Deconstructing Future Shock

There is a growing consensus in the cryonics community that for many people it is not technical feasibility but fear of an unknown future that makes them uncomfortable with the idea of cryonics. In fact, to some the future is not just “unknown” but they fear that by the time they will be resuscitated their skills and knowledge will have become obsolete, they will no longer own any assets, and worse, all their family and friends will be dead and gone.

If we want to effectively counter these fears, or at least provide some reasons for optimism, we need to dig a little deeper into this issue. First of all, we should not treat all (potential) cryonics patients as a homogenous group. Someone who was cryopreserved in the mid-20th century will face a much longer period of nonparticipation in society than a young person who has just made cryonics arrangements and who will be cryopreserved at a time which is closer to the first resuscitation attempts. It should also be mentioned that the ease of adapting to a new society is itself a function of age. If history is any indication, younger people usually adapt more easily to a changing society.

Which in turn draws attention to a much neglected point about cryonics. Cryonics patients will be resuscitated in a youthful state without the typical challenges and ailments that are associated with old age. We should expect a resuscitated patient to have at least the youthful vigor and brain plasticity of a young person, albeit with perhaps more “wisdom.”

A credible cryonics organization will not have as its only mandate just to keep the patient in cryostasis but also to successfully rejuvenate the person and re-integrate him/her into society. It is important in our communication to emphasize that reintegration does not start after the person has been resuscitated but should start as soon as the patient has been placed in long term care. The person’s assets can be managed in a trust and real estate can be maintained, or acquired, to ensure it will be up-to-date to the prevailing era’s preferences and standards. If proper thought is given to this issue, the person should at least have access to a modern home and money in the prevailing currency of the time (if “money” as we know it has something like the same significance then).

The biggest worry, however, concerns the prospect of being introduced to an era with radically different morals, conventions, and forms of human interaction. There is a good reason to believe, however, that such changes might actually be quite modest. Our morality has been shaped over millions of years of evolution and it is not realistic to assume fundamentally different forms of morality will dominate in the next century, even if humans increasingly merge with technology.

All this still assumes that the cryonics organization does not play a proactive role in the mental re-integration of cryonics patients. I think that the longer that cryonics organizations will be around, and the closer we get to a time where advanced molecular medicine is feasible, the more thought will be given to minimizing future shock for cryonics patients. The aim of cryonics organizations is not just the restoration of a patient’s physical health but also his/her mental health—and that implies minimization of stress and alienation.

And what about friends and family? Will they not be left behind? Well, I think the more assurance about the future a cryonics organization can provide for potential members, the lower the threshold for whole groups of people to make arrangements. It will be the person who does not make cryonics arrangements who makes the odd, solitary, decision. At that point, the human tendency to conform will start working in our favor.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, February, 2015

Cryonics as an Employee Benefit

Since Alcor introduced Associate Membership in 2012 the results have been quite encouraging. There a lot of people who support our mission but are not able, or ready yet, to make cryonics arrangements themselves. For others, it is simply the first step towards making cryonics arrangements. Clearly, the threshold for becoming an Associate Member is substantially lower than the threshold for becoming a fully funded Alcor member. Is there anything we can do to further lower the threshold for making cryonics arrangements with Alcor?

Most people who have made cryonics arrangements did not come to this decision by reflecting on aging and death and then consulting the library or searching the internet for technological solutions. Most people were first introduced to cryonics when it was covered in the media (newspapers, radio, television, etc.) or through family, friends, or colleagues.

What has not happened to date is that cryonics arrangements are offered to (potential) employees as part of an employee benefit package.

Many employers continue to offer employees a basic or enhanced benefits package as part of compensation. In fact, as times change, the kinds of benefits that organizations offer have evolved as well. Currently we are seeing an increased emphasis on preventive care, more flexibility for parents, and self-directed retirement investments. To cater to the increasing number of women entering the labor market, and the increased preference to have children at a later age, some forward-looking companies are even offering to cryopreserve the eggs of their employees in order to facilitate this change.

