X-Message-Number: 33441 From: Date: Wed, 9 Mar 2011 01:57:02 EST Subject: Allbout Evil Part 1 Content-Language: en Recently, this exchange took place on Chronosphere: Re Melody Maxim: "If you think that the current cryo organizations are so screwed up, she is free to get up off her ass and start a new organization..." Response: That is really, really stupid comment. If you think that the current government is screwed up, you are free to start a new government. The same for the Army, or Red Cross. Yup, Right! I didn't think it was a stupid comment, and I believe my response should receive as wide a circulation within the cryonics community as possible, so here it is: Actually, it is a very on-point comment, in this case, and here's why. Most people who have any interest in the world around them will find lots to be dissatisfied with - governments, NGOs, churches, the local Little League; all can and do disappoint - sometimes genuinely, and sometimes on a colossal scale (consider the distribution of HIV infected blood by the Red Cross in the 1980s, or the Catholic Church's child molestation scandal). It is perfectly OK (and a good thing in the bargain) for people to complain in such situations, and to "rundown" the performance of the misbehaving institutions, without being obligated to start new ones. We all have lives, and we would go mad and get nothing done, if we acted to correct each moral or practical institutional error that came to our attention. The material differences in Maxim's case which change her situation, and justify the comment about her are as follows: 1) Cryonics is very small, and therefore individual actions can have staggering leverage in changing the course of affairs, and can easily completely transform a field or an organization. Anyone with experience in small, charitable, or special interest groups, knows first hand how a single individual can build a group up into greatness, or destroy it utterly. It happens every day. Thus, the amount of leverage and influence a single person can exert, and the size of the group, are very material. 2) This effect is vastly amplified when a whole discipline, or area of undertaking meets the criteria of #1, above. No one would argue that aviation is not a critically important and highly influential component of our global civilization today. And yet there was a time when it was a tiny, tiny thing - smaller than cryonics, with very few people involved. At the start, it was utterly dominated by the Wright Brothers, who had some very strange ideas about the specifics of the technology that should be used to pursue it (wing warping and control surface issues) and they controlled the fundamental patents - all off them. They were strangling technological progress in aviation via countless lawsuits. One man in particular, Glenn Curtis, pretty much broke this stranglehold. Juan Trippe similarly transformed passenger aviation with Pan Am. That's the nice thing about getting involved in transformative technologies when they are nascent: the leverage you have as an individual to affect outcome is so powerful, it is impossible to adequately express it in words - you have to "see it to believe it," or to understand it. 3) There is a tipping point between "idle bitching" (which is never idle - what people say about enterprises and products to others, is just like voting) and activism. That line is crossed when your criticism becomes substantial, focused and sustained. There is both a quantitative and a qualitative difference between saying, "I think McDonald's promoting their artery clogging food to children is despicable," and launching a website dedicated to putting them out of business, working to introduce legislation to ban Happy Meals, and picketing their eateries." Likewise, while there are tens, or hundreds of thousands of people who voice sympathy for the goals and position of the (very numerically small) "Patriot Movement" in the USA, there are very few Timothy Mc Veighs, who will blow up buildings. Thus, there is a tipping point between voicing criticism/support and becoming an activist. Nation-states spend billions of dollars trying to carefully determine when individuals of interest to them reach/exceed this tipping point, with respect to their national and international interests; and wisely so! 4) Not all activists are created equal. Lot's of peoples' kids have been abducted and "disappeared" or murdered by pedophile monsters. It happens every day. Some of these people are tongue tied and shy, others are permanently incapacitated by their grief and loss, and almost all of these suffering souls lack the unique mix of talent, drive, and native communication ability that John Walsh has. There, in fact, is a perfect example of the leverage of a single individual. When Adam Walsh was abducted and killed, he was just one of countless other victims whose cases were mishandled by law enforcement, and to which the public was largely indifferent. One man, Adam's father, John Walsh, changed that: and to the extent that pedophilia, violent and otherwise, has become a central issue in the US, and in most of Western Europe, John Walsh is significantly responsible (e.g., Adam's Law, America' s Most Wanted...). Anyone who thinks John Walsh is "just an average guy" is mistaken; he is an extraordinary man, with a unique blend of talents that made him, in conjunction with his tragic circumstances, one of the few, if not one of the the only people who could do what he did. 5) Melody Maxim is an