Mike, let’s be fair about this. Veterinary surgeons for thoracic surgery (after loss of Jerry Leaf) and chemists for running perfusion machines were also used during your tenure managing biomedical affairs at Alcor two decades ago. You trained and utilized lay people to do all kinds procedures that would ordinarily be done by medical or paramedical professionals, including establishing airways, mechanical circulation, and I.V. administration of fluids and medications. Manuals provided to lay students even included directions for doing femoral cutdown surgery.
The good cases that you were able to do with lay help (and being only a dialysis technician by credential yourself) are the stuff of cryonics legend. That was how cryonics was done back then. With the resources that were available then, and the need to provide cryonics response over vast geographic areas, using trained lay cryonicists was the most effective way to deliver cryonics care for many years. Some history of this is discussed here
In the 2000s Alcor began to supplement trained lay cryonicist teams by deploying a staff paramedic to cases whenever possible. In the 2010s, Alcor began using Suspended Animation, Inc., more extensively. As announced here,
Alcor policy is now to use Suspended Animation, Inc.., (SA) for all cases in the continental U.S. outside of Arizona which SA can reach in time. Local trained lay teams are now only used as first responders, bridging time between notification of emergencies and arrival of SA.
The significance of this is that SA now uses board certified cardiovascular surgeons and certified clinical perfusionists on almost all cases. I’ve met two of SA’s contract cardiovascular surgeons, one of whom trained under Michael DeBakey. These are top-rank professionals who go out on cryonics standbys, and get cryonics patients on cardiopulmonary bypass faster than ever before in cryonics. They established fem-fem bypass on one patient last year in only 15 minutes.
These are professional surgeons and perfusionists who do median sternotomies and cannulations so fast that in their day jobs they actually save patients who suffer cardiac arrest from fixable causes (e.g. “fatal” DVTs). This is now the level of care available under ideal circumstances in cryonics.
In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years. Alcor has transitioned toward utilization of professionals whenever possible or practical. There are now more medical professionals doing the work of cryonics than ever before in the history of cryonics; not just scientists and technicians, but actual clinicians.
You are also mistaken, at least partially, about utilization of animal models in training. Even though professional surgeons and perfusionists already have extensive and ongoing clinical experience, SA uses a porcine model to train its contract surgeons, perfusionists, and other personnel in the specific procedures of cryonics.
There are shortcomings to this model. Contract clinicians are extremely skilled at specific procedures that must be done, but they are not cryonicists. For example, they don’t understand cerebral ischemic injury, its mechanisms, and significance in the context of cryonics. This can hypothetically lead to difficulties understanding and managing cases with moderate periods of warm ischemia that would ordinarily be “written off” in conventional medicine. Cryonicist involvement is still essential. However on balance, as measured by the speed and competent handling of standbys and transports in which they have been involved, participation of cardiovascular surgeons and perfusionists has been very positive. I hope we can continue to afford it.
Brian, when you say: “Mike, let’s be fair about this. Veterinary surgeons for thoracic surgery (after loss of Jerry Leaf) and chemists for running perfusion machines were also used during your tenure managing biomedical affairs at Alcor two decades ago. You trained and utilized lay people to do all kinds procedures that would ordinarily be done by medical or paramedical professionals, including establishing airways, mechanical circulation, and I.V. administration of fluids and medications. Manuals provided to lay students even included directions for doing femoral cutdown surgery,” you are either not reading what I wrote or are not being fair yourself. I not only acknowledge that this was so, I go so far as to say it is completely acceptable with the caveat that such people are instructed, vetted and mentored properly. I’ll go even further (as I have repeatedly, elsewhere) and state that the most highly qualified medical personnel can be dangerous, or even worse than useless unless they have been trained and mentored in human cryopreservation as a specialty. There’s nothing remarkable about this; no reasonable person would want a psychiatrist or a dermatologist doing bowel or brain surgery.
Some of the same people who performed very well in the past, and who are not medically qualified, are still at Alcor. The individual people, per se (in this instance), are not the problem. Rather, it’s the absence of the paradigm of cryonics as a professional medical undertaking that’s missing. The evidence for that is present in Alcor’s own case histories where highly qualified medical personnel do things like discontinue cardiopulmonary support on still warm patients in order to open their chests for cannulation (http://alcor.org/Library/pdfs/casereportA2435.pdf) or drill burr holes without irrigating the drilling site with chilled fluid to prevent regional heating of the brain under the burr. We are in complete agreement on these issues, as far as I can tell. Where we apparently differ is on how to resolve them.