Unfortunately, employee benefits are still largely driven by an attitude towards life that passively accepts aging and conforms to conventional, but outdated, notions of “death.” We are encouraged to save money for “retirement,” that point in life where our physiology starts to fall behind the needs of the labor market. We encourage people to provide for their families in case of “death.” It would be a major step forward if companies did not just offer the tools to remain healthy but also provided a choice to be cryopreserved in case a person is afflicted with a critical illness for which contemporary medicine does not have an answer.

It is well established that cryonics draws a lot of people of extraordinary intelligence and ability. Not surprisingly, many of these people run successful businesses and organizations. If the life extension community can come together and persuade these companies to offer cryonics as an electable employee benefit, the interest in cryonics will most likely increase, even among those who do not elect to benefit from these services. Not all companies may be in a position to offer such benefits for financial or public image reasons, but I suspect that a non-trivial number of Alcor members with companies should be able to do so. And as soon as some companies do, the threshold and administrative challenges for others will drop. We should at least expect this benefit to be offered at companies whose officials are public about their cryonics arrangements (like Alcor!)

Some companies already offer term or whole life insurance as a benefit and it should not be too hard to tweak this benefit to transform this into a funding mechanism for cryonics. Employers then will also pick up (or partially pay) the annual membership dues (and CMS payments) for all employees who choose cryonics as a company benefit. Transferability is an important consideration if cryonics is offered as an employee benefit so that departing employees can take their arrangements with them without having to start the life insurance or funding process all over again.

Offering cryonics arrangements as an employee benefit should be as common as offering health insurance. No matter how much emphasis a company puts on preventive care, protection against critical illness and catastrophic accidents needs to be a part of that package if the concept of a long and healthy life is to be embraced.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, January, 2015

Alcor For The Living

At the recent annual Alcor Annual Strategic Meeting a number of rather encouraging motions were passed that will lower the cost of cryonics for many members. Membership dues are reduced by 10%, one uniform (lower) additional fee for overseas cases was established, and members now have the option of either paying annual CMS dues or paying higher cryopreservation minimums. The last decision in particular should have some positive effects for (potential) younger members who usually can take out substantial amounts of life insurance for only a modest monthly premium. It will also provide a strong incentive for members to remain funded well above the current cryopreservation minimums. Last, but not least, Alcor will also become somewhat more flexible in accepting different kinds of funding (for example, 50% cash and the rest in assets), which can make a big difference for older members who can no longer increase their insurance policies. These changes do not mean that Alcor has become inexpensive by any means; we still are losing too many members due to affordability issues. More progress will be needed.

Member retention, however, is not only about affordability and cost. Members should also feel involved and appreciated by the organization. On the financial front Alcor has made a step towards recognizing long-term members for their support in the form of membership discounts. But there are a lot of other ways to strengthen the bond between Alcor and its membership.

One of the unintended consequences of standby and stabilization services transitioning from a member / volunteer basis to a paid / professional basis is that one of the major reasons for Alcor members to get together (i.e. standby training) is no longer that important. While there is the occasional regional social gathering, there has not been a deliberate effort to stimulate and encourage local members to get together. For example, in regional areas that used to be hotbeds of cryonics activity and that still have a lot of members, like New York, there is little physical or social cryonics infrastructure left. For most members, I suspect that the occasional meeting in California, or a conference, is not going to cut it. If we want members to feel more involved with our organization we need to think of new ways of bringing them together, either through actual meetings or online. The popularity of the annual Teens and Twenties events indicate that many members thoroughly enjoy more interaction.

Also, recognition for long-time membership can have many forms. Membership discounts are a good start but what about invitation-only gatherings for long-time members at Alcor? Flying big donors in to observe the progress made at the facility and in introducing new technologies, and giving them more opportunity to provide feedback on important strategic decisions would be a great start. For too many older members, Alcor has simply become an organization that sends them invoices.

