Excerpted from Cryonics, January 1986

The Myth of the Golden Scalpel

by Mike Darwin

Both Ettinger's THE PROSPECT OF IMMORTALITY and the cryonics movement as a whole have been accused of being unscientific, of offering unrealistic hope. In view of the history of cryonics since THE PROSPECT, this criticism appears justified. Ettinger wrote THE PROSPECT as an extrapolation of research observations, without further recourse to experiment. The cryonics community THE PROSPECT has spawned has continued to act on the basis of that original hypothesis. Historically, we have been more concerned with preserving hope than with real examination of the problem of preserving biological structure.

A major reason why nine patients were allowed to thaw out and rot in Chatsworth was because the relatives (and in some instances the patients themselves) were more interested in buying hope than in buying a real chance at revival. In hospitals, nursing homes, and other agencies where people are cared for in a framework where they cannot speak out for or defend themselves, society at least attempts to set up feedback mechanisms in the form of watchdog agencies and ombudsmen to set standards and evaluate care. In the absence of such precautions, anyone can claim anything, and it becomes impossible to sort out reality from fantasy.

One of most difficult and dangerous aspects of cryonics has been the absence of feedback. If you enter a hospital for surgery, take your car in for repair, or contract for the addition of a room to your home, you will have little doubt as to the quality of the work or the desirability of the outcome. The reason this is so is because of feedback. The task undertaken yields results in a meaningful time frame -- and the results can be evaluated. This has not been the case with cryonics. We have proceeded by speculation in a time frame of hundreds of years. In consequence, our society (which is not composed of total fools) has peered around the edges of our hope and speculation, noted the absence of substantial evidence, and dismissed cryonics as a viable alternative to death. To put it mildly, the absence of feedback on our procedures, in the form of real research results, has created a severe marketing problem.

This lack of feedback has affected every technical question in cryonics. Which freezing technique is best? What is the safest temperature to store at? How much and which kind of cryoprotective agent should be used? How can "outsiders" verify that a patient is really being maintained in storage and that the quality of that storage is adequate and everything it was promised to be? These are serious questions and they cut to the core of our program and often are at the root of divisions and dissension within the cryonics community.

There is a significant and growing contingent of people who accuse ALCOR and "Southern California cryonics" of being "too high tech" or more precisely too "chauvinistically high tech." John de Rivaz, commenting in the September, 1985 issue of The Immortalist has stated that "the organizers of cryonics and other immortalist societies should offer members as many options as are conceivable, from high technology, high cost California style cryonics on one hand, right down through interment in the Arctic or peat bogs or storage in a deep freeze as practiced by Dr. Martinot in France on the other." The thrust of this kind of commentary is that cryonics and hope ought to be affordable to everyone. A noble sentiment, and one which we share. But the question is how do we rationally, realistically get there? Are we just trying to provide hope or are we trying to do something that will realistically result in our continued survival?

Cryonic suspension as practiced by ALCOR is expensive because we are trying to offer more than empty hope. We know what our objective is: to preserve structure and viability under the best possible conditions. To this end we spend a fair amount of time and energy trying to insure that the care given meets our objectives. Tossing someone into a peat bog or dropping them into a vat of formaldehyde on the grounds of providing some hope not only isn't going to work -- it is cruel and immoral as well. Proposals such as Mr. de Rivaz's cross our desk all too often. What about freeze-drying people? What about chemical fixation? What about any alternative to spending time, effort, and money? In short, what about a Cosmic Automatic Road to Immortality?

The fact of the matter is that techniques other than cryogenic storage following "high tech" perfusion may offer some hope, may even be superior to cryonics, but we don't know this! We selected cryonic suspension on the basis of conservative criteria because we don't know how memory is stored or how much molecular structure needs to be preserved to conserve identity or allow for reanimation. We chose cryonic suspension because on the basis of the best available evidence it is the best technique around for achieving biopreservation.

ALCOR has not been content to let the matter rest there. We realize that Ettinger's original hypothesis needs a great deal of additional evidence before we can rest comfortably or even be assured that cryonics is good enough to achieve the goal of continued survival. It was nearly 20 years after publication of THE PROSPECT that ALCOR undertook the first basic research to examine the premise of cryonics. That research consisted of systematic electron microscopy to evaluate the extent of cryoinjury both under "optimum" conditions and after 24 hours of death with simple refrigeration. In 1983, ALCOR performed the first postmortem examination of frozen-thawed suspension patients' remains (following conversion to neuropreservation) and discovered the presence of massive fracturing in most organs -- including the central nervous system. For nearly 20 years patients have been suspended without anyone doing evaluations on animals, let alone on people, to determine what even the simplest gross effects of cooling to liquid nitrogen temperature were. For 20 years we've been freezing people without really knowing what kind of damage we were doing, or how we might improve things to minimize that damage!

Using conservative criteria, such as state-of-the-art medical and cryobiological technology, provides us with a benchmark and a framework against which we can measure progress. Such technologies are "expensive" because they involve feedback. When we suspend someone at ALCOR we conduct sophisticated laboratory evaluation of every step of the procedure. We do bacterial cultures on our perfusates and perfusion circuits to act as a check that good sterile technique is being employed (not only to protect the patient, but to protect the staff as well -- contamination goes both ways!). We run chemical analyses on the perfusate to make sure that it was mixed and formulated properly. We also take tissue, blood, and perfusate samples to evaluate the state of the patient before, during, and after suspension. In cryonics we don't have the "luxury" of waiting a few weeks to see if our patients recover from the surgery, or develop an infection from "sloppy" technique. Unless we provide the feedback in the form of quality control and laboratory evaluations, there just won't be any.

