Wait but Why

[jordansparks]

There's a fairly well written article about cryonics here:
https://waitbutwhy.com/2016/03/cryonics.html
But the ideas that it lays out are flawed, and are based on the utopian Alcor and CI themes instead of on science.
1. Become a member, get a life insurance policy, wear a bracelet, die. This might make you feel good, but it won't help you survive. The exception is if you live in Detroit, Phoenix, or maybe LA. If you live anywhere else, all you've done is purchase alternative funeral arrangements. The cryonics companies are naive to suggest otherwise. (I'm not going to call them dishonest because I think they actually believe this BS). The "cryonics window" is extremely short (when it exists at all) because of the difficulty of getting chemicals into old deteriorated capillaries. These are not healthy brains.
2. Cool off and get transferred. Unfortunately, surface cooling is too slow. At the same time, internal cooling is too complicated, as is very obvious from just reading through any case reports. Internal cooling takes far too long, and then it nearly always fails anyway. Cooling off and getting transferred may prevent outright necrosis, but it will not preserve your mind.
3. Get vitrified to be brought back in near-perfect condition. That link is to ACS with no delay, healthy brains, and aldehyde stabilization. That has no connection at all to the service that cryonics companies are hawking.
4. Blue-Green-Yellow segments. The quality of the preservation will not affect the time needed to bridge the gap. Every single cryonics patient is damaged at the molecular level, so there's no such thing as "higher-quality" that could shorten your preservation. That's a myth. The blue line in the graphs should be essentially horizontal until just a few years before the yellow diagonal line would hit it. There is no last in first out except for those last few cases over 100 years from now. I don't mind showing the yellow line curving up, but that blue line needs to stay horizontal.
5. Pascal's Wager should not be rehashed for cryonics. It suffers from the fallacy of "avoiding the wrong hell". This is far more relevant than you might first imagine. What if you pick the wrong kind of cryonics? What if the current popular cryonics is useless, and there's a slightly different procedure that works better? You've avoided the wrong hell. Instead of Pascal's Wager, use evidence of preservation quality as an argument.
6. Hope: Yeah, that does sound gullible. Stick to science.

[PCmorphy72]

“internal cooling is too complicated”
In "My Time of Dying" I’d like assisted suicide under the well-known/widely-used induced hypothermia: any experimental/exotic drug into my still pumping blood would be better than any “well-used” pure barbiturate. That’s "legally" too complicated even in Oregon.

[jordansparks]

I consider cooling to be a second line of defense. Immediate chemical treatment of the cells to halt metabolism and add cross-links should be the primary goal. But since we know that perfusion is not uniform, cold perfusate can be used to slow metabolism in nearby tissue. Conductive heat transfer is so much slower than most people intuitively think because they confuse it with convective heat transfer. As a real-world example, consider thawing a turkey. In the fridge, it takes about 4 days. Even in a water bath, it takes about 8 hours. Why should it take so long? Because conductive heat transfer is just really really slow. A cryonics ice bath is a terrible idea because there are clearly better options. Instead of wasting time on an ice bath, we plan to use a reliable and proven surgical technique that usually takes under one minute so that we can start perfusion immediately. Cooling is secondary. When I say "internal cooling is too complicated," I mean using their techniques.

[PCmorphy72]

Although I slightly edited my post just while you were replying, since I quoted your “internal cooling” I think it was clear that I was talking about "convective induced hypothermia" (perhaps at lower temperatures than these/those techniques).

[jordansparks]

Yes, hypothermia would be great, but as you agreed, it's never going to be used on a cryonics patient. Even the laws for pets won't allow premortem hypothermia.

[PCmorphy72]

I agree, actually, but not with your “never”.

[jordansparks]

Well, never in my natural lifetime. Never in the next 50 years at least.

[Konrad]

What surgical technique gives you perfusion in under a minute? Why not cool using liquid ventilation?

I expect that the same 1kW heat exchanger CCR uses on dogs would beat Alcor’s best-case cooling with PIB + thumper.

[jordansparks]

The surgical technique is described here:
http://oregoncryo.com/manual/cannulae.html
http://oregoncryo.com/manual/surgicalProcedures.html
Liquid ventilation would be far slower than the technique above. Also, cooling is far less effective than actual perfusion.