The most important recommendation that I would like to make is that Alcor should have something to offer to members before they are cryopreserved. Or to put it another way, people should feel that it also makes a lot of sense to join Alcor while “alive.” We can think of offering additional benefits that are exclusive to Alcor members; complimentary magazines and newsletters from like-minded organizations, discounts on conferences and events, affordable access to state-of-the-art physiological monitoring or alarm systems, a designated Alcor email address and secure data storage for each member etc. Alcor membership should not be perceived as a desperate attempt to escape the current limitations of medicine to get launched into an unknown, distant future, but more as becoming part of a smart and forward-looking community that is creating that very future.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, November, 2014

Biological Repair Technologies

While I believe it is very hard to irreversibly destroy information, I had become quite concerned that the earliest presentation about future cell repair technologies for cryonics patients might have become lost forever. Jerome “Jerry” White’s paper, “Virus-Induced Repair of Damaged Neurons with Preservation of Long-Term Information Content,” was frequently referred to in papers on the topic of revival technologies, but I had never seen the actual paper and was curious and determined to find it. When I discovered that even the people in cryonics who usually own (or can access) a wealth of historical cryonics materials (Mike Perry, Mike Darwin, Steve Bridge, etc.) were not able to track down a copy I became progressively pessimistic and even started questioning whether the presentation was actually transcribed at all. I wrote a column about the missing paper in which I put forward the sad possibility that the paper was lost to us forever. I never gave up though. Then, in September 2014, Mike Perry wrote me to tell that Alcor member Art Quaife was in possession of the paper and would send a copy to him. After receiving the paper, a PDF copy was soon produced and Mike also spent considerable time creating an editable text version.

The premise of White’s paper is straightforward but ingenious (especially considering the fact that it was presented in 1969). We already know of biological “machines” that can enter the body of the patient and make modifications to cells and DNA. They are called viruses. When this is recognized it is not too far fetched to recognize the possibility of separating the virus as a biologically active delivery vehicle from its adverse health effects. The idea of using viruses to deliver genetic material has now become fully established in modern gene therapy. For example, the virus responsible for causing HIV and AIDS can be stripped of these properties but can still be used as a vehicle to modify genes within a cell. In his paper on biological cell repair, White proposed to modify viruses to engage in information gathering, gene modification, and cell repair.

Space does not permit me here to analyze the paper in detail but I would like to briefly discuss two issues concerning the feasibility of biological cell repair for the revival of cryonics patients, namely, capabilities and temperature.

Modifying a virus to change genes is one thing, but rebuilding damaged cell membranes and intracellular organelles is another and it is not fully clear how a virus can be modified to accomplish this. In addition, for non-neural cells a case could be made that it is often more time- and cost-effective to simply destroy and remove cells and cell structures with severe damage (after gathering sufficient information about the cells and their organization). For brain cells there is a special difficulty in that the ultrastructure appears to be identity-critical in a way not expected in non-neural tissue. So the conservative approach here would dictate repairing these cells instead of replacing them. The challenge is that although human physiology already has endogenous mechanisms to maintain DNA integrity and repair damaged DNA, the human genome does not encode for wholesale repair of cells (including their genomic content) that have sustained substantial damage. This, I should add, combined with only limited neurogenesis in the brain, may explain why aging and dementia are strongly correlated. One of the challenges of viral-induced repair of cells is that inserting new genetic information that allows for novel endogenous repair capabilities is itself dependent on the existence of viable cells in the body of the patient. This challenge is also identified in White’s paper when he proposes to create artificial viruses that “carry out degrees of repair greater than those the cell in its damaged condition would itself provide.”

An even bigger challenge for biological repair is temperature limitations. While it has been established that some enzymes still function (albeit at a slower pace) at low or even subzero temperatures, the temperatures that cryonics patients are stored at are substantially lower than that. This would seem to require that we first thaw the patient before conducting repairs. This course of action could create serious problems for the average cryonics patient. In the case of frozen patients, the ice will turn to water again and (damaged) biomolecules that were locked into place could dissolve into solution (which may constitute irreversible loss of identity-critical information). In the case of vitrified patients, ice nuclei that formed during the descent to cold temperatures (or continued forming during intermediate temperature storage) can organize themselves into ice during thawing. Another problem with conducting repairs after thawing is that ischemia will be permitted to continue, causing more damage. While White stipulates that “repair proceed faster than deterioration, whatever the temperature” it is not likely that credible future repair scenarios will permit substantial deterioration to occur during, or prior to, repair.