The most interesting thing to me about this post from Brian is information it communicates for the first time. I follow Alcor’s announcements, read its magazine and track its public blog, as I necessarily must, so I am surprised to learn that “In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years.” This is the kind of information that I would expect to see showcased in the organization’s literature and on its website, not disclosed here. This is the kind of thing that happens over and over and which degrades member confidence in the transparency of the organization. The next question is, who what, where and how? What are the details of this training? What kind of model is being used? What are the results to date?
Yes, SA does use pigs for training, but they use them in a non-survival mode—they get no robust feedback about errors, and no new insights. In fact, Brian might have mentioned that Alcor has used both animals and human cadavers in this manner, but I think he understood that the point I was making was about vetting your skills in an outcome driven fashion. That is not being done.
What’s even more disturbing is that there is virtually no visibility into the outcome from even these training operations. SA and Alcor are both essentially black boxes—there is no data, no performance reports, not even any reports or internal scoring of how well simulated cases proceeded. There’s at least one reason for this, and that is that there is no scoring system, internal or external. When things go wrong, well, it’s oops, we shouldn’t do that next time. And if that isn’t the case, then I’d love to hear it and I want to see the data to document it. That is an eminently reasonable request.
It’s great that Alcor can sometimes mount skilled perfusionists and highly skilled emergency vascular surgeons. But that isn’t the issue. The issue is the framework of knowledge, understanding and consistent performance that is absent. A surgeon or a perfusionist are, absent mentoring (internship), TOOLS to be used by and within that framework. If a man tells me he has the best glass cutting tool money can buy, but he doesn’t know how to cut glass, well, I’m going to be underwhelmed.
Alcor patient case reports are disorganized, inconsistent and erratic narratives that make objective evaluation impossible. No great genius is required to consistently collect and organize the key data that define how well a case went—or didn’t. The first cryonics case report was done by a 17 year old and a 22 year old graduate student:
Examples of competently executed cases and case reports are available on Alcor’s own web site and the data captured, reduced and presented in these case reports was achieved using a tiny fraction of the financial and personnel resources Alcor currently has available:
I’m not trying to be contrary, difficult, or unreasonable. What I am asking for is core competence, not perfection. There is nothing either exotic or impossible in that. For example, Alcor has a Novametrix CO2SMO capnograph and respiratory function analyzer. The device can effortlessly capture and write to disk over 60 different respiratory parameters and it measures the end-tidal expired carbon dioxide (EtCO2) in the patient’s breath. The EtCO2 is the gold standard for determining how effective cardiopulmonary support (CPS) is. And if CPS is not effective, than that is both additional ischemic time the patient is experiencing and it is an opportunity to intervene and fix the situation. Or at worst, it offers the possibility of learning what caused inadequate CPS so that it might be avoided next time. The only skill required to use the device is to put the walnut sized sensor in line between the patient’s airway and the ventilator on the LUCAS CPR machine: http://frankshospitalworkshop.com/equipment/documents/pulse_oximeter/user_manuals/Novametrix_8100_-_User_manual.pdf
That should make it easily possible to produce graphic data like this:
THAT kind of data speaks definitively to how that patient was stabilized and transported, and in aggregate it provides a statistical dataset that speaks to the overall performance of the organization. It should be accompanied with graphic data for the patient’s TEMPERATURE, mean arterial pressure (until the time of arrest), the SpO2 (pulse ox) and other relevant data. This was done in the past by stressed out, sleep deprived, mostly volunteer people who were trained in-house. If that kind of data collection and accountability are considered “perfectionist,” or some kind of golden past no longer to be achieved, then I restate my opinion that something is terribly wrong.
Paramedics are taught that the single most important and most critical indication of the efficacy, or lack thereof, of CPR is the EtCO2 of the patient over time. Where is this data???? This is only one of countless examples I could use—but it is especially relevant because it is simple data to collect, and I know from Alcor’s recent case reports that they have a CO2SMO and they are actually using it on patients during the peri-arrest hospice period. Again, where is the data? That data is the ONLY way anyone has to evaluate the quality of cryonics cases because the patients cannot speak to us.
If you want to stop my criticisms, you need only show me the data and offer me and everyone else the opportunity to be reasonably certain it is valid and representative.
Your points are mostly well-taken, Mike. Not everything is better than it used to be. While the basic cryopreservation technology (vitrification) is better, and some important aspects of service delivery are better, Alcor does not have in-house expertise comparable to the era of you and Jerry Leaf. With the benefit of hindsight, I would say that people of such caliber willing to devote their life to cryonics are a historical anomaly not amenable to formulaic replication.