[Konrad]

How slow is too slow? You get 1 degree C a minute in dogs with a working heart. That’s a lot of cooling going straight to the brain and kidneys. Peripheral circulation is essentially nonexistent at that point. Of course, humans have proportionally bigger brains, and in our case, external compressions instead of a working heart.

Let’s say you could get the brain down to ice temperature in 1 to 2 hours. Nobody’s tried it in cryonics except for Darwin, but that’s my guess. Would that help or hinder ACS? I’m assuming you have a trade off between viscosity and preservation, as with vitrification.

[jordansparks]

You still don't get it. The quality is really bad if you don't perfuse while the patient is still alive and healthy. Our patients are not alive and they are not healthy. Their brains have already suffered ischemia in the hours leading up to death as well as after death. 30 minutes of cooling might be ok if it was in a healthy patient with good circulation, but this is totally different. External compressions aren't going to keep that brain tissue alive. It's already ischemic, and worst thing you could do is flood it with oxygen, a very reactive molecule that causes tremendous damage in this situation. ANY delay is too slow. ANY!
So why does Alcor advocate an ice bath? I don't really know. I think they are going through the motions without understanding physiology. Maybe there's nobody on staff who realizes that they could cannulate quickly. They seem to delegate their surgical tasks to doctors for hire who could care less about taking the time to work on a surgical technique that has zero application in living patients. I'm just dumbfounded that they continue to promote external cooling, as if this is some sort of healthy hypothermia situation.

[Mati_Roy]

Thanks for writing this.

Everything you wrote makes sense to me, except I think it's too harsh to say:
> This might make you feel good, but it won't help you survive. The exception is if you live in Detroit, Phoenix, or maybe LA.

Out of the 70 last Alcor patients, 20 died in Scottsdale or Phoenix of which 13 had relocated near death*. So about 20% people outside of Phoenix relocate in time. I'm not sure how many people try to relocate in time, but my guess is not that much? So once you take the fraction of people that relocate in time over the fraction of people that try to relocate in time, it might be over 50%. So I don't think not living near a cryonics facility makes it useless to be a cryonics member.

Re 5. Yeah, that's also what I tell people!

* Here's the compiled data: https://docs.google.com/spreadsheets/d/ ... NRj9Gdk3I/. I haven't compiled further than the last 70 patients yet because I haven't taken the time to read their reports. Also, when Alcor's reports are ambiguous, I assume the worst.

[jordansparks]

That spreadsheet deserves a new thread. It looks like it took forever.

[Aaron_Agassi]

I do not know what the truth is, but it scares the living shit out of me that such crucial questions are not more openly, seriously and widely debated.

Too bad cryonics lacks the infrastructure of organ harvesting for transplant, replete with quick response and transport too and from the ends of the developed world. But I have an ambitus proposal in remedy. Know more at: http://www.FoolQuest.com/kriosgrad.htm

[jordansparks]

Not that again. To everyone else, that page seems to be nothing but completely incoherent rambling. It's amazingly long. It's a total waste of your time to try to make sense of it. I already wasted a good 30 minutes of my life thinking that there might be something rational buried within.

[Konrad]

To be honest, I suspect that there is no good reason to use fluorocarbon ventilation in cryonics. Water gives better cooling and any gas will do. (The gas is only there to cushion the liquid for better flow.)

The whole oxygenation thing is strange, now that I think of it. It seems obvious in hindsight, since propofol is there to reduce metabolism and people have even suggested H2S to stop the Krebs cycle. It’s like Alcor is running around in front of TV cameras with a crash cart, pretending they’re in an episode of ER.

I don’t know enough to comment on cannulation. The revolving door of surgeons is more troubling. Alcor regulars apparently can’t discuss it due to NDAs, so they can convey this information only via dramatic eye rolling and exasperated sighs.

[Konrad]

Correction: Oxygen is necessary to prevent sludging of red blood cells and edema, which otherwise halt brain perfusion after ~15 minutes. Whether it’s worth the damage done by the oxygen is another issue, but from pure cryonics perspective it makes sense.

Jordan, would your cannulation method also work for regular cryonics?

