X-Message-Number: 2520
Date: 07 Jan 94 04:43:29 EST
From: Mike Darwin <>
Subject: SCI.CRYONICS The problem of cryonics


The Problem of  Cryonics
by Mike Darwin

      Thomas Donaldson in his Cryomsg #2512 has further opened  an 
already  large wound on my hide, and one  which has been festering for 
some years now.  The wound I refer to is the problem of cryonics and 
research.  I wish to start out by echoing most of what Thomas has said.   
As one (of the VERY few) who has done and IS actually doing  research to 
improve  human cryopreservation , and as someone with a long history of 
involvement in cryonics I feel uniquely qualified to comment on Thomas' 
remarks.

      Much like Thomas I have, over the years, come to realize that the 
criticism some professional cryobiologists have leveled at  cryonics has 
some powerful truth to it, and that we had best pay attention.  I will 
in fact spend a fair amount of time here criticizing cryonics myself.  
In fact, so strong has my feeling become that I now try to avoid using 
the word cryonics as much as I can and I no longer use the words cryonic 
suspension to describe the act of cryopreserving legally dead people.   
Before I get down to the criticism I have of cryonics and to the 
positive things that I think can and should be done to address them, I 
would like to provide a little history about the two broad approaches to 
cryonics that have existed almost since its inception.

      The very first cryonics organizations  (LES and CSNY) espoused 
what I will call Approach A.  Approach A emphasized the importance of 
research to improve and ultimately perfect human cryopreservation and 
emphasized cryonics  (freezing people with today's crude techniques) as 
a long-shot with at best unknown chances of success.  Approach A is best 
characterized by a statement made during its inception: "Being frozen is 
the SECOND worse thing that can happen to you."   Approach A focused on 
hard work and real-time progress towards suspended animation with the 
goal being implementation and integration of human cryopreservation with 
medicine and with the society as a whole.

      Approach B came fast on the heels of Approach A.  Approach B 
emphasized the capabilities of  the future to carry out repair, the 
current evidence that cryopreservation techniques were achieving good 
preservation (usually through irrelevant and often misleading tangential 
cryobiological research), and focused on public relations, impressive 
*appearing* physical plants, and membership/customer recruitment as the 
primary answer to cryonics' problems.  This is not to say that Approach 
B did not want to see cryobiological research done.  By all means they 
wanted to SEE it done (which is quite distinct from wanting to DO it).  
Approach B is best characterized by the statement: "I don't worry about 
the extra damage caused by lack of access to the Chamberlains' perfusion 
technology; our friends of the future will be able to fix  those 
problems,the important thing to consider now is the well-being of CSC."   
Approach B relies heavily on "Our  Friends of the Future" to solve all 
our problems.  (That quote, incidentally, is from Robert F. Nelson, 
former President of the Cryonics Society of California, which let all 
its patients thaw out and decompose.)

	When we started in cryonics 30 years ago (1994 is the 30th 
anniversary of the publication of  Ettinger's THE PROSPECT OF 
IMMORTALITY) we started with both Approaches having  one fundamental 
thing in common: an unproved assumption.  This assumption being  that 
(relatively) prolonged periods of global cerebral ischemia followed by 
cryoprotective perfusion and freezing to dry ice or liquid nitrogen 
temperature are compatible with  the recoverability (i.e., survival) of  
human beings so treated.

	We felt and feel compelled to apply this treatment NOW because we 
have no other better alternative and because the stakes are VERY high 
(the otherwise certain loss of lives which are valuable to us, sometimes 
including our own!).   What we then did  was to subject our hypothesis 
that this approach might work to VIGOROUS internal and external 
scrutiny.  There have been nearly 30 years of such scrutiny and few if 
any pieces of evidence put forth  which argue compellingly  AGAINST 
human cryopreservation have surfaced during this interval.  However, 
this does NOT  mean that it will work, only that good  and SPECIFIC 
reasons WHY it will NOT work have not yet been put forth. 