articulate and reasonably intelligent person with above average communication skills, and technical expertise in an area of great use to cryonics. One has only to look at Jerry Leaf, who was in many ways similar to Maxim in technical acumen and in energy, interest in cryonics, and motivation to change it. Unlike Maxim, Jerry was not a prolific writer. However, what he was, was disgusted and appalled at what he saw when he arrived on the scene in cryonics in the 1970s. He soon became frustrated, and then downright angry at the intransigence he encountered on the part of many in cryonics to change. Indeed, the one cryonicist who Maxim does not materially criticize, and who she "get's on with," Bob Ettinger, was Jerry's most implacable "foe" in terms of interfere with Jerry's efforts to improve the level of patient care. Ettinger is a consummate politician, so this may not be obvious in his public statements, but the fact remains that it is so. Ettinger, and his late wife Mae Junod, were relentless in their resistance to even the most basic of changes, such as moving away from perfusion using embalming techniques, done recipe-style, with zero data collection and no public accountability (and for many years done with almost homeopathic levels of cryoprotection). Jerry's response was very different from Maxim' s. He got involved, he became confrontational, very confrontational, but in almost exclusively positive ways. He sought out anyone and everyone in cryonics who either shared, or could help him execute his vision of transforming cryonics from a ritualistic mortuary-style procedure, to a science and medicine based disciple with documentation, case analysis, and feedback - all of which allowed for progressive, positive evolution in the technology. 6) Ultimately, because he found then extant cryonics organizations so intractable, he DID have to found his own company to deliver cryonics services, Cryovita Labs. These efforts were tremendously successful. They transformed cryonics. And while many of those gains were lost with lost with his cryopreservation, and my abdication of responsibility to continue that effort, there is still a significant core of people trying very hard to achieve that level of excellence again, or at very least to "eliminate" the culture of errors and iatrogenesis which now dominate cryonics. 7) Maxim has now unarguably become an activist, and spends enormous amounts of time and effort on cryonics. She is actively involved in and encouraging both government regulation, and the banning of access by cryonics personnel to dying patients in hospital. She is doing these things absent input or collaboration from even a SINGLE committed cryonicist. She has attacked and belittled me, and yet she has provided not a single technical criticism of the large body of technical writing and work that I've done. Her two main points of attack are both based on distortions or lies.She repeatedly claims that I said I've done 1,000 dog perfusions and she also claims I've " lied about being a Board Eligible Perfusionist." Here is what I actually said: "If all I had was perfusion experience in cryonics; I'd have had essentially no experience at all. At one time I was told I was a Board eligible perfusionist (1970s), but I never sat for the Boards and quite honestly, I did very little clinical perfusion. I started out in extracorporeal medicine doing acute (ICU) hemodialysis and working in the dog lab doing CPB. My guess would be that I've pumped ~1,000 animals in my career; this is a trivial case load compared to that of a profession perfusionist over the same span of years. On the other hand, they call it a learning curve because it does plateau and after a certain amount of experience, animal or human, you do reach a level of knowledge and experience I liken to having learned to ride a bicycle. Having said, make no mistake about it, it has been 8 years since I 've done CPB and I would require substantial re-education in terms of my procedural skills and knowledge; reflexive behavior and immediately accessible knowledge and judgment. And this brings up THE critical point I was trying to make: there are two kinds of knowledge in a craft: didactic (book or factual knowledge) and procedural or hands-knowledge. To some extent it is almost impossible for most people to master didactic knowledge in a discipline like surgery, perfusion, or operating an automobile without also having procedural knowledge; actually DOING the tasks involved, like driving an automobile under real-world conditions if you want to be able to drive a car. " What I said (above) was that in 30+ plus years I've "pumped about 1,000 animals." That's probably true; I didn't keep statistics. I started perfusing animals when I was 14 years old - initially turtles, and then rats and guinea pigs. Most of these were not "survival" experiments, but the topic under discussion was the learning curve for perfusion technology. And a significant part of that learning curve is understanding the basic physiology and the mechanics and physics of the procedure. For instance, the relationship between cannula size and flow and back pressure, the effect of tubing diameter on flow under the influence of gravity (critical for obtaining adequate venous return) and the purpose, structure and performance of various circuit elements, such as type of pumps, filters/bubble traps, pressure monitoring equipment and so on. Many of these perfusions were cryoprotective perfusions, usually followed by