Does this close the door on biological cell repair? Not necessarily. We can imagine breakthroughs in cryoprotectant design that reconcile negligible toxicity with extreme resistance to ice formation. Patients cryopreserved with such agents could be thawed without risk of ice damage. When temperatures are raised to a point where meaningful enzymatic activity is possible, various biological strategies (metabolic inhibition, reversible fixation) could be used to allow time for repairs. Another idea is to pursue a hybrid strategy in which (crude) nano-size mechanical machines are used to access and open the circulatory system while disrupting nucleation and/ or delivering anti-nucleating molecules. After completing this task at cryogenic temperatures, the patient can be thawed and biological cell repair technologies introduced.

This discussion of the (potential) limitations of biological repair technologies draws attention to the relationship between cryopreservation technologies and repair technologies. We tend to think of preservation and repair technologies as independent endeavours but it has been shown here that the choice of cryoprotectant technology can influence the choice of the most effective repair technology. For example, if a cryoprotectant is just a moderately strong glass former, ice formation upon warming should be expected and mechanical repair technologies may be necessary for conducting the initial steps of repair (preventing ice formation). Or consider intermediate temperature storage. If we store patients just below the glass transition temperature of the vitrification solution, nucleation may still continue, which would favor ice formation upon warming, and thus, again, the need for initial mechanical cell repair technologies to stabilize the patient during the initial stages of repair. Some people think that biological cell repair is an inefficient and impractical (if not impossible) task and the resuscitation of cryonics patients will require mechanical nanoscale repair devices. This may very well turn out to be the case, but demonstrating the technical feasibility of biological cell repair would further strengthen the case for cryonics. Let us hope that Jerry White, who is currently cryopreserved, will be one of the beneficiaries of such powerful technologies.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, October, 2014

Changing the Subject on Cryonics

Every Alcor member has experienced this. What appears to start as a discussion about the feasibility of cryonics quickly turns into a conversation about “overpopulation,” “selfishness,” “immortality,” “mind uploading,” “transhumanism,” etc. This predictable course of events is quite frustrating to the cryonics advocate but rather convenient for the critic because the actual technical and rational arguments in favor of cryonics no longer need to be scrutinized. I would be the first to admit, however, that this response often reflects a form of anxiety associated with cryonics that a critic does not want to deal with. But I think we should also recognize that often we have only ourselves to blame when someone tries to change the subject.

Since the beginning of cryonics the field has always been associated or even bundled with “something else.” Specifically, many public advocates of cryonics have also strongly advocated physical immortality, transhumanism, or the idea of substrate-independent minds (“mind uploading”). In particular, transhumanists are prone to present cryonics as just one component in a broader set of beliefs. While such an approach can be great for community building between like-minded people, it can present a serious obstacle to reaching out to the rest of the world. Not only does such rhetoric have limited appeal to the general public, it is not consistent with the idea of cryonics being an experimental critical care procedure.

I became painfully aware of this phenomenon when I read a “refutation” of cryonics by the economist Bryan Caplan that was essentially a critique of mind uploading. Now, some cryonics advocates do believe in substrate-independent minds, but mind uploading is not an essential part of cryonics and suggesting otherwise will just provide a convenient excuse to avoid discussing the merits of cryonics at all. I have seen many, many other such examples where a skeptical investigator simply confined himself to offering a critique of immortality or transhumanism and left it at that. Why does this happen?

I think we often do a lot ourselves to “prime” our presentation of cryonics to produce such a response. Could you imagine if someone introduces a new life-saving technology while also advocating socialism, atheism, or immortality? We would feel obliged to point out that medicine should have universal aspirations and not be tied to political or (anti-)religious notions. It should not be any different in the case of cryonics.