And, as the history of cryonics has sadly shown, without both positive and negative feedback there is no way to know whether you're on the right track. Opinions then hold the same weight as facts, and anyone is free to speculate and peddle false hope and empty promises. And empty promises can kill.

Not very long ago, I spoke with the family of a suspension patient who was unable to afford continued whole-body cryogenic care (the patient was suspended before current funding criteria were in place). They had been told and apparently believed that simply removing their relative from suspension and immersing the patient in formaldehyde solution promised some chance of eventual revival. No amount of trying to explain that the brain would be completely autolyzed and digested before formaldehyde (or peat bog acids, for that matter) could diffuse in was of any avail. We have actually conducted experiments to evaluate this, and we could thus speak with certainty that the brain would be decomposed long before formalin could diffuse through many millimeters of skin and bone and reach even the surface of the cerebral cortex. Despite the fact that neurosuspension was offered free of charge they preferred to believe that chemical preservation "offered some chance."

This same kind of attitude characterizes many of the people who have accused ALCOR of wielding a "golden scalpel" and of being unwilling to offer a family of low cost alternatives or even "anything the customer wants." What they fail to understand is that, in the absence of the same kind of evidence that exists for cryonics, the various low cost options they tout might be simply no better than empty ritual or hopeful prayer. If it doesn't matter how effective the preservation is, or even if it works at all (such as in the case of the peat bog suggestion) then why even bother with the business of preservation at all? Why not just believe in a merciful God and a bountiful Heaven and be done with it? Why even go to the inconvenience of opening a hole in the moss of a bog?

Offering ineffective or totally unsubstantiated forms of treatment just because a patient cannot afford cryonic suspension is not something that ALCOR (or any cryonics organization) should rationally be expected to become involved with. An instructive analogy would be a hospital which offered to have a witch doctor chant over a cancer patient because he couldn't afford chemotherapy or to offer to remove someone's gall bladder using kitchen utensils and no sterile technique because they cannot afford state-of-the-art surgery. For anyone who is truly in need, ALCOR has been and is willing to go out of the way to be accommodating and hold costs down. But we also realize that any procedure costs something, and that those now in suspension as well as those who have made suspension arrangements with ALCOR depend on us. Our first responsibility is to them. That means that standards will have to be set and operating criteria established to protect everyone from litigation and false expectations, as well as false promises.

There may be adequate or superior alternative techniques to cryogenic storage. But it is going to cost something to investigate them and to establish quality control and other criteria to see to it that they are adequately administered. 20 years after cryonics was suggested we are just now beginning to put into place the framework to demonstrate whether or not existing freezing techniques are effective in preserving most of the molecular structure of the patient. It has been a long, hard battle to lay that framework. We are heavily committed to it, and our expertise is in that area. Those who would rush into chemically fixing patients or storing them in department store freezers should be prepared to do the groundwork themselves to establish the safety and reliability of those techniques in preserving ultrastructure over long periods of time. And they should not expect us to follow until this has been done.

Even so, the fact is ALCOR has had a long standing commitment to the pilot evaluation of fixatives and imbedding schemes for preserving structure. As far as we know, we are the only organization in the world which has already examined tissue at intervals after fixation at room temperature to evaluate loss of structure. (We've looked at brain tissue stored in aqueous fixative for up to three years and the results are not good.) We are also storing imbedded tissue (which has all its water replaced by plastic compounds, and which should minimize entropic damage) and will be examining that at intervals as well. In the meantime, we have no intention of offering any preservation procedure which we do not have reasonable confidence in, and we are not about to abandon costly quality control and feedback for wandering around idly and "hoping" everything went as we intended.

Our commitment to quality control and feedback has already paid off. In a recent suspension we discovered that a potentially serious error had been made in perfusate preparation, an error which fortunately did not result in harm to the patient. We also detected a break in sterile technique during pump set-up as a result of doing perfusate cultures. This kind of feedback alerts us to trouble spots and helps ensure that a consistent and high quality of care is delivered. The majority of cryonics organizations have conducted suspensions in the past without reference to or even concern about quality control or good care. We have been told over and over again that it doesn't matter how you get frozen as much as if you get frozen -- all the errors on this end will be sorted out on the other. This kind of attitude has resulted in patients being perfused under filthy conditions with embalming equipment or not being perfused at all and with patients being stored at high subzero temperatures while armchair arguments are advanced to wish away objections and information that contraindicate this approach.

These advocates of hope and hype, no matter how good their intentions, sooner or later will confront the fact that this a rather inflexible and altogether too real world in which we live. If we are to survive we must keep our eyes open and never lose sight of the hard realities. Cryonics cannot and will not save everyone. Money, circumstances, and just plain bad luck have and will result in some painful defeats. For the time being we have to learn to live with that. Retreating into fantasy or becoming merchants of empty hope is not going to result in our long term survival. Progress will come only through feedback and rigorous reexamination of our premises and practices in the light of growing knowledge.