Tag: Medicine

Cryonics, trans-temporal communism and future squatters

Cryonics advocate Eugen Leitl puts forward some hard-hitting and thought-provoking observations about cryonics (reminiscent of Mike Darwin’s more recent thoughts on the subject):

Cryonics, like Natural Selection, or the theories of General and Special Relativity, is core-smashing in character, and in the case of cryonics, the idea is so antithetical to the existing order of civilization that it can it only be advanced by insurgent means. This is so because cryonics overturns the Vitalistic view of life, challenges the conventional definition of death, invalidates the core tenets of contemporary medicine, erodes the need for a mystical afterlife, radically redistributes capital (disrupts inheritance, bequests, and mortuary customs), mandates a complete change in reproductive behavior, perturbs generational succession, requires space colonization, requires (and supports) profoundly disruptive technologies such as cloning, regenerative medicine, nanotechnology, artificial intelligence, and finally, ends the species and enables, if not requires Transhumanism. As a consequence, cryonics creates adverse emotional and intellectual states within the existing culture such as survivorship guilt, indefinitely extended anxiety and uncertainty accompanying life-threatening illness (the cryonics patient remains ‘critically ill’ for decades or centuries), prevents the psychological closure that accompanies “true” death with disposition of remains, creates indefinite anxiety about the well being of cryopreserved loved ones, disrupts the intimacy of family interactions during the “dying” process, may bitterly divide family members who are opposed to cryonics versus those who are in favour, and blocks or disrupts deeply held mechanisms for coping with death and bereavement that are inculcated from childhood by eliminating the customary wake, funeral, and other comforting rituals.

In particular, he opines that “the idea that cryonics was just an extension of medicine and is compatible with religion and existing social and political institutions, while superficially satisfying, is both mistaken and bound to fail.” After this observation one would expect him to advocate some radical form of transhumanism as a vehicle to promote cryonics. But he further believes that:

Distinct from initialization failures, there are inherent in cryonics several corrosive and self destructive ideas that have grown over time until they have virtually overwhelmed cryonics today. The first of these is “temporal load shifting,” or more colloquially, the problem of ‘our friends in the future…his causes cryonicists to increasingly shift the burdens, technological and financial, present and future, onto the people (supermen) who we believe will revive us from cryopreservation, a concept that may fairly be called Trans-Temporal Communism: from cryonicists now according our ability (none); and from our ‘supermen friends in the future’ according to our needs (infinite). Trans-Temporal Communism leads to the creation of ‘Future Squatters; people who believe that technological advances will happen when conditions are right for them to occur. This is a brilliant position because it is never wrong; it is the perfect piece of circular reasoning that justifies doing nothing. This creates a perverse situation wherein intelligent and talented people who enter cryonics do not, as might at first be thought, find it impossible to believe that cryonics, vast extension of the human life span, or, for that matter, many of the transformational technologies of Transhumanism are impossible, but rather they that find it not only believable, but inevitable that these developments will occur within their lifetimes (i.e., Kurzweil and deGray)….The Future Squatters who have come to dominate contemporary cryonics are not merely parasites content to sit and wait until robots show up at their doors with immortality on a silver platter, all too often they are actively contemptuous and dismissive of the (fewer and fewer) people working hard to build a practical, sustainable and robust cryonics that withstand the tests of time and deliver its patients to a future they have created; a future not only technologically capable of restoring them to life; but morally and financially impelled to do so, as well.

If one rejects both cryonics-as-medicine and the futurist / transhumanist vehicle to communicate the idea of cryonics, one wonders what the correct approach should be. The observation that “the core problem in cryonics is the absence of a philosophical and moral basis for cryonics and the accompanying ethics and dogma required to enforce it” does not seem to follow from the preceding observations.  Most importantly, what is this “philosophical and moral basis for cryonics” that is required, and why is it separate and different from the general moral conduct that social interaction and reason generate?

It is becoming clearer and clearer that demonstrating the technological feasibility of cryonics is not sufficient for the acceptance of cryonics. There seems to be a growing consensus that “fear of the future” and lack of closure are among the biggest hurdles for giving the idea a charitable hearing.  But little thought is being given to this topic, and it is quite correct that this omission can be squarely attributed to a kind of simplistic futurism that is circulating in cryonics circles. If  even most self-identified transhumanists cannot bring themselves to make cryonics arrangements, why would one expect the rest of the population to embrace the idea?