freezing, in order to better understand cryoinjury. Many more were related to understanding ischemic injury, and ways to avoid it. Over 30 years I perfused turtles, rats, guinea pigs, cats, rabbits and dogs. Materially, I was at pains to point out that this did not make me in any way as qualified as a clinical perfusionist. What I didn't say, and should have, was that in some ways these experiences made me more qualified - in the setting of cryonics, because, for instance, perfusing cryoprotectants, reperfusing brains and bodies after prolonged ischemic intervals, and carrying out prolonged asanguineous perfusion at ~ 5 deg C, all require unique knowledge, insights and skills that a clinical perfusionist simply (and quite understandably) has no opportunity to gain experience with. Her second big gripe is that I said I was told I was eligible to become a Board Certified perfusionist in the mid-1970s. As I pointed out when I made this remark, this was not something I pursued. Perfusion was a relatively new field in the 1970s, and I do not know what the requirements were for Board Certification at that time. This is the back-story to that remark: The hospital where I worked as both an acute (ICU) and chronic (outpatient) dialysis technician in the 1970s had had a dog lab, which they had shuttered. When they decided to try to offer heart transplantation, they constructed a new facility and began an aggressive program of animal work to master the skills required. A number of the technical staff who had operated the previous dog lab had migrated in to hemodialysis and perfusion, and one these men had done both. He was a personal friend, and he became the manager of the new dog lab. I began volunteering in the dog lab, primarily as a " perfusionist," often working 3 and sometimes 4 days a week. This was where I first learned that dogs do not tolerate median sternotomies well (splitting the breast bone to gain access to the heart and lungs). The surgeon running the program was a jerk. He was the kind of guy who called highly competent scrub nurses "wastes of space" and "a waste of atoms," and who hurled $10K DeBakey major cardiovascular instrument trays across the OR, and upended back tables covered with costly instruments and basins of ice/fluids, when procedures failed. This surgeon killed more dogs than I could count - they died of pulmonary edema, one after the other: something he often blamed on the perfusionists. It wasn't until years later that I learned that none other than Christian Barnard, faced exactly the same problem when he was tooling up to do the first human heart transplant in 1967. Barnard was smart enough, and humble enough, to go to Russia and study under the maverick Russian surgeon Vladimir Demikhov, in order to master the SURGICAL technique required to get consistent survival of dogs in this model. However, humility was not this surgeon's strong suit, so the carnage continued, until another surgeon, skilled in cardiothoracic surgery in dogs using the median sternomoy approach, arrived on the scene. I don't know how many dogs we pumped, but it was a lot - because when one died acutely, this fool had another brought in. We would often bounce between the two ORs several times in a 12 hour day! I was also being taken to assist on human cases, and sometimes to run the pump solo. This was a different era in medicine. While most of us in hemodialysis (excepting the RN's) had no undergraduate degrees, those who were deemed capable, were placed in ICU, where they administered blood and blood products, dynamically adjusted ionotropes during the dialysis of critically ill and hemodynamically unstable patients, administered "dangerous" IV medications of all manner, including vancomycin, iron-dextran (Imferon), cisplatin, and just about any other drug that could be given while a patient was on dialysis (i.e., that bound to protein, or was otherwise not dialyzable). We did this because it saved work for the nursing staff, since the patient already their vascular system accessible, and large volumes of fluid could be given comparatively rapidly. AND that fluid could then be removed (leaving the drug behind); no small matter in patients who can't make urine and are restricted to ~1,000 mlL of fluid intake per day). I was told I would make a good perfusionist, and since the person who wanted to recruit me was a principal in the local AmSECT chapter, he told me that if I studied the materials for the exam that he gave me, and continued with clinical work, I would be eligible to sit for the boards under the " grandfather" rules. This was much the same position Jerry Leaf was in; the difference being that he was vastly more experienced than I, and had pumped hundreds of human cases, and countless dogs. I remember being told that the certification process was transitioning, or had just transitioned at that time (was becoming more rigorous), and I also recall being told that no undergraduate or graduate degree would be required, given my prior "history." To what extent this was true, I don't know. And it really didn't matter, because given my commitment to cryonics, it would have been logistically impossible. You can bail on dialysis to do a cryonics case, but at that time, it was not possible to do so in clinical perfusion without causing scheduling mayhem, and possibly jeopardizing lives. End of Part 1 Content-Type: text/html; charset="UTF-8" [ AUTOMATICALLY SKIPPING HTML ENCODING! ] Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=33441