      * Frankly this is not much to go on (it is, after all,  a trying 
task to disprove a negative!). *   Such reasons may be put forth 
tomorrow, or the day after, in which case we have all been "wasting" our 
time and if we are wise will go elsewhere in our attempt to remain 
alive.   

      The difference between those practicing Approach A and those 
practicing Approach B  is that  those of us in the Approach A camp did 
not stop there.  We then went on to take our theoretical speculations 
about the best approach to implementing human cryopreservation and try 
them out in the laboratory and get feedback.  We've cryopreserved cats, 
rabbits, and  dogs using the same techniques applied to humans and 
sought to determine whether or not we are preserving the structures 
which neuroscientists tell us are likely to be important to identity.  
Where possible we have used viable (i.e., real-time recoverable)  models 
wherein dogs are recovered alive to determine the efficacy of the front-
end (reversible) part of our procedure.  And lastly, but by no means 
least importantly, we have sought feedback from the patients themselves 
in the form of laboratory evaluations, clinical observations and, where 
practical, gross anatomical, ultrastructural and histological 
evaluations.  	

	Frankly, I have found the results of  most of these studies to be 
discouraging and am working hard to try to improve the degree of 
preservation we achieve.  But the point is that those of us practicing  
Approach A are (the best of us) *seeking feedback*.   We are also 
evaluating new ideas such as new mixtures of cryoprotectants, cooling 
rates, concentrations of protectants (up to and including vitrification) 
using a rabbit brain slice model with histology and ultrastructure as 
the endpoint.  

    (Lest I give the impression from the above that we have been a 
beehive of research activity over the past 30 years let me disabuse you 
of that notion at once.  Comparatively little of the work that needs to 
be done has been done.  And the overall level of interest in the 
cryonics "community" to rectifying this situation seems next to nil.)

      In my opinion this is about  the BEST we can do right now, short 
of actually reviving someone.  However, it is still far from good 
enough.   And because there is no universally agreed upon gold standard 
of results (since the best one,  the patient waking up and letting us 
evaluate how s/he is ,  is  not yet do-able) there is room for much 
useless and destructive  speculative fooling around  with the 
cryopreservation protocol (and thus with the patient!).  This has caused 
many human cryopreservation patients  to be subjected to protocols of 
treatment which are KNOWN to be unnecessarily injurious by the criteria 
we use in undertaking human cryopreservation in the first place 
(minimizing histological , ultrastructrual, and biochemical disruption).    
It has also lead to a willingness to make compromises to the care of 
individual patients in order to serve the interests of the group (i.e., 
lets not rock the boat: we'll let this guy have 10, 20, 30 minutes, and 
hour of ischemia so we don't risk the wrath of the hospital, the 
Coroner, the Medical Examiner, etc, or this patient's suspension 
threatens everything,  so why don't we thaw  her out and get the 
government, relatives, etc. off our backs because we have the OTHER 
patients and OURSELVES to think of).

      It doesn't take a genius to realize that most of the PROBLEMS that 
lead to compromise of the individuals' well being to that of the group's 
well being stem from the fact that the practice of cryopreserving "dead" 
people is completely OUTSIDE of  the existing medical and social milieu.  
AND WHAT IS MORE, IT WILL REMAIN OUTSIDE OF SUCH ACCEPTANCE UNTIL 
REVERSIBLE, VIABILITY PRESERVING , CRYOPRESERVATION (i.e., SUSPENDED 
ANIMATION) IS ACHIEVED.

	So where does this leave us?  It leaves us with some sobering 
realizationsm, not the least of which is that until we get to the GOOD 
SCIENCE of the "gold standard kind"  (resuscitation) we are all of us 
taking some hellacious risks.  This is acceptable WHEN THERE IS NO OTHER 
ALTERNATIVE AND THERE IS MUCH TO LOOSE, AND IN PARTICULAR, WHERE WE ARE 
UNLIKELY TO DO MORE HARM (After all, the patient is already "dead" by 
current criteria and has been quite completely abandoned by his/her 
medicine).  