[jordansparks]

That looks like something Mike would say. I'm not sure if I want to get into a proxy argument. The simple answer is that that's true if the patient died suddenly, and if you start soon enough, and if the setting allows it. But I'm not sure any cryonics case meets those criteria. I think it's rare that a setting would prevent surgical procedures, but allow an ice bath and CPS. No procedure is appropriate inside a hospital or nursing home, for example. Once the patient has been moved to a setting that allows procedures, the obvious choice is to wash out those red blood cells instead of futilely trying to slow down their degradation.

Yes, this cannulation method would also work for old-style cryonics.

[Konrad]

That did come from MD, in fact. The oxygen issue bugged me after you mentioned it. I couldn’t come up with a good explanation so I went straight to the source.

I get your point about people not dying in pristine condition, but you have to start somewhere and work your way up. This isn’t a moon shoot where you can engineer your way to a solution without mid-course corrections. Biology is squishy.

I’m beginning to suspect that sharing a dewar at LN2 temperatures is the only way two cryonicists can be around each other without fighting.

[jordansparks]

We're all frustrated because our options are so bad. Arguing is one way to feel like we're getting somewhere. It doesn't actually solve any problems unless the people arguing are making independent progress.

[jordansparks]

I was reminded off list of Curtis Henderson, who sat for an hour at the hospital waiting for the funeral director, and who seems to have benefited from CPS, as evidenced by the CO2 detector. But did he really benefit, in the end, from having lay people perform his procedures? That was a topic of much debate ten years ago, and I'm of the opinion that he probably did not get his mind preserved. If it had been performed by cryonics professionals, someone with funeral director credentials would have been part of the team, and there would not have been a delay. When considering all these different scenarios, we should only be considering those which involve cryonics professionals.

[Konrad]

I guess it depends on what you mean by cryonics professional. In theory, the people at SA are professionals since they are paid for cryonics services. On the other hand, there are complaints about their competence from some long-time cryonicists with far more experience doing standby & transportation.

Strangely, those cryonicists are not employed in that field, or no longer employed in it, or are officially employed to do other work, but apparently also to act as a backup to SA. The support they do provide often seems inept, and their involvement is redacted from the case report in a deliberately misleading way. None of it bothers them because they blame everything on the contract surgeons. But wait, the work that is supposed to be their full-time job never gets done either, and there too they blame a revolving door of employees whom they hire and fire, even going so far as to accuse them of sabotage.

At least that was my experience with the ones I personally worked with. Now, that doesn’t mean that the problems with contract surgeons aren’t real. But those problems are far less serious than cryonics insiders who act with outright malice, generally for no underlying reason that I can see, beyond the joy they find in being destructive.

[Konrad]

In hindsight, my assumption on who the professionals are has really just been the former CryoCare/BioPreservation team. I base that not on a whole lot of systematic thought, but a subjective impression of the Cryonics publications I read in the early 2000s, most of which were by then a decade out of date. That represents, at best, the cryonics of the 80s and 90s. What happened to that group at the end, I don’t quite understand, except that everyone involved seems very bitter about it.

My point, I guess, is that the things you say about contract surgeons and cryonics professionals sounds very much like what I heard regularly from Sandra Russell. It’s not obviously wrong, but on the other hand, she’s also bat-shit crazy. After asking me help salvage some of the research they’ve been working on for over a decade, it turned out that getting usable data from her was probably the single biggest obstacle. I wrote some of this up on Reddit, but basically the summary is this: although they are or were capable of doing good work in the past, Sandra and Joan engage in elaborate fraud for, as far as I can tell, no reason. Using a ever changing cast of temporary workers is exactly how they avoid accountability.

Anyway, I don’t if those two have anything to do with what you said, but if so, beware the source.

[Konrad]

Also, we may be frustrated over bad options, that’s true. Yet our position is no worse than that of every single person who ever lived. But to clear, my view of cryonists was no reflection on you but is based on the former CryoCare/BP folks.

Do you know anything about what led them to break apart, by the way? The last Cryocare annual report sort of reads like a work of fiction. Drama, public showdowns and secret arrangements. Plus the specter of the IRS. The last especially seems a little over the top for an organization with no cash and little prospect of having any income to shelter from taxes.