With respect to communications, the two new potential O.R. surgeons I spoke of were not a public announcement being withheld because Alcor is opaque and untrustworthy. Contact was made with them only within the past few weeks, as discussed at a recent public board meeting. I mentioned them only because your message seemed to imply that Alcor was content with the status quo.
I confess that you have a knack for twisting the knife of public criticism in ways that prompt me to “announce” things that aren’t ripe for announcement, and that lead to more questions and criticism. When will I learn? :)
“I follow Alcor’s announcements, read its magazine and track its public blog, as I necessarily must, so I am surprised to learn that “In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years.” This is the kind of information that I would expect to see showcased in the organization’s literature and on its website, not disclosed here. This is the kind of thing that happens over and over and which degrades member confidence in the transparency of the organization. ”
In fact, I did mention the new surgeons, briefly, in an Alcor News post on April 2:
http://www.alcor.org/blog/?p=2518
And similarly in the issue of Cryonics magazine now in production. Since we are just starting to work with these surgeons, it didn’t yet seem appropriate to report much more. We are continually reporting on just about everything. Your attempt to cast Alcor as non-transparent should be obviously false to anyone who looks at what we communicate.
I think I’m missing something here. As I understand it, you (Mike Darwin) have a great deal of experience and expertise in the actual practice of cryonics, as well as a lot of actionable recommendations. The current staff at Alcor (e.g., Max More) seem to take you seriously.
Is it a silly question to ask why you’re not working for Alcor?
Mike, let’s be fair about this. Veterinary surgeons for thoracic surgery (after loss of Jerry Leaf) and chemists for running perfusion machines were also used during your tenure managing biomedical affairs at Alcor two decades ago. You trained and utilized lay people to do all kinds procedures that would ordinarily be done by medical or paramedical professionals, including establishing airways, mechanical circulation, and I.V. administration of fluids and medications. Manuals provided to lay students even included directions for doing femoral cutdown surgery.
http://www.alcor.org/Library/html/1990manual.html
The good cases that you were able to do with lay help (and being only a dialysis technician by credential yourself) are the stuff of cryonics legend. That was how cryonics was done back then. With the resources that were available then, and the need to provide cryonics response over vast geographic areas, using trained lay cryonicists was the most effective way to deliver cryonics care for many years. Some history of this is discussed here
http://www.alcor.org/Library/html/professionals.html
In the 2000s Alcor began to supplement trained lay cryonicist teams by deploying a staff paramedic to cases whenever possible. In the 2010s, Alcor began using Suspended Animation, Inc., more extensively. As announced here,
http://www.alcor.org/blog/?p=2174
Alcor policy is now to use Suspended Animation, Inc.., (SA) for all cases in the continental U.S. outside of Arizona which SA can reach in time. Local trained lay teams are now only used as first responders, bridging time between notification of emergencies and arrival of SA.
The significance of this is that SA now uses board certified cardiovascular surgeons and certified clinical perfusionists on almost all cases. I’ve met two of SA’s contract cardiovascular surgeons, one of whom trained under Michael DeBakey. These are top-rank professionals who go out on cryonics standbys, and get cryonics patients on cardiopulmonary bypass faster than ever before in cryonics. They established fem-fem bypass on one patient last year in only 15 minutes.
http://www.alcor.org/blog/?p=2175
Another patient was placed on bypass only 7 minutes after arrival in SA’s vehicle using emergency median sternotomy, never before done in cryonics.
http://www.alcor.org/blog/?p=2267
These are professional surgeons and perfusionists who do median sternotomies and cannulations so fast that in their day jobs they actually save patients who suffer cardiac arrest from fixable causes (e.g. “fatal” DVTs). This is now the level of care available under ideal circumstances in cryonics.
In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years. Alcor has transitioned toward utilization of professionals whenever possible or practical. There are now more medical professionals doing the work of cryonics than ever before in the history of cryonics; not just scientists and technicians, but actual clinicians.
You are also mistaken, at least partially, about utilization of animal models in training. Even though professional surgeons and perfusionists already have extensive and ongoing clinical experience, SA uses a porcine model to train its contract surgeons, perfusionists, and other personnel in the specific procedures of cryonics.