In fact, recognizing this neutral and universal aim of cryonics will also provide us with sensible responses to counter some of the arguments that are made against it by asking why cryonics is held to different standards than other experimental medical procedures. “Selfishness? Our desire is to make cryonics available to all and save lives.” “Immortality? All we are saying is that we should replace our existing, dated, definition of death with a more rigorous definition.” “Transhumanism? The belief systems of some cryonics advocates have little bearing on its feasibility.” There are many arguments against cryonics that make little sense, or would even be considered abhorrent, if used against more mainstream experimental treatments, and it is important to consistently reiterate this position. But it is going to be challenging if we keep presenting cryonics in a matter that induces the audience to change the subject.

One objection I have heard against this perspective is that it is rather fear-driven, if not cowardly. Instead, we should not be embarrassed about our beliefs and be honest about our ultimate objectives and convictions. I think this argument is mistaken because it assumes that cryonics advocates are a homogenous group with identical beliefs and values. As cryonics keeps growing, this will become more and more untenable. The real risk is to waste such membership growth opportunities by essentially encouraging an inward-looking outlook.

Looking at this issue from the perspective of individual survival, such public indulgence with other controversial ideas strikes me as counterproductive. If your survival depends on the exercise of some personal restraint, and resisting the desire to argue all kinds of other issues that you care about, can you not do this? Would you rather be “right” but dead?

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, September, 2014

How to Validate New Cryonics Technologies

Evidence in cryonics is a complicated concept. For starters, it is not possible to “prove” cryonics will work, here and now, because the fundamental idea of cryonics is to stabilize critically ill patients (people considered “dead” by less rigorous criteria) in anticipation of more advanced future medical technologies. What we can do is validate cryonics technologies with reversible cryopreservation (“suspended animation”) as a benchmark. As a general rule, we can state that we make progress in cryonics when stabilization, cryopreservation, and maintenance (“storage”) technologies cause less damage than the technologies that preceded them. But how do we know if this is the case?

The most rigorous form of validation, human clinical trials, is usually not available in cryonics. There are often new (approved) emergency medical technologies, however, that can be modified to be used in cryonics procedures. A major advantage of adopting such technologies is that the validation has already been done by other organizations or companies. Examples of such technologies will often fall under the rubric of emergency medicine. For example, an FDA-approved technology that improves blood flow during cardiopulmonary resuscitation can be added to Alcor’s stabilization equipment to improve stabilization procedures.

One step down from rigorously designed human clinical trials are animal studies. In cryonics we often make a distinction between small animal studies (e.g., mice, rats) and large animal studies (e.g., pigs, dogs) etc. It seems common sense to think that large mammals provide stronger evidence for a technology than smaller animals but the real issue at stake here is not how large an animal is but how closely an animal model tracks what happens in humans. For example, if cat brains have an uncharacteristically high tolerance for cerebral ischemia, the (smaller) rat may actually be a more realistic model for validating neuroprotective strategies in humans.

One area where choosing the correct animal model has proven itself to be of crucial importance concerns the effect of cryoprotectants on the brain. Most mammalian species experience dehydration of the brain after equilibration with a vitrification agent. Because it is reasonable to assume that severe dehydration adversely affects brain viability it is tempting to select an animal model that experiences little cryoprotectant-induced dehydration. But one thing that we have learned from burhole measurements and CT scans in human cryonics patients is that under optimal conditions cryoprotective perfusion with both glycerol and the modern vitrification agents produces severe shrinkage of the brain. So if we want to validate strategies to eliminate this dehydration the most important consideration is not how “large” the animal is but how well the animal tracks the effects of cryoprotectants on the human brain.

Most technologies in cryonics need to be evaluated with ultrastructure and/or viability as an endpoint. But there are also new developments in cryonics where such a benchmark would not make a lot of sense. For example, if we build a new patient enclosure to keep the patient cold during cryoprotective perfusion we can just measure the core temperature of the patient to see if we have done a satisfactory engineering job. Another example is the design of new dewars where we can look at variables like the boiloff rate and long-term durability of the design.

