future can revive them. As an experiment-in-progress,
the outcome of the cryonics experiment is not yet known. This
fact deals a devastating blow to the idea of trying to use
quality control in cryonics, because the best and most valid
marker of quality control (memory survival statistics for each
kind of preservation technique) are simply not available. And
yet, without quality control, cryonics has no hope of being
anything other than a religion (a standard religion of hope and
blind denial of death), or at best a fine art (perhaps the art of
aesthetic mummification). In other words, without objective
performance feedback of some kind, cryonics may be a religious or
artistic enterprise, but it is not in any sense a scientific one.
Mike Darwin and I (and certain others in other cryonics
organizations) have long argued that the only way for cryonics to
escape being nothing more than a religion, is for the enterprise
of cryonics to fully embrace objective outcomes measures which
can be used as reasonable proxies or "surrogate markers" of
success in preservation of human brains (human memories). An
obvious surrogate marker of cryonics success would be some
measurement of damage to brain ultrastructure, as determined by
marker perfusion studies and light and electron microscopy.
Another surrogate for brain "viability," to be used eventually
when ultrastructural preservation improves, would be some measure
of partial functional survival of brain tissue, such as brain
slice viability, or EEG preservation.
In the absence of electron micrographic structural studies for
each suspension case (which can be quite expensive), less
expensive studies of tissue damage such as CPK-BB levels can be
used, and A-V O2 differences and lactates can be used to assess
continuing aerobic tissue metabolism (or lack of it). Even more
cheaply, since we know that tissue damage correlates very well
with slow rates of cooling after cardiac arrest, temperature
decent curves for each patient can be used as an objective
outcomes measure, as a proxy for brain damage. The point is that
it needs to be SOMETHING, or the method does not progress, and
the cryonics enterprise is then not a science, but (literally and
metaphorically) a pathology. And a scam for people who think
they're paying money for engineering or advanced medicine, rather
than religious services or funereal pageantry.
What success historically has there been in getting outcomes
measures and quality control feedback loops into cryonics? Well,
I'm sorry to say, damned little. There is, for instance, no
evidence whatsoever that freezing people with today's techniques
does any better job than what we did to them 10 years ago when I
first became a cryonicist myself. And such evidence as exists
that some methods (CI's) produce *worse* outcomes, is simply
ignored! I look at the reports of suspensions today and am still
seeing people perfused with embalming pumps at organizations
other than mine. And why not, if quality doesn't matter?
Sometimes temperature descent curves are not published, and I
suspect are not even measured-- let alone CPKs or lactates or A-V
pO2s. After all, why should they be?
All this is hard and expensive, after all, and cryonics is a
business where the customer often doesn't care about all the
scientific stuff anyway. Cryonics is therefore slowly
degenerating to a religion in most places because the people who
want cryonics, have come to it WANTING a religion. The market
will eventually provide what the customer wants, especially if
it's the easiest thing to do. If your customers cannot tell
shoddy service from good, why not fire that crabby manager who
makes you continuously strive to produce something better, and
tells you that you are incompetent when you don't? In cryonics,
that's exactly what has happened. The biggest service providers
in cryonics no longer worry about quality control, and now do
exactly what feels good, instead. Why not?
And then we come to Nanotechnology, an idea which came into
cryonics about the same time I did, and which is probably the
single most destructive idea ever invented, when it comes to the
promise of making cryonics into an real medical undertaking.
Never mind skeptical cryobiologists and their statements about
turning hamburgers into cows-- one of these men could not do as
much damage to cryonics in a whole lifetime as E. Drexler
inadvertently managed to do with one book. Nanotechnology--
which when spelled with a capital N signifies a religion, like
Christianity or Communism-- promises a millennium in which any
reasonable damage to the brain can be fixed. Comes the resurrec-
tion, we'll all be changed in a twinkling from corruptible to
incorruptible, rather the opposite to what happened historically
with cryonics organizations <g>. With Nanotechnology (also known
as pie-in-the-future) why should we strive to do a better job of
suspending somebody each time, when what we're already doing --
no matter what that is-- is sure to be plenty good enough?
PLENTY good enough. Why not just sit on our butts? With
Nanotechnology (hallelujah), our butts won't even get sore,
because Nanotech is the cure for everything. It's even the cure
for trying to make cryonics into a science, don't you know.
So here we are in 1996, not much further along than in 1986,
and I sometimes despair. The cryonics organization I'm with
performs every surrogate marker study it reasonably can in our
suspensions, and is now engaged in a strenuous effort on many
fronts to improve the technique of cryonic suspension (we're
making progress too, and can show it). But we're a small
organization and it remains to be seen if we'll get any help. As
far as I can see, very few people, even within cryonics, seem to
give a damn about any of this. And of course the general public
hasn't the least clue about any of this controversy.
Steve Harris, M.D.
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