There are shortcomings to this model. Contract clinicians are extremely skilled at specific procedures that must be done, but they are not cryonicists. For example, they don’t understand cerebral ischemic injury, its mechanisms, and significance in the context of cryonics. This can hypothetically lead to difficulties understanding and managing cases with moderate periods of warm ischemia that would ordinarily be “written off” in conventional medicine. Cryonicist involvement is still essential. However on balance, as measured by the speed and competent handling of standbys and transports in which they have been involved, participation of cardiovascular surgeons and perfusionists has been very positive. I hope we can continue to afford it.
Brian, when you say: “Mike, let’s be fair about this. Veterinary surgeons for thoracic surgery (after loss of Jerry Leaf) and chemists for running perfusion machines were also used during your tenure managing biomedical affairs at Alcor two decades ago. You trained and utilized lay people to do all kinds procedures that would ordinarily be done by medical or paramedical professionals, including establishing airways, mechanical circulation, and I.V. administration of fluids and medications. Manuals provided to lay students even included directions for doing femoral cutdown surgery,” you are either not reading what I wrote or are not being fair yourself. I not only acknowledge that this was so, I go so far as to say it is completely acceptable with the caveat that such people are instructed, vetted and mentored properly. I’ll go even further (as I have repeatedly, elsewhere) and state that the most highly qualified medical personnel can be dangerous, or even worse than useless unless they have been trained and mentored in human cryopreservation as a specialty. There’s nothing remarkable about this; no reasonable person would want a psychiatrist or a dermatologist doing bowel or brain surgery.
Some of the same people who performed very well in the past, and who are not medically qualified, are still at Alcor. The individual people, per se (in this instance), are not the problem. Rather, it’s the absence of the paradigm of cryonics as a professional medical undertaking that’s missing. The evidence for that is present in Alcor’s own case histories where highly qualified medical personnel do things like discontinue cardiopulmonary support on still warm patients in order to open their chests for cannulation (http://alcor.org/Library/pdfs/casereportA2435.pdf) or drill burr holes without irrigating the drilling site with chilled fluid to prevent regional heating of the brain under the burr. We are in complete agreement on these issues, as far as I can tell. Where we apparently differ is on how to resolve them.
The most interesting thing to me about this post from Brian is information it communicates for the first time. I follow Alcor’s announcements, read its magazine and track its public blog, as I necessarily must, so I am surprised to learn that “In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years.” This is the kind of information that I would expect to see showcased in the organization’s literature and on its website, not disclosed here. This is the kind of thing that happens over and over and which degrades member confidence in the transparency of the organization. The next question is, who what, where and how? What are the details of this training? What kind of model is being used? What are the results to date?
Yes, SA does use pigs for training, but they use them in a non-survival mode—they get no robust feedback about errors, and no new insights. In fact, Brian might have mentioned that Alcor has used both animals and human cadavers in this manner, but I think he understood that the point I was making was about vetting your skills in an outcome driven fashion. That is not being done.
What’s even more disturbing is that there is virtually no visibility into the outcome from even these training operations. SA and Alcor are both essentially black boxes—there is no data, no performance reports, not even any reports or internal scoring of how well simulated cases proceeded. There’s at least one reason for this, and that is that there is no scoring system, internal or external. When things go wrong, well, it’s oops, we shouldn’t do that next time. And if that isn’t the case, then I’d love to hear it and I want to see the data to document it. That is an eminently reasonable request.
It’s great that Alcor can sometimes mount skilled perfusionists and highly skilled emergency vascular surgeons. But that isn’t the issue. The issue is the framework of knowledge, understanding and consistent performance that is absent. A surgeon or a perfusionist are, absent mentoring (internship), TOOLS to be used by and within that framework. If a man tells me he has the best glass cutting tool money can buy, but he doesn’t know how to cut glass, well, I’m going to be underwhelmed.