In conclusion, there are a number of ways to validate new technologies in cryonics. If a new technology has undergone human clinical trials we often can just adapt that technology for cryonics without designing new experiments. In the case of more cryonics-specific technologies animal studies can be conducted and the choice of animal model will be dictated by how close a model tracks what we know to occur in humans (among other considerations like ethics and cost). Finally, when a new development in cryonics is mostly an engineering challenge, validating its efficacy is often just an issue of doing basic physiological measurements or practical tests.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, August, 2014

I’m Not Dead Yet!

The prevailing view among cryonics advocates is that cryonics patients are not dead. This view is reflected in the cryonics custom of calling people who are cryopreserved “patients” instead of corpses. We feel quite strongly about this, but to what extent do our organization and practices actually reflect this perspective?

Let us consider an event in which a person had a traumatic accident and is in a coma. There is no evidence of severe brain damage but it is not known if and when the patient will regain consciousness again. In a sense this patient appears better off than a cryonics patient because contemporary technologies are at least sufficient to sustain the patient in his current state. On the other hand, unlike the coma patient, the cryonics patient is not in a race against time and will be in a stable condition until advanced resuscitation technologies are made available.

We would be surprised, if not outraged, if we learned that family members and friends started calling a patient in a stable coma a corpse and started closing his bank accounts, selling his assets, and removing his internet presence. But this is what often happens to cryonics patients. While some of this behavior can be attributed to the different legal status of coma patients and cryonics patients, in many cases we simply don’t make the effort. Despite our objection that our patients are “not dead” we do not always act consistently with this view. Why is this important?

Acting consistently with our perspective that our patients are not dead is of crucial importance because the most formidable obstacle for people to make actual cryonics arrangements (instead of just endorsing the practice) is fear of losing their family, friends, and assets in an unknown future. Alcor’s response should not be to simply assure them that everything will be fine but to offer constructive solutions to these concerns that makes potential members feel safer.

Making potential members feel safer, and even positively interested in surviving and reaching the future, should start by broadening our presentation of cryonics to include topics such as re-integration and asset preservation. Currently, these topics (if discussed at all) are delegated to a dark corner on the Alcor website as if such concerns are just afterthoughts. We need to think of better ways to integrate these topics in our presentation of cryonics to the general public.

When someone decides to become an Alcor member (s)he should be issued an Alcor email address with the assurance that this email address will remain functional during cryopreservation and that Alcor will keep updating technologies to let communication options evolve with the times. Alcor can also offer a secure space on the main website where personal data and memories can be stored. After cryopreservation of the patient, authorized family members, relatives and/or Alcor should be able to update this space as well.

An even more ambitious realization of this idea is for Alcor to appoint a reintegration staff member whose sole responsibility is to help members maintain a presence during cryopreservation by assisting the member in preservation of assets and execution of trusts. This person could also function as a liaison between family members / friends and the patient during cryopreservation.

I think moving in this direction could go some way towards reducing the fears that people have about alienation and loss in the future. It is interesting to reflect why such efforts have not received a more important place in the history of Alcor. I think the most obvious answer is that Alcor has a hard enough time keeping the organization running and making sure members get a good cryopreservation. But I suspect there is also another reason. The people who have shaped most of Alcor’s presentation and policies are invariably “hardcore” advocates of cryonics and combine a strong desire to survive with a strong confidence in the technical feasibility of the idea. It would be a mistake to base our presentation and implementation of cryonics on such an unconventional subset of the population. We need to keep calibrating our presentation and services until it all becomes hugely attractive, instead of a source of anxiety.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, July, 2014

Killing Yourself to Live

I recently observed a heated exchange on Facebook about cryonics. One person said something to the effect that cryonics lacks evidence and that chemical preservation (“chemopreservation”) is the preservation technology backed by real evidence. Such statements bother me for a number of reasons. The most important reason, and this cannot be reiterated enough, is that while evidence can be presented that strengthens the case for cryonics (i.e. makes it more plausible), cryonics as such cannot be proven yet because this would require that we have certain knowledge about the capabilities and limits of future medical science. But the whole premise upon which cryonics rests is that future medicine may be able to fix conditions that cannot be treated today (including additional damage done by the cryopreservation process itself). Cryonics is a form of decision making under uncertainty and demanding proof in advance for its success is asking for the impossible.