Cryonics advocates often seem to believe that if they refute the common scientific and technical objections to cryonics (which is not that hard to do because the psychological resistance to the idea prevents critics of checking even the most basic facts about the rationale and practice of cryonics) the social and psychological reservations will take care of themselves. This is not just incorrect, such reservations are often the most fundamental.

One would be surprised if an invasive, experimental medical procedure would lack detailed information about post-procedure care, responsibilities of  the hospital and family members, and reintegration. Considering that for many people cryonics constitutes a solitary leap into an unknown and far-away future, is it reasonable that providers of such care, and advocates of cryonics, think about doing a better job of responding to these concerns. This is mostly unexplored territory because even the most alienating events in human life as we know it cannot capture this aspect of cryonics.  It is doubtful that such concerns can be removed by altering the philosophical and moral basis of cryonics.

The pursuit of cryonics as medicine

The biggest obstacle to the acceptance of cryonics is medical myopia; the idea that someone who has been pronounced dead by contemporary medical criteria will still be considered dead by future criteria. Advocates of human cryopreservation strongly argue against this. There are few things more discomforting than the idea that medical professionals of the future will look back in horror and wonder why we gave up on people who still possessed the neuroanatomical basis of their identities and memories.

But there is another kind of myopia in the public discussion of cryonics that warrants consideration. It is taken for granted by some critics of contemporary cryonics that cryonics has always been framed as a form of medicine. Nothing could be further from the truth. The history of cryonics is replete with debates between advocates of the medical model and those who believe that timely transport of the patient to a cryonics facility for low temperature storage should be adequate for future resuscitation by advanced nanotechnology. It is only because  cryonics advocates with medical and research backgrounds such as Mike Darwin and Jerry Leaf vigorously argued for adopting conventional medical techniques and protocols that today’s cryonics organizations can even be criticized  for falling short of these criteria.

There is a silver lining to a lot of the controversy that surrounds today’s cryonics . Critics now adopt the premise that cryonics is a form of medicine to make a case against practices they consider suboptimal.  It was not long ago that public critics of cryonics simply dismissed the whole idea as pseudo-science. This was never a sophisticated response but ongoing advances in cryobiology (such as vitrification of the central nervous system) and synthetic biology/nanotechnology have made this position even more of a showcase of ignorance. When people read the news about animals being cloned from straight frozen DNA they will be less receptive to tendentious claims that existing cryonics technologies are hopelessly inadequate to preserve the identity of a person.

The current development in which cryonics is being criticized from a clinical framework should have positive effects on how cryonics will be approached from a regulatory framework. It does not make sense to argue that cryonics is a pseudo-science and offering false hope but at the same time insist that cryonics organizations adopt high standards of medical care. The acceptance of the concept of “patient care” in cryonics would be incoherent without (implicitly) embracing the premise that cryonics patients have interests and deserve legal recognition of that fact. As more public information is disseminated about the quality of brain vitrification that is possible today, the need to recognize cryonics as an elective medical procedure will receive more attention from bioethicists and medical professionals.

There are those who believe that the acceptance of cryonics itself is being held back by amateurism. If this is the case there should be unexploited profit opportunities for cryonics providers that pursue the highest standards of medical care.

The future of Alcor

Alcor’s recent news item about its 2009 Annual Board Meeting and Strategic Meeting contains a number of encouraging statements. On the front of institutional reform, however, there is not much news to report. The passage about the need to balance recruiting new Board members and preserving institutional memory reads as a rather uninspired defense of the Board’s recent decisions. In light of the growing recognition that most of Alcor’s problems over the years can be tracked back to the composition and functioning of the Board of Directors, one would have expected more innovation on this front.  A major problem with a self-perpetuating Board of Directors remains that there are few mechanisms available in case a competent Board of Directors would change in an incremental fashion into a contra-productive Board. Perhaps the idea of term limits could prevent such scenarios.

In particular, there is an urgent need to adopt institutional changes that can prevent the highly variable quality of patient care that has been observed in the history of the organization.  Another challenge that remains is the recruiting of  additional Board members with a strong knowledge of Alcor’s technical operations and the delivery of standby services. Without this knowledge (and some degree of common sense) it is highly unlikely that the Board can do a serious job of overseeing such matters.

