Nectome

[jordansparks]

Nectome is another company trying to provide aldehyde fixation services.
https://nectome.com/
Aurelia Song (formerly Robert L. McIntyre) was one of the authors on the Aldehyde-stabilized Cryopreservation paper 10 years ago. They have spent the last 10 years working on refinements. Nectome has been around for most of that time and has been trying to start providing services. They made this announcement recently:
https://www.lesswrong.com/posts/E9xfgJH ... /less-dead
and this paper was published:
https://www.biorxiv.org/content/10.6489 ... 724v1.full

Here are some of the similarities and differences with Sparks Brain Preservation:
- We both provide aldehyde fixation followed by cryoprotection and storage at freezer temperature.
- We're both in Oregon. Medical Aid in Dying (MAiD) is useful in Oregon.
- We currently provide nationwide service. We will come to you. Nectome requires patients to travel to Oregon.
- They will not provide services unless MAiD in used. We strongly recommend MAiD, but do not require it.
- We've had a room in our facility for around 10 years where someone can take advantage of MAiD. Nectome has historically placed a very low priority on any sort of facility of their own. I'm unclear if their future plans include any facility.
- We've both struggled with how or whether to provide whole body services. Our current plan, for those who desire whole body, is to preserve the body separately from the brain using a different technique. We plan to fix, desiccate, and vacuum seal the body. Nectome currently claims they will always preserve the body. That seems to unnecessarily raise costs for most people. I wouldn't be surprised if they follow our lead and optionally store a desiccated body.
- We both perfuse fixative. SBP follows perfusion with immersion because perfusion is unreliable even in the very best circumstances.

I applaud what they are trying to do, but their claims are exaggerated. It's not really a new protocol; it's just aldehyde fixation, the same technique that's been used in science for over 100 years. The main problem with their claims is that there is simply no way at all to guarantee adequate perfusion. Even if MAiD is used, humans go through an agonal process that seems to gradually shut down blood flow to various areas of the brain. In their paper, they sedated the pigs with injections and then injected a euthanasia solution that took effect in one minute. This is completely different from a real human case where they take pills that work much more slowly, not to mention a very significant difference in brain size. My position is that they will almost always have inadequate perfusion, and for them to claim otherwise is misleading. As any mainstream neuroscientist will tell them, they might get nearly perfect preservation if they perfuse the aldehyde while the patient is still alive, but even that is known to fail a certain percentage of the time. We're talking about old unhealthy patients here with lots of variation, not ideal lab cases. Did their pigs have atherosclerosis? They did address these limitations in the paper, but these limitations critically undermine the claims in the announcement such as "We are capable of preserving every neuron and every synapse in the brain". No.

The next problem is their business model. To perform this procedure, a facility and a full staff are required. The staff cannot be hired contractors. They must instead be full-time employees who regularly perform the identical procedure with human bodies. Otherwise it's like trying to cook in someone else's kitchen with a recipe that you almost never use. Mistakes will be made and it will almost certainly go badly. They can't possibly offer a service that they plan to perform once every few years (or decades at the current level of demand) and maintain any sort of proficiency. Their business model involves too few customers to succeed.

[jordansparks]

There's a new long post about Nectome here:
https://www.lesswrong.com/posts/3i5GMhp ... hat-i-know

Song says, "I think we will be getting to thousands of preservations per year in a few years". Clearly not. Statements like that make me immediately distrust everything else as nothing but hype.

They seem to be planning to use a residential home as their facility because "There are very few restrictions on where someone can get MAiD, or where Nectome is able to do a perfusion." Unfortunately, as they will quickly find out, there are plenty of restrictions. They are called zoning laws. Zoning laws have been a huge headache for us trying to set up our facilities. Local cities cannot restrict what you can do, but they absolutely can restrict where you do it. They shut down businesses all the time that violate zoning laws. My best guess is that Nectome is going to use the house just to perform cases and not for other ongoing business activities. But that means they don't plan on having a staff that gets regular training. The business plan just seems awful.

Allowing an open casket funeral is a terrible idea except in very rare unavoidable instances. The brain is NOT yet stable because perfusion is never perfect. The brain must be immediately removed and submerged. Claiming that it's stable after perfusion is not true.

An endowment fund for each patient would be nice, but in the real world everyone is chronically short of cash. Even high net worth individuals don't have much liquidity. People with a lot of money are careful how they spend it. So charging high prices won't work either.

They seem to be running on investors and VC funding. Those people will want a return on their investments. That's not going to happen. How long can they sustain the cash burn before running out of investors? They've been going for longer than I thought possible, and I hope they prove me wrong.

I just got to the part of the article that talks about us (I didn't realize that was there). Jessica says they aren't in competition with us. Really?