The other problem, which I have covered in more detail in my extensive treatment of chemical preservation called “Chemical Brain Preservation and Human Suspended Animation” (Cryonics Magazine, January 2013), is that the evidence in favor of chemical preservation is necessarily incomplete because functional tests are excluded. All preservation technologies that involve a form of chemical fixation produce one consistent outcome. They render the (brain) tissue “dead” by contemporary viability criteria. Now, one could argue that making such an argument is akin to what opponents of cryonics do when they claim that our patients are dead. But this is a misunderstanding of the aim of human cryopreservation.

Cryonics is not just about “preserving structure” or preventing information theoretic death. Cryonics as practiced by Alcor is about keeping the patient alive. It is only when we fail to meet this objective that we are obliged to argue that lack of viability does not mean irreversibility. We can examine the brain (or the whole body) in its damaged state to infer the original state and (eventually) revive the patient. So when we use concepts such as “preservation of structure” or “information-theoretic” death it is important to remember that these are conservative fallback options when our efforts to keep the patient alive by conventional medical criteria have failed. The possibility of inferring the original state from the damaged state should never be used as an excuse to permit more damage than necessary. And this is the problem with chemical preservation of the brain. To borrow a song title from the metal band Black Sabbath, such approaches to life extension are akin to “killing yourself to live.”

Why is all of this important? If we want cryonics to gain greater recognition we should conceptualize it as something that is an extension of contemporary medicine but smarter. Cryonics breaks with the prevailing practice of abandoning people simply because they cannot be successfully treated by today’s medical technologies. What may appear irreversible now may be treatable in the future. But we do want to place these patients in cryostasis in the most viable state. Ultimately our aim is widespread recognition for placing critically ill people in suspended animation until a cure for their disease is found. Instead of saying “look how good the structure of this patient’s brain looks” we should aim for a situation in which we can say “this patient is in the same condition as when (s)he was admitted to us but now we have hundreds of years to think about a medical cure.” Evidence of good ultrastructural preservation after vitrification constitutes a strong case for cryonics, but cryonics can do better than doing good electron microscopy.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, June, 2014

Who’s Leaving Whom?

It is well established that cryonics can be a formidable source of division within families. A classic example is the claim that a person who makes cryonics arrangements has reduced the amount of money available to spend on other goods and services—and will ultimately leave less money behind after passing away. We may think that such a perspective leaves little room for financial autonomy and tolerance in a family but experience confirms that many families operate exactly like that.

A related non-financial argument is that a person who makes cryonics arrangements is “selfish” by going it alone and leaving his family to die. Naturally, this argument can be turned on its head. A friend of mine once stated that, given the interest of her boyfriend in cryonics, the decision not to make cryonics arrangements herself would be akin to a decision to (eventually) abandon him. From the perspective of a cryonics advocate this argument can be further strengthened. If one believes that a cryonics patient is not dead, the decision not to make cryonics arrangements would be akin to walking away from someone who is critically ill (or in a coma).

In the examples so far we have faced a situation in which one person responds to the decision of another person. In many cases, however, the decision whether to make cryonics arrangements is the subject of joint deliberation. If we approach the subject from the perspective of not wanting to abandon a loved one there are a number of good reasons to decide in favor of a family making cryonics arrangements.

First of all, the decision not to make cryonics arrangements will lead to a predictable outcome: death (at least for the foreseeable future). And death is not a joint experience but the cessation of a family as a living entity. Why would a family voluntarily put a predictable expiration date on its existence?

Secondly, family members usually do not die at the same time. This not only applies to children but to couples as well. Couples think that the best they can do is to stick together “till death do us part.” In principle, cryonics can break with this tradition by placing one person in cryopreservation (and eventually both of them). While the relationship of the “survivor” to the cryonics patient is not identical to both being alive it is a whole lot better than throwing them in a hole or burning them because today’s medicine is not able to sustain them.