One of the most positive items in Alcor’s report is the recognition that Alcor would benefit from substantial cost savings in its operations.  Throughout most of Alcor’s history the organization has been dependent on (unpredictable) donations from wealthy members to sustain normal operations.  Obviously, this way of funding the operations of a cryonics organization (as opposed to long term patient care) constitutes an irresponsible gamble. Donors should be commended for being reluctant to contribute to Alcor (any further) until Alcor has shown evidence of getting its financial house in order. A number of sensible proposals were discussed to generate more structural income for the organization such as increasing membership dues, raising cryopreservation minimums, introducing a recommended funding level (as opposed to just a minimum funding level), and creating income-generating endowments.

One aspect that is largely ignored in this report, however, is the potential for substantial cost reductions in Alcor’s daily operations itself. For most of its history Alcor used to be rather transparent about staff member salaries in its communications and the magazine. It may not be a coincidence that this practice disappeared  during the period when Alcor saw substantial increases in compensation for (some of) its staff members. To give some perspective, the old Tim Freeman Cryonics FAQ included the following question and answer:

7-2.  Is anyone getting rich from cryonics?  What are the salaries at these organizations like?

In December 1990, Cryonics magazine reported that the Board of Directors of Alcor voted a 25% pay cut for all of the staff, so they could keep their budget balanced.  Many of the Directors are also on the staff.  The salaries after the cut ranged from $22,500 annually for the highest paid full-time employee (the President) to $14,400 for the lowest-paid full-time employee.  None of the Alcor staff are getting rich from their salaries.

It would be a worthwhile undertaking to do a comprehensive study of Alcor’s staff and consultant compensation history and policies (or lack thereof). There is never a shortage of arguments to justify higher compensation and ad-hoc decision making in cryonics, but it is doubtful that generous salary increases in the industry over the years were necessary to recruit or retain competent staff members. It might even be argued that a number of problems in cryonics are actually linked to offering wages that exceed what the employees who receive them would otherwise earn in the market place. Similarly, substantial cost savings can be obtained by increasing productivity and decreasing staff members. Issues of compensation and staff efficiency should be essential topics of consideration in any serious discussion about Alcor becoming more self-sustaining and less dependent on wealthy donors.

Another topic that deserves attention in this context is that all of Alcor’s major technologies (medications protocols, organ preservation solutions, vitrification agents) are licensed to the organization by independent research labs. Although Alcor itself is mostly to blame for not having developed competing technologies of its own since the mid-1990s, it is important to recognize this dependence. At the very least, Alcor could benefit from a cost-benefit analysis of some of these technologies and from developing contingency plans to deal with scenarios in which these technologies would no longer be available or cost-prohibitive.

During most of its history Alcor (and later, CryoCare) promoted the idea of cryonics as a medical procedure and criticized other cryonics organizations like the Cryonics Institute for being overly optimistic and reckless.  In an ironic twist of fate, some critics of Alcor now use this perspective to criticize the organization for not living up to the idea of cryonics as medicine. As a general rule, this is to be welcomed. Where this criticism can go off track, however, is when it is insufficiently recognized that knowledge of conventional medicine is a necessary, but not a sufficient, condition to do good cryonics. One of the worst scenarios for the future of cryonics is one in which regulators impose standards upon cryonics organizations that  actually increase the challenges of providing good patient care; something that has happened already in the case of the Cryonics Institute when the organization was forced to perform a complex technical procedure like cryoprotective perfusion at a funeral home.

Faced with the technical complexities of ramped cryoprotective perfusion, Alcor has decided to develop a system that not only uses software to record perfusion parameters (concentration, pressure, temperature, refractive index etc.) but to use the same software to control them as well. Provided that this new system lives up to its expectations, this development will be a major step towards a system that can use real-time feedback to adjust perfusion parameters in a manner that so far has only been available in small organ cryobiological research. The data that will be generated during cases can, in turn, be used to create cases reports that follow a consistent, formal standard. When these reports are used in an intelligent fashion, the prospect of developing technologies and protocols that can reduce the high variability in patient care will be feasible.