Alcor patient case reports are disorganized, inconsistent and erratic narratives that make objective evaluation impossible. No great genius is required to consistently collect and organize the key data that define how well a case went—or didn’t. The first cryonics case report was done by a 17 year old and a 22 year old graduate student:
http://www.lifepact.com/images/MTRV3N1.pdf
Examples of competently executed cases and case reports are available on Alcor’s own web site and the data captured, reduced and presented in these case reports was achieved using a tiny fraction of the financial and personnel resources Alcor currently has available:
http://www.alcor.org/Library/html/casereport8511.html
http://alcor.org/Library/html/fried.html
http://alcor.org/Library/html/casereportC2150.htm
http://alcor.org/Library/html/casereport8504.html
LOOK AT THESE CARE REPORTS CAREFULLY and then look at those on the Alcor website from 1997 forward: http://www.alcor.org/Library/index.html#casereports
I’m not trying to be contrary, difficult, or unreasonable. What I am asking for is core competence, not perfection. There is nothing either exotic or impossible in that. For example, Alcor has a Novametrix CO2SMO capnograph and respiratory function analyzer. The device can effortlessly capture and write to disk over 60 different respiratory parameters and it measures the end-tidal expired carbon dioxide (EtCO2) in the patient’s breath. The EtCO2 is the gold standard for determining how effective cardiopulmonary support (CPS) is. And if CPS is not effective, than that is both additional ischemic time the patient is experiencing and it is an opportunity to intervene and fix the situation. Or at worst, it offers the possibility of learning what caused inadequate CPS so that it might be avoided next time. The only skill required to use the device is to put the walnut sized sensor in line between the patient’s airway and the ventilator on the LUCAS CPR machine: http://frankshospitalworkshop.com/equipment/documents/pulse_oximeter/user_manuals/Novametrix_8100_-_User_manual.pdf That should make it easily possible to produce graphic data like this:
http://i293.photobucket.com/albums/mm55/mikedarwin1967/EtCO2inCPSgraph.png
THAT kind of data speaks definitively to how that patient was stabilized and transported, and in aggregate it provides a statistical dataset that speaks to the overall performance of the organization. It should be accompanied with graphic data for the patient’s TEMPERATURE, mean arterial pressure (until the time of arrest), the SpO2 (pulse ox) and other relevant data. This was done in the past by stressed out, sleep deprived, mostly volunteer people who were trained in-house. If that kind of data collection and accountability are considered “perfectionist,” or some kind of golden past no longer to be achieved, then I restate my opinion that something is terribly wrong.
Paramedics are taught that the single most important and most critical indication of the efficacy, or lack thereof, of CPR is the EtCO2 of the patient over time. Where is this data???? This is only one of countless examples I could use—but it is especially relevant because it is simple data to collect, and I know from Alcor’s recent case reports that they have a CO2SMO and they are actually using it on patients during the peri-arrest hospice period. Again, where is the data? That data is the ONLY way anyone has to evaluate the quality of cryonics cases because the patients cannot speak to us.
If you want to stop my criticisms, you need only show me the data and offer me and everyone else the opportunity to be reasonably certain it is valid and representative.
Your points are mostly well-taken, Mike. Not everything is better than it used to be. While the basic cryopreservation technology (vitrification) is better, and some important aspects of service delivery are better, Alcor does not have in-house expertise comparable to the era of you and Jerry Leaf. With the benefit of hindsight, I would say that people of such caliber willing to devote their life to cryonics are a historical anomaly not amenable to formulaic replication.
With respect to communications, the two new potential O.R. surgeons I spoke of were not a public announcement being withheld because Alcor is opaque and untrustworthy. Contact was made with them only within the past few weeks, as discussed at a recent public board meeting. I mentioned them only because your message seemed to imply that Alcor was content with the status quo.
I confess that you have a knack for twisting the knife of public criticism in ways that prompt me to “announce” things that aren’t ripe for announcement, and that lead to more questions and criticism. When will I learn? :)
“I follow Alcor’s announcements, read its magazine and track its public blog, as I necessarily must, so I am surprised to learn that “In Alcor’s O.R., Alcor is presently evaluating and training two board certified general surgeons to supplement the veterinary surgeon and neurosurgeon who have been used by Alcor for the past 15 years.” This is the kind of information that I would expect to see showcased in the organization’s literature and on its website, not disclosed here. This is the kind of thing that happens over and over and which degrades member confidence in the transparency of the organization. ”
In fact, I did mention the new surgeons, briefly, in an Alcor News post on April 2: http://www.alcor.org/blog/?p=2518 And similarly in the issue of Cryonics magazine now in production. Since we are just starting to work with these surgeons, it didn’t yet seem appropriate to report much more. We are continually reporting on just about everything. Your attempt to cast Alcor as non-transparent should be obviously false to anyone who looks at what we communicate.
I think I’m missing something here. As I understand it, you (Mike Darwin) have a great deal of experience and expertise in the actual practice of cryonics, as well as a lot of actionable recommendations. The current staff at Alcor (e.g., Max More) seem to take you seriously.
Is it a silly question to ask why you’re not working for Alcor?
Dig into Mike Darwin a little more. He was president of Alcor from 1983 to 1988.