But what if we consider a whole family making cryonics arrangements and some will make it and others do not? This is indeed a heart wrenching scenario but these kinds of things happen in mainstream life, too. Survivors usually do not respond by taking out the whole family but mourn, remember, and pick up the pieces. A more dispassionate response is to say that some family members surviving is still preferable in that the surviving person’s situation is improved (compared to being clinically dead) without worsening the situation of the non-survivors (who are now non-existent). It is also important to emphasize here that survival is not an external event that “just happens.” We can do a lot to improve the probability that a whole family sticks together by executing the right paperwork and ensuring that younger family members will be able to take advantage of rejuvenation biotechnologies.

There are examples of individuals and families who made cryonics arrangements pretty much upon hearing about the idea. Most families take a little more time (or never get to it). One good piece of advice is to take out
life insurance for the whole family while rates are still affordable (especially for very young children). For most families there are very good general reasons to take out life insurance, such as providing financial stability for the surviving partners and children. So getting life insurance is a good idea while the conversation about the subject continues. It is not trivial to make last-minute cryonics arrangements, but it is impossible to get life insurance for a person who is dying or already dead and most people cannot pay for cryonics in cash.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, May, 2014

Technological Advances in Cryonics: What’s Next?

In the history of cryonics we can identify a number of major technological developments: the introduction of cryoprotectants to reduce ice formation, the use of mechanical chest compression devices to restore brain perfusion and accelerate cooling, comprehensive multi-modal medications protocols to mitigate warm ischemia and favor good cryoprotective perfusion, remote blood washout with an organ preservation solution to protect against cold ischemia, closed-circuit cryoprotective perfusion to reduce osmotic damage, and, of course, the introduction of vitrification agents to eliminate ice formation altogether.

What are the kinds of major technological developments that we can expect in cryonics in the foreseeable future? When we talk about technological progress we should distinguish among advances in medical science that simply require implementation in cryonics, advances in medical science that require various degrees of modification to be used in cryonics, and technological developments that are conceived and developed within cryonics. These distinctions are important to recognize because they can tell us whether new advances “simply” require acquiring these technologies or whether an ambitious research and development program needs to be launched to validate, develop, and introduce these technologies.

The three most important future technological advances that I can foresee are:

1. Liquid ventilation (cyclic cold lung lavage). Currently there are two basic modes of cooling in cryonics: (a) external cooling in an ice bath and (b) internal cooling with an organ preservation solution. Considering the harmful effects of warm ischemia on the structure of the brain and distribution of the vitrification agent, it is very important to introduce a rapid method of initial cooling that does not require surgery and can approximate the rates of internal cooling. The most potent candidate here is liquid ventilation in which a cold perfluorocarbon is pumped in and out of the lungs to accelerate cooling of the patient.

2. Intermediate temperature storage (ITS). As vitrification eliminates ice formation, fracturing remains the only mechanical form of injury in contemporary cryonics. The most obvious solution is to store patients below the glass transition temperature ((‑123°C for the M22 vitrification solution) but not so low as to induce fracturing. Functional neuro ITS units have been built and detailed designs for whole body ITS units have been developed. Concerns that have not been fully addressed yet include optimal storage temperature and cost. The most pressing practical question at this point is whether fracture-free storage may be possible at liquid nitrogen temperatures if ischemia-induced ice formation is eliminated and a proper cooling protocol is used. Also, would it possible to eliminate the need for ITS altogether if a cold gas is circulated through the patient’s circulatory system instead?

3. Opening the blood-brain barrier. It has been well established that under good conditions loading of the vitrification agent produces severe dehydration of the brain. While dehydration may not substantially alter brain structure, it is a problem in terms of maintaining viability of the brain and producing good electron micrographs. We now know of a number of agents that can modify the blood-brain barrier to allow cryoprotective perfusion without severe dehydration. Current concerns include whether such agents produce edema in other parts of the body, what the optimum protocol and dosage should be for humans, and whether the use of such agents reduces or favors ice formation in ischemic brains.

Other conceivable advantages that can improve cryonics include lower toxicity vitrification agents, drugs that can substantially reduce metabolism in the brain, and integration of brain imaging and cryoprotectant perfusion.

Originally published as a column (Quod incepimus conficiemus) in Cryonics magazine, April, 2014