Gender differences in stroke treatment and prevention

Over the years, experimental science has developed a standard protocol for the testing of medical hypotheses using animal models which calls for the use of males only. Why? Because no laboratory scientist wants to deal with those pesky female hormones. Female hormone fluctuations are viewed as just another variable to be controlled (generally by excluding females altogether) — all the better for making interpretation of results simple and straightforward.

But, as common sense might dictate, it turns out that results from male-only animal models often give a less-than-accurate view of the whole picture when this research is translated and applied to treatment of disease in humans. Why? Because, as most people without a doctorate in physiology can tell you, physiological gender differences exist. Is it any surprise, then, that disease treatment and prevention should also be prescribed with these physiological differences in mind?

And so the buzz for the past few years in the medical community is the astonishing fact that stroke treatment and prevention are not the same in men and women. In labs that have recently begun to investigate these differences, drugs that were found to protect male brains against stroke in animal models did nothing to protect female brains. The major message behind all this press: doctors cannot continue to apply one-size-fits-all prescriptions for stroke prevention and treatment.

The real fact is that it is even more complicated than a “simple” physiological difference. Traditionally, cardiovascular disease has been viewed as a “man’s disease” (men have about a 19 percent greater chance of stroke than women). Accordingly, studies have found that women are less likely to receive prescriptions for blood pressure medications or be advised to take aspirin, both of which have been shown to reduce stroke risk. Strangely, women are less often treated after having a stroke, even though they appear to respond better to acute stroke treatment (such as tissue plasminogen activator) than men. So while men do indeed have more strokes, women are still more likely to die from stroke.

Women are also at increased risk if they take birth control pills, use hormone replacement therapy, have a thick waist and high triglycerides, or are migraine sufferers. And, contrary to anecdotal evidence, women appear to be less likely to go to the hospital at the first sign of stroke symptoms.

Oregon Health and Science University is at the forefront of research into gender differences in medicine, having developed the first research institute of its kind, the OHSU Research Center for Gender-Based Medicine. Given that Oregon recently ranked 46th out of 50 states for incidence of stroke deaths among women (as reported by Making the Grade on Women’s Health: A National and State-by-State Report Card, 2007), there is obviously a need for gender-based medical research to save the lives of women at increased risk of cardiovascular and other disease.

Life not death

The idea that cryonics does not involve the freezing of “dead” people but is form of low temperature care to prevent death is almost as old as the idea of cryonics itself. In May 1968, Cryonics Reports, the publication of the Cryonics Society of New York (CSNY), writes that recognition of cryonics as a form of treatment to be administered prior to death should help overcome a major psychological impediment to its acceptance and major step forward in redirecting the aim of medicine.

LIFE NOT DEATH

Only scientific research will provide the understanding that will lead to changes in human growth and development. But to bring about these changes it must be applied to human beings. The aim of medicine is to sustain and improve life. It is therefore mandatory for the physician to utilize every known treatment in order to save a patient. Cryonic suspension is a known means of treatment, because freezing a body definitely prevents physical deterioration. The goal of cryonic suspension is preservation and it works!

The fact that resuscitation after freezing is presently impossible is irrelevant if there is the slightest chance that it will be possible in the future. By freezing the body we are stopping the spread of a condition that is certain to destroy it completely. This is a desirable and valid goal.

Perhaps the major psychological impediment to acceptance of the treatment is the concept of freezing after “death.” When we refer to “death” we mean legal death only. Because we believe it may be possible ultimately to revive a patient placed in cryonic suspension, we do not regard that patient as “dead” biologically.

A patient is declared “dead” when the attending physician decides that resuscitation is impossible by any known or available means. Death is not synonymous with absolutely irreversible damage, but only damage that can not be reversed at the time of treatment. Resuscitation technology is improving constantly; conditions that are irreversible today will easily be reversible tomorrow.

It would seem, therefore, that the term “death” should be reserved only for those special circumstances in which it is impossible to place the patient in cryonic suspension. After freezing or supercooling, the patient should be declared “in suspension.” This should be considered a temporary condition of indefinite duration.

The general acceptance of the idea that cryonic suspension is a treatment to be administered prior to “death” not after, would be a major step in crystallizing and redirecting the aim of medicine, saving the lives of many people, and clearing a pathway for an all-out drive to conquer aging.

Cryonics Reports, Vol. 3, No. 5, May 1968