      And this brings me to my second major point: the issue of not 
doing harm.  When I first got involved in cryonics it all seemed so 
simple.  It was such a logical, compelling idea and it seemed so 
COMPLETELY GOOD.  Twenty-five years of involvement have sobered  my 13-
year old's perspective considerably.   Application of cryopreservation 
to legally dead people NOW  has MANY implications and effects and, as I 
have observed first hand, much opportunity to cause harm if not to the 
patient AFTER legal death,  then certainly to the patient BEFORE and 
during  legal death; and just as certainly to those who survive the 
patient in the form of his/her family and friends,  the cryopreservation 
organization's personnel, the society, and so on.  I will list just a 
few of the kinds of "harm"  I have observed cryonics to have caused as 
it is currently practiced :

* Patients have been kept alive or resuscitated from deep shock (and 
accompanying merciful unconsciousness)  to experience days, or in some 
cases weeks, of painful (even agonizing) low quality life in order to 
facilitate suspension.

*  There is lack of closure for the relatives,  loved ones, and friends 
of the suspended:  they must continue to worry and often take action and 
spend money to insure the continued good care of  their loved one(s)  in 
suspension:  

Always there is a background of concern and anxiety:  what about  the 
financial security of the cryopreservation organization?, what about 
earthquakes?, economic upheaval?, vandalism?, etc.  This ongoing 
concern/anxiety (and at its worst, naked fear) constitutes a real cost 
often not perceived by anyone in their early (pre cryopreservation) 
stages of involvement.  Even a noncryonicist relative has some burden to 
bear since they can (and often do) experience anxiety about mishandling 
of their loved one's remains (thawing/decomposition, public scandal, and 
so on) as well as invasion of privacy and disruption of the normal 
familial relationships during the dying process which is occasioned by 
the presence of cryopreservation personnel,  equipment, etc. at the 
deathbed;  whether in the home or  acute or extended care facility.  
(Given the past history of cryonics these concerns cannot be called 
altogether inappropriate.)

*  There is present lost value to life in terms of moneys out-the-door 
for dues, insurance payments, and so on, which now amount to on average 
over 1K per year per person for many cryonics organizations. While it 
can be argued that this money buys real-time peace of mind, it can also 
be argued that it buys a lot of real-time heartache and anxiety (see 
below).   A related financial issue is that cryonicists may leave family 
members who are dependent upon them poorly provided for (in order to 
facilitate their suspension) or they may tap into assets or cause 
survivors to do so in ways financially harmful to the family.  I have 
personally witnessed this happen several times and it has been very 
distressing to me.

*There is also anxiety and altered behavior (refusing to fly in 
airplanes,  engage in sporting activities, travel abroad etc.)  as 
individuals seek to maximize their chances of being suspended under good 
circumstances or being suspended at all.  This extends to things like 
having to forego experimental medical treatments because involvement in 
cryonics would be a disqualifier or the travel that would make 
suspension problematic.  There is often agonizing over these issues and 
what the right choice to make is...

* There is the shame and decreased social esteem that *some* people feel 
as a result of having made cryopreservation arrangements (and I 
emphasize SOME here because this attitude does not in my experience 
characterize how most cryonicists feel; but it is a commonplace feeling)    
Some respond to this by keeping their arrangements a  secret, a practice 
which has to have a deeper psychological  cost , completely apart from 
the energy required to maintain the subterfuge.

* The ENORMOUS personal and financial costs experienced by 
cryopreservation organizations' staff, and caring  family and friends 
during the terminal phases of the patient's illness with death looking 
imminent, followed by recovery, followed by crisis, followed by rally --
all  the while triggering standbys and costing everyone tremendous 
emotional and physical energy,  not to mention money!

*Finally, there is the cost that the society as a whole bears as a 
result of court system actions and extra charges to Medicare/Medicaid as 
a result of application of premortem therapies to facilitate optimum 
cryopreservation: these range  from extending the dying process to allow 
the timely arrival of a transport team to prescription of 
medications/laboratory evaluations to improve suspension or more 
accurately determine when legal death will occur, to legal actions to 
determine the rights/limitations of cryopreservation  organizations and 
the individuals they serve as well as those of the next-of-kin.


	What I am saying here is that over my 25-year-long career in human 
cryopreservation I have come to appreciate that "cryonics" is not a  
"no-load"  undertaking and that the cost  in both human and financial 
terms is far, far higher than I though it would be 25 years ago.  This 
has caused me to shift my priorities in important ways.  For one, I 
would feel a hell of a lot better about these costs if  I could be SURE 
that the treatment had a definite chance of working in the same sense 
that I can be sure of  a heart transplant or a shot of antibiotic 
working: no certainties but a reasonable statistical base to go with!  
It's more than a little hard to watch someone writhing in agony because 
of actions you've taken to keep them alive when the outcome is as 
pitifully uncertain as it now is.

	What is more, I think that human cryopreservation would  be 
profoundly better off for such a change as well.  About 25-30% of all 
patients cryopreserved NOW (and for the foreseeable future)  will be 
treated under terrible conditions ( which will almost certainly render 
them unrecoverable): they will be coroners cases, be autopsied, suffer 
from ULTIMATELY IRREVERSIBLE degenerative brain disease before 
suspension, use up their financial resources and not get suspended at 
all, and on and on and on.  Further,  as I previously stated in this 
essay,  I have come to the almost unshakable conclusion that respect for 
the rights of the cryopreserved  will not occur until we can demonstrate 
that they are viable or potentially viable using the same rigorous 
techniques used in other areas of medicine and science.   All the 
lawsuits and lobbying in the meantime will largely amount to tilting at 
windmills if the society as a whole, or the empowered segment of it, 
does not recognize the viability of cryopreserved  individuals.  And 
even those treated under the BEST of circumstances are still being 
treated after considerable periods of ischemic insult and after much 
unnecessary damage...

	If only we had suspended animation for the brain or something 
approaching it.  Where I differ from many others in the so-called 
"cryonics" community is that I believe that achieving this "if only" is 
eminently do-able in real-time with the application of effort and money 
sufficient to the task .  And further, I believe that the amounts of 
effort and money are not impossibly large or far  removed from our 
grasp.  That is the goal I have chosen to work towards.  In the meantime 
I will continue to "freeze" people and to do it the best way I know how.  
But I have considerably less enthusiasm for the undertaking than I once 
had and considerably less personal interest as well.  I think this shift 
in perspective is an eminently sane and valid one.  I have no objection 
to freezing people under the conditions I have described above 
(providing that the patient UNDERSTANDS what the known "side-effects" 
are).  *But I feel that to pursue that course without an EQUALLY (as a 
minimum) firm commitment to solving the problem of  "cryonics" by 
developing reversible brain cryo (or other) preservation is a fool's 
game and doomed to failure.  And what is more,  one that I want no part 
of.*

	And that  IS my take home message here.

            Finally, a word about the Approach B people.  They haven't 
gone away.  In fact, in my opinion,  they have come to dominate 
cryonics.  They have depersonalized  Our Friends of the Future and 
renamed them Nanotechnology:  which is a lot more impressive sounding.  
They trivialize the horrendous problems and shortcoming of today's 
cryopreservation technology and speak  SERIOUSLY of  the possibility of 
today's patients being revived in 30 to 50 years!  Such foolishness does 
a disservice to everyone interested in cryopreservation as a route to 
survival and such overbearing optimism will in my opinion cause these 
people to make decisions elsewhere in their program  that will lead them 
to to the same inevitable (and unenviable) end  CSC experienced a decade